Reader Amy passed on the article “Weight loss clinic doctor suspended; Slimband Substandard care of gastric banding patients” which was sent to her news package at work, where she receives any and all health and mental health-related articles.  I thought I would translate it from sizeist bullshit to English.  The article’s actual text is indented and may be triggering for all the reasons you might think, you can skip those parts and still get the gist of the post.

As I’ve written about before, at best weight loss surgery is a crap shoot that might kill you. This clinic’s assembly line approach, and its medical director’s negligent behavior, are perfect examples of that:

The medical director of Canada’s busiest private weight−loss surgery clinic has been suspended three months for substandard care of patients, including one who died in a Calgary hotel room a day and a half after his operation. Dr. Patrick Yau has said he conducted 6,000 gastric banding surgeries at the Slimband clinic in downtown Toronto whose colourful advertising was once widespread.

A doctor, who chose to advertise a dangerous surgery as if it were a hot new movie, was suspended for three months because he did a shitty job – including killing a patient.

His discipline related to two specific cases, including one where he gave weightloss surgery to a 61−year−old woman who had a normal BMI. Experts say such treatment, which can have complex physical and emotional side effects, should only be for the morbidly obese.

In the first case, the issue was that he gave a life-threatening surgery to a thin person, and people are only comfortable with fat people’s lives being put at risk in that way.

The other case involved a 38−year−old obese man from High Prairie, Alta., with type 1 diabetes, who was released a day after his operation without any testing of blood sugar. He flew back to Alberta that day and was found dead in a hotel room the next morning, the hearing heard. The Alberta coroner said he died from bacterial meningitis and complications of his diabetes. The College discipline committee chastised Yau for not having proper procedures in place before patients are discharged.

In the second case they were ok with the risking the patient’s life because he was fat, but the doctor didn’t bother to test the blood sugar after his operation despite the fact that the patient was a type 1 diabetic – maybe the doctor was late for his tee time, maybe he just didn’t care that much about a fat patient, maybe he’s just wildly incompetent. Regardless, this led to the patient’s tragic death.

He pleaded “no contest” to charges of failing to meet standards of the profession, and in exchange the College withdrew a charge of incompetence. It was not his first run−in with the regulator. The hearing heard he had been cautioned − a lower form of censure − three times before for similar issues. And he was twice ordered to undergo remedial education, including having a personal “coach” in 2015.

Even though he killed someone, and he had a history of incompetence (with three prior censures for “similar issues,” twice being required to undergo remedial education courses, and being required to have a personal “coach,”) they let him take him plea that he failed to “meet the standards of the profession” and withdrew the incompetence charge.  I mean, the person he killed was fat so it barely counts, right? In three months he can be back to putting fat people’s lives at risk, but not thin people since we consider it criminal to give thin people a surgery that is recommended for fat people – even if they have the exact same actual health issues.

With extensive advertising on TV and the Internet, Slimband was the most visible of private clinics across the country that offer weight−loss surgery, and described itself the busiest. Yau said he has performed over 6,000 gastric−band surgeries, more than any other physician in the country, usually with “excellent results.”

The doctor claims that in his assembly-line style practice he has performed over 6,000 surgeries usually with “excellent results” – except when he kills the patient or does something that requires censure and remedial education of course.

A 2012 National Post report, however, quoted malpractice lawsuits and former Slimband employees who raised questions about whether patients who signed on following a persistent sales effort were adequately screened, sufficiently warned about possible complications or provided sufficient post−operative care.

Turns out that when the doctor said he usually had “excellent results” what he meant was that there are malpractice lawsuits and former employees who are concerned that in the company’s quest to profit off fatphobia, they failed to give patients true information about possible complications, or provide them with appropriate post-operative care.

The company said at the time that patients are fully informed of the risks and receive post−op service that is the best in the industry. It also cited customer surveys that showed the vast majority of patients were satisfied.

The company says that things are fine, because the “vast majority” of clients who filled out a survey said that they were satisfied.  Of course, the patients they killed would be less likely to fill out the survey, so…

Though its website is still live, Slimband closed on March 22, said Elisabeth Widner, the College’s prosecuting lawyer. She did not explain reasons for the shutdown.

