Americans are fatâand getting fatter. AcÂcording to national survey data, the first two decades of the twenty-first century saw levels of adult obesity rise from an already worrying 30.5 percent to more than four in ten American adults (42.4 percent), with the proportion of âseverely obeseâ adults nearly doubling, going from 4.7 to 9.2 percent.1 Since 1988, obesity prevalence in children and adolescents (ages two to nineteen years) also has roughly doubled.
In his 2005 book, A Life Unburdened: GetÂting Over Weight and Getting On With My Life,2 author Richard Morris provides a powerful first-hand description of what âa day in the life of a fat manâ is like. During the period described, Morris weighed over four hundred pounds and âwas a dead man walking,â suffering âfrom a toxic mix of obesity-related ills that included shortness of breath, sleep apnea, hypertension, aches and pains in [his] joints, depression, a frail immune system, asthma and other ailments too numerous to list.â The details Morris shares about the daily grind in a four-hundred-pound body are not unlike the description of the obese offered by Galen, the second-century Roman philosopher-physician, who wrote that such a person âcannot walk without sweating, cannot reach when sitting at the table because of the mass of his stomach, cannot breathe easily. . . cannot clean himself.â3
In Galenâs time and up until the twentieth century, people in most places âwould probably have experienced overweight and obesity as exceptional rather than normal.â3 When MorÂris, in his early forties, embarked on a quest to understand the sudden normalization of obesity and howâas an exercise enthusiast and endless dieterâhe had ended up not just overweight but morbidly obese, one of his most profound insights was to recognize âthe folly of a mediÂcal industry that expends immense resources on the treatment of obesity-related symptoms, but adopts a hands-off approach when it comes to treating the source of those symptoms: poor nutrition.â The National Institutes of Health (NIH) helped consolidate the myopic focus on aggressive medical intervention at âConsensus Development Conferencesâ held in 1985 and 1991, respectively, where the gathered experts not only solidified the view of obesity as a chronic disease4 but âconcluded that surgery is the only effective treatment for severe obeÂsity.â5 The Institute of Medicine followed up in 1994 with the suggestion âthat the condition be treated as doctors treat other genetic and bioÂlogical diseasesâwith extended drug therapy or surgery.â6
Morris shares a sobering observation in that first chapter: âthe reality of being fat is so unlike anything else that fat people live in an entirely different world.â That world, both he and the media tell us, is sometimes punctuated by desperation. Fortuitously for Morris, his investigations led him to the Weston A. Price Foundation and to other resources and authors willing to contradict standard nutrition dogma; these gave him the courage to âignore the exÂpertsâ and return to eating the real and unproÂcessed foods of his childhood, whereupon he not only rapidly shed one hundred fifty pounds but regained his agility and zest for life.
Many other miserably overweight AmeriÂcans take a different approach, however, lured by the promise of quick results from whatever weight loss gimmicks are in vogue at the time.7 As one writer puts it, âBeing fat in America means you are a problem to be solved and a rich market to reap.â8 The fact that medical/pharmaÂceutical weight loss interventions virtually never deliver on their long-term promises only makes the market that much more lucrativeâwhatâs not to like about a business model in which the industryâs target audience is âlosing and gainÂing the same pounds over and overâ?8 As new generations of overweight adults and children succumb to the hypeâperhaps oblivious to the fact that âthe experience with obesity medicaÂtions is littered with many unintended adverse events that have resulted in the withdrawal of many drugs from the marketâ9âtrade magaÂzines are eagerly prophesying that obesity will be âthe next blockbuster pharma category.â10
FROM DONKEY MILK TO RAINBOW-COLORED PILLS
In ancient Greek and Roman times, physiÂciansâ weight loss recommendations revolved around moderating oneâs eating, occasionally fasting, performing âregularâ or even âstrenuÂousâ exercise and doing more physical work.3 If further intervention seemed necessary, adÂditional recommendations might include taking substances designed to promote elimination, either through vomiting (emetics) or via the bowels (cathartics). Emetics of the era included âhellebore plants and honey water,â while cathartics might include âjuice of scammony (bindweed), Cnidian berry and sea spurgeâ or laxatives such as âdonkey milk with honey, wild parsley, dodder of thyme. . . and honey water or sweet wine.â3
