The surgical lipo-industry - Forum

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Re: The surgical lipo-industry - Ärzteforum

Post#21 »

I have not responded to the bariatric issues because I wanted
to personally review the literature and come back with references.
Since I have only been tangentially involved with the field in
the past 10 years and since this list has a very high standard
for debate it may take a while.

I said:

e. Absolutely NOTHING else works.

I stand by the statement in a statistical since. My memory of the
literature's results for 5 year sustained weight loss
with non-surgical interventions is 5% rather than the 20% Avi
mentions. Compared to surgery (60-80%) that is not working in my book.
I will agree that energy physics pretty much guarantees that if you
use more calories than you eat one loses weight.

There have been a number of editorials in the literature addressing
the prejudice obese people face. The statement about "God made them
that way" is really unacceptable as is the implication that their
obesity is a simple matter of a lack of will-power.

Isn't it obvious that difficult surgery will have poor results in
some surgeon's hands. Many examples have been well documented and
discussed on this list - reconstructive biliary surgery and major
liver resection to name two. We don't condemn patients with operable
liver cancer because God gave them their cancer and when 'you' actually
do the cases they all seem to have complications.

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Lady Surgeon

Re: The surgical lipo-industry - Ärzteforum

Post#22 »

This is certainly an interesting discussion. I have been trying to lose weight the old-fashioned way and I am satisfied with my progress so far. I belong to a weight loss mailing list and many of the surgeons have had horrible experiences with physicians.
Several people (most of the members are female) are in the 300-400 lb range and I don't think you have any idea of the desperation that they feel. Many of them are housebound and have many of the obesity related diseases. They are used to people pointing at them in the street and yelling at them from their cars. They worry about fitting into airplane seats and carry seat-belt extenders with them when they travel.
Most people on the list know by now that I am a surgeon and I do my best to answer questions if they are directed at me. I will correct misinformation but I try to avoid defending our profession. Nevertheless, just today one member accused me of being "just like other doctors...arrogant and judgmental". I was assured by other members that I was not in error but, unlike this list, dissent is not valued. Like most people with a chronic disease, they are more informed than I am about new drugs and strange new weight loss methods. They have tried every diet imaginable. I think there is considerable prejudice in the medical profession towards the obese. I would never have bariatric surgery but, if I had some of the experiences that I've heard about, maybe I would have a different opinion.

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Re: The surgical lipo-industry - Ärzteforum

Post#23 »

The data is level 3 and 4. No RCT's.
However, the magnitude of the difference is rather large.

In general, if the difference in outcome is large, RCT's can be smaller,
and the need for an RCT for validaion is not as acute. Suppose you want
to adopt an new method of treatment, perhaps more costly. If the
difference in outcome is small, say between 20 and 25% you need level 1
evidence to justify the cange. If the difference is 10 vs 50%,
level 2 (smaller RCT) may be adequate. And there is absolutely no need for
an RCT if the difference is 0 vs 100%.

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