In the only bit of good news, the clinic is now shut down and no longer mutilating fat people for profit.

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Chins, like human bodies, come in lots of different shapes and sizes.  But, as they do with human bodies, our society’s screwed up stereotypes of beauty try to tell us that there are only certain chins that are acceptable.  And then the medical industry steps in to make money from this ridiculous notion. Enter Kybella.

Kybella is an Allergan product.  If that company sounds familiar it’s because they also sell Latisse (it will grow your eyelashes and don’t worry, that eye discoloration is probably temporary,) and the lap band device that tries to use stomach binding to force body size manipulation. This is a company that has committed atrocities of research, and once ran a contest where the prize was a dangerous abdominal surgery that you could “gift” to a friend or family member.

Kybella involves a series of injections of deoxycholic acid into the chin to destroy the fat cells. According to their website:

KYBELLA^® is a prescription medicine used in adults to improve the appearance and profile of moderate to severe fat below the chin (submental fat), also called “double chin.”

Moderate to severe fat below the chin?  Seriously.  We’re talking about a double chin like it’s a medical problem? Also, if you have only “mild” fat below the chin apparently you’re shit out of luck. These people will stoop to literally any low to make money.  As my friend CJ Legare says – this is about stealing our self-esteem, cheapening it, and selling it back to us at a profit.

So what are we risking to have a differently shaped chin?

KYBELLA^® can cause serious side effects, including trouble swallowing and nerve injury in the jaw that can temporarily cause an uneven smile or facial muscle weakness. In clinical studies, nerve injury in the jaw resolved on its own in a median of 44 days (range of 1 to 298 days), and trouble swallowing resolved on its own in a median of 3 days (range of 1 to 81 days).

The most common side effects are swelling, bruising, pain, numbness, redness and areas of hardness around the treatment area. These are not all of the possible side effects of KYBELLA^®. Call your healthcare provider for medical advice about side effects.

And for what are we risking a possible 298 days (that’s almost 10 months!) of nerve damage and 81 days of trouble swallowing? Here are some “before and after” pictures from their own website (you can click on the images to enlarge them:)

Lucky that they labeled them “before” and “after,” otherwise it would be hard to tell which is which.

And how much are we paying for these chin transformations? According to Glamour.com, around $5,400.  For some perspective, I could choose to have a slightly different looking chin or I could pay for 2,168 school lunches for kids who need some help.

I think that this passage from their website captures the full on ridiculousness of this entire situation:

Getting a filling at the dentist last Friday certainly wasn’t comfortable, but it was checking out that really got uncomfortable. I was being checked out by an employee who has worked with both me and my partner Julianne and has always been super nice and truly helpful.

They asked me what I was doing tomorrow and I said going on a run (Saturday is long run day, it dominates literally my entire day.)  They immediately responded “my stomach used to go out too much  too, but I found this great diet” then stood up and pulled their shirt back to show me how flat their stomach is. The numbing agent had me numb from my chin to the top of my forehead so my WTF? expression game wasn’t where I wanted it to be, plus I was focused on trying to keep from drooling out of one side of my mouth so I was going to just let it go.

Then they sat down and started to go into exactly what the diet entails (“First, I bought a big bag of tomatoes…”)  I interrupted and said in what I was hoping was a friendly but firm tone that conveyed finality (and didn’t involve drooling) “Yeah, I don’t want to hear about your diet.”  They said “ok” and then moved on to non-diet discussions.

Why am I telling you this story?  Of late, there has been a lot of discussion of whether people have the right to talk about their diet/weight loss in various situations, regardless of how it might affect folks practicing Size Acceptance, Health at Every Size, or dealing with eating disorders.  Regardless of the context of a sizeist world where those with large bodies face shame, stigma, bullying, and oppression and where weight loss talk is deeply tied not just to sizeism, but also to healthism, ableism, “goody fatty” tropes, and privilege. So, knowing that, the question seems to be: Is it ok for people to talk about their diets?

The answer depends on context. So we’ll look at this in various situations.