Fast-forwarding through time to the late 1920s, the landscape for weight loss intervention changed dramatically when a biochemist named Gordon Alles discovered some interesting properties of beta-phenyl-isopropylamineâothÂerwise known as amphetamine.11 Smith, Kline and French (SKF) (later, SmithKline Beecham, and still later, after numerous mergers and acquisitions, GlaxoSmithKline12) patented the chemicalâs base form in 1933 and began making an amphetamine vapor product, Benzedrine, initially marketing it as a decongestant.11 By 1937, the drug (in tablet form) had segued into becoming Americaâs first âantidepressant.â
During the war years, the pharmaceutical industry and consumers became enamored by another nifty amphetamine applicationâits use as a tool for weight loss. A 2008 discussion of âAmericaâs first amphetamine epidemicâ in the American Journal of Public Health estimates that by 1945, U.S. civiliansâ consumption of amÂphetamine products made by SKF (Benzedrine and also Dexedrine) and another manufacturer, often for weight loss, âconservativelyâ amounted to thirty million tablets per monthâenough to supply the standard dosage of two tablets per day to half a million Americans.11 Although the drugsâ easy availability soon began to lead to widespread âmisuse and abuse,â these and other dangersâsuch as elevated blood pressure and stimulant-induced psyÂchosis13âreceived little attention.11,14
In 1947, the American Medical Association (AMA) formally green-lighted the advertising of amphetamine drugs for weight loss, and in the early 1950s, sales of amphetamine (as well as methamphetamine) products skyrocketed to new heights. However, because amphetamines caused many users to experience âunpleasant agitation,â companies introduced a âsimple and terrifyingâ solution: combination diet pills that included âamphetamines, diuretics, laxatives and thyroid hormones to send the body into weight-loss overdrive, as well as benzodiazepines, barbiturates, corticosteroids and antidepressants to deal with nuances like insomÂnia and anxiety.â15 These untested combination products âproliferated throughout the 1950s,â11 and by the 1960s, thousands of âfly-by-nightâ clinics across America were peddling fancy new iterations of the diet pillsârainbow-colored stimulants âcombined with other medications to counteract the side effects of stimulantsââthat promised a âpleasingly uniform reduction in weight.â14
As Erin Blakemore wrote in Smithsonian Magazine in 2017, the pillsâ colorfulness was a conâand a deception in which doctors willingly participated. Blakemore explains:
âFor decades, diet pill companies marketed their wares directly to doctorsâand told them that by prescribing a rainbow of pills, they could sell the illusion of personalization. âYou should have more than one color of every medication,â said one brochure, warning doctors never to prescribe the same combination twice. âThatâs a little psyÂchology and is well worth it.ââ14
The diet pills were highly profitable. One doctor, Blakemore recounts, purchased a lot of one hundred thousand pills for $0.00071 apiece and sold them for $0.12 eachâa one hundred sixty-nine-fold markup.
Eventually, the potentially fatal âside effectsâ and frank addictiveÂness of amphetamine-based weight-loss drugs began to tarnish the drugsâ innocuous reputation, forcing complacent regulators to take action. After the Food and Drug Administration (FDA) restricted âall approved amphetamine-derived anti-obesity drugs. . . to short-term useâ and made the drugs âsubject to label warnings regarding the risk of addictionâ in 1977,3 pharmaceutical companies slacked off for a while on developing new amphetamine drugs for weight loss, but in the early 1990s, Wyeth (then American Home Products) launched a new boom with a widely prescribed and immediately disastrous product popularly known as âfen-phen,â which combined serotonin-boosting fenfluramine with the âmotherâs little helperâ stimulant phentermine.6 Soon, researchers were reporting serious heart-valve disease in people who had taken fen-phen for as little as one month,16,17 andâtwo hundred million dollars in profits laterâWyeth withdrew both fenfluramine and fen-phen from the market.6
THE NEW CASH COWS
Ever in