First, if it’s a space where the rule is no diet or weight loss talk, then it’s simply not ok to talk about diets or weight loss. Fat people live in a world where we get ceaseless messages conflating weight and health, that giveweight loss the credit for health improvements in highly dubious ways, suggesting that becoming thinner is – in basically every way – synonymous with becoming “better.”

It is vital that fat people who want to opt out of a weight loss paradigm and a thin-obsessed culture have the ability to create non-oppressive spaces that center their needs and feelings, and that means spaces without diet or weight loss talk. People dealing with eating disorders need to have spaces where they aren’t triggered by diet talk.  Put simply – our spaces, our rules.

Next, let’s look at general conversation.  Of course in these situations people are allowed to talk about their diet/weight loss.  We don’t have the option to control what other people talk about, but that doesn’t mean we don’t have options.

We can choose to talk about our Size Acceptance and/or Health at Every Size practice in the same way that people talk about their diets. Or we can just remove ourselves either without comment, or by saying something like “Oh, I don’t do weight loss talk.  I’m happy to talk about something else, or to go over there if you’d rather continue to talk about your diet.”

Which brings us to the clerk at my dentist’s office. This interaction shows exactly how screwed up our society is around weight loss talk.  I say I’m going for a run and the person responds “my stomach used to stick out too much too.”  WT actual F? There’s nothing wrong with my stomach – it sticks out just the right amount (and if it changes, it will stick out just the right amount then too.)

The fact that me saying I running was enough for someone to think they “know” that I think there’s something wrong with my body tells you all you need to know about the prevalence of diet and weight loss talk in our culture. If I’m a paying customer somewhere, then I’m not about to listen to diet talk. I’m not necessarily going to be unfriendly, but I’m going to be firm and clear that I’m not there to buy a diet, so I’m not interested in hearing diet and weight loss talk.

People are allowed to attempt – and believe whatever they want to about – weight loss. We are allowed to create rules for our own spaces, and we are allowed to create boundaries in our own lives.  It’s perfectly ok to opt out of diet culture, and it’s perfectly ok to choose to avoid talk that suggests that fat bodies will be somehow “better” if they are a different size.

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I saw an article posted on Facebook called “The Big Problem With Oprah And Other Celebs Who Tout Diets”  I started reading the piece and it was pretty good. The author, Jean Fain, who identified herself as “a psychotherapist specializing in eating disorders” was doing a decent take-down of the celebrity diet culture including the quote:

From where I sit, clean eating, lifestyle plans, weight management programs, juice cleanses, support systems… they’re all diets, and they’re all bound to fail. But with their intoxicating blend of impossible expectations, misguided authority and restrictive guidelines, celebrity diets are predestined to fail spectacularly.

Yes!  This all day! The article was going great until it hit this:

Self-compassion also means never going on a diet. When you’re self-compassionate, there’s no need to count points or calories or carbs. That’s because you generally appreciate your body and the food you feed it. You naturally eat less and weigh less without dieting.

What? I couldn’t believe it (that’s not true – I could believe it because we live in such a screwed up diet culture, I just didn’t want to believe it.)  It turns out that the author of the article is also the author of the book called “The Self-Compassion Diet.” The irony of her claiming that diets don’t work – except her diet – and that “Self-compassion means never going on a diet…you naturally eat less and weight loss without dieting” while marketing her book “The Self-Compassion Diet” was not lost on me.

I left a comment in the Facebook discussion:

I think that this is seriously problematic, especially in an eating disorder context. She conflates weight and health, and then she says “When you’re self-compassionate, there’s no need to count points or calories or carbs. That’s because you generally appreciate your body and the food you feed it. You naturally eat less and weigh less without dieting.” While I’m sure saying that helps her sell her diet book, it is completely unsupported by evidence.

She replied:

Ragen, there actually is a study that says just that. I don’t have the citation handy, but if you email me I’m happy to send it to you after vacation.

 

So she sent me the study that, remember, she claimed showed that “When you’re self-compassionate… You naturally eat less and weigh less without dieting.” Let’s take a look, shall we:

• The entire sample was 159 college students from 18-25 years old (9 were omitted from the final results by the study authors for being “outliers”) so the sample is not exactly robust.

• 74% of the subjects were “normal weight” to start with so, even using their own messed up ideas about weight and weight loss, we’re down to 39 of the participants having “weight to lose”

• BMI was only taken only once, by self-report. They did not track a change in BMI or a change in weight at all in the study, so the data are silent on whether self-compassion leads to weight loss.

• In fact, it’s a study of “associations.” That means that the study is completely correlational, and causality cannot be drawn at all. That’s why the word “may” occurs 53 times in 10 pages.

• There seems to be quite the hurry to suggest, based on correlation, that having self-compassion leads to a lower BMI.  But it’s just as (if not, perhaps, more?) likely that having a lower BMI in a thoroughly sizeist society may lead to greater self-compassion, since a person with a lower BMI will likely have less experience being ceaselessly barraged with an epic ton of sizeist shame, stigma, bullying, and oppression, while living in a world that isn’t built to accommodate them, all of which gives fat people the message that we aren’t worthy of any compassion – self or otherwise. But sure, it could be that having higher self-compassion causes a lower BMI….  Regardless, that conclusion is beyond the scope of this study.

I asked Deb Burgard, a PhD, eating disorders specialist, and psychologist to check my work just to be sure, and she generously agreed and provided this excellent analysis as well:

The actual hypotheses come back as:

Self-compassion will be positively related to mindful eating      

Yes (college students who are exposed to one are probably more likely to be exposed to the other)

Self-compassion will be inversely related to eating disorder symptomatology

Nope (only dieting)

Self-compassion will be inversely related to BMI  

Yes  (but we don’t know if thin privilege makes it easier to have self- compassion or if dieting is actually the moderator here since the process of dieting is a mindfu*ck that creates a barrier to self-compassion, or if weight stigma creates the barrier, or something else)

Mindful eating will be negatively related to eating disorder syptomatology

Yes   (This is pretty much a tautology since the operational definition of one is the opposite of the other)

Mindful eating will be negatively related to BMI                                            

Nope

Mindful eating will moderate the relationship between self-compassion and eating disorder symptomatology

Nope

Mindful eating will moderate the relationship between self-compassion and BMI

Nope

Here is what I find most interesting:  (From the discussion:) “This study found that self-compassion negatively predicted eating disorder symptomatology and dieting-related eating disorder symptomatology specifically . . .” (p 234).     Actually, self-compassion was unrelated to actual ED symptoms (bulimia, food preoccupation, oral control) and only to the dieting subscale (which was not one of the hypotheses).

So you can imagine that people who are thinner are less likely to diet and also less likely to be exposed to cultural expectations that one is a loser if one can’t “successfully” diet/be thin.

The fact that these researchers are touting mindfulness or intutive eating or self-compassion as a way to be thin is an expression itself of weight stigma.

There are numerous examples in the text of the assumption that higher BMI people must eat more, eat in a more disordered way, etc. but their own finding is that mindful eating is unrelated to BMI!

In any case, this research says exactly zero about the idea that if a higher-weight person has self-compassion, they will lose weight. In fact, that idea may itself be an example of how stigma and oppression make it harder for people to feel supported in practicing self-compassion, since the fact that their bodies don’t stay thin must mean they do not really deserve self-compassion, or they must not be doing it right, or whatever specific f*ckery is on today’s menu.

I think it’s worth delving deeper into that last bit, because it’s easy to think “Hey, even if the weight loss doesn’t happen, the person still ends up with more self-compassion right? So isn’t that a good thing?”

The problem is that’s there’s every chance that when you tell fat people to believe that self-compassion will lead to weight loss, then those people are likely to end up believing that they are not doing self-compassion “correctly” and/or that they don’t deserve self-compassion if they aren’t simultaneously becoming thinner (which they are unlikely to do, especially in the long-term.)

At the same time, you suggest that other people can judge by someone’s body size whether or not they have self-compassion, which just adds to the tremendous stigma and stereotyping that fat people deal with.  And that’s oppressive.

So I think that, however well-intentioned she may be, Jean is harming people. From my perspective, she is co-opting the idea of self-compassion in order to make a profit by misleading fat people into buying a big book of magical weight loss beans. Regardless of her intentions – which, again, may well be good – I think that the impact of her work is harmful, and her belief that this study supports her claims is nothing short of disturbing, as is the idea of someone who conflates self-compassion with body size (and markets the diet book she wrote) identifying as a specialist in working with people who have eating disorders.

To be clear, what she is doing is legal – people are (for now) allowed to try to sell promises of weight loss, however unlikely they are to be successful. But we don’t have to buy what they are selling – and we have every right to expect that they will be able to provide evidence that actually backs up their claims.

Regardless, the bottom line here is that we are all worthy of compassion, including self-compassion, at any weight. The only outcome we can currently prove about developing more self-compassion is that it will increase the amount of compassion we have for ourselves (and I’m a fan of that.) I think that self-compassion is not a diet; and anyone who says it is, is trying to sell something.

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A bunch of you have asked me to blog about this new weight loss trend.  I think it says a lot about this that I couldn’t remember the clinical name so I googled “balloon you swallow to lose weight” and it came right up.  So, you know, yikes.

The basics: Orbera is a balloon that a doctor places into the stomach and then fills with saline.  It then floats around the stomach, taking up space.

Let’s see what we can learn from their own website:

During the first two weeks you can expect:

Placement of the balloon within the stomach produces an expected and predictable reaction characterized most commonly by a feeling of heaviness in the abdomen, nausea and vomiting, gastroesophageal reflux, belching, esophagitis, heartburn, diarrhea and, at times, abdominal, back or epigastric pain and cramping. Food digestion may be slowed during this adjustment period. These symptoms can be treated with antiemetic, antispasmodic, and anticholinergic medications

But hold on because there’s more in store for you:

• Gastric discomfort, feelings of nausea and vomiting following balloon placement as the digestive system adjusts to the presence of the balloon.

• Continuing nausea and vomiting. This could result from direct irritation of the lining of the stomach or as a result of the balloon blocking the outlet of the stomach. It is even theoretically possible that the balloon could prevent vomiting (not nausea or retching) by blocking the inlet to the stomach from the esophagus.

• A feeling of heaviness in the abdomen.

• Abdominal or back pain, either steady or cyclic.

• Gastroesophageal reflux.

• Influence on digestion of food.

• Blockage of food entering into the stomach.

• Bacterial growth in the fluid which fills the balloon. Rapid release of this fluid into the intestine could cause infection, fever, cramps and diarrhea.

• Injury to the lining of the digestive tract as a result of direct contact with the balloon, grasping forceps, or as a result of increased acid production by the stomach. This could lead to ulcer formation with pain, bleeding or even perforation. Surgery could be necessary to correct this condition.

 

• Balloon deflation and subsequent replacement.

And there are at least a couple of ways that it can kill you:

• Death due to complications related to gastric or esophageal perforation is possible.

• Death due to complications related to intestinal obstruction is possible.

In their own study the 160 people who got the balloon experienced a total of 810 “device-related Adverse Events.” in six months or less.

 

And what are we risking this for?

The average participant lost 21.8 pounds in the six months they spent having adverse events (that, luckily, didn’t kill them) from a silicon balloon floating around their stomachs.  The control group lost 7 pounds.

Six months later, our balloon swallowers had regained 5.6 pounds (25.69%) of the weight that they lost in the first 6 months which puts them right on track to have gained back all of their weigh (with some regaining more than they lost) within 5 years. The control group had regained .7 pounds (10%,) also on track for the weight regain that the long-term studies of weight loss tell us to expect. Of course, like almost all weight loss studies, at this point they simply stopped following the subjects.

The only possible “good thing” about this that I can see is that some people whose doctors might want to amputate their stomachs might stick a balloon in them instead.  It’s still terrible, but at least it is reversible and fewer people will die, or live the rest of their lives  with horrific side effects, as a result.

So, basically, once again, they are asking fat people to risk our lives (not to mention quality of life) for nothing. Welcome to the “War on Obesity” which wants us thin or dead, and doesn’t much seem to care which.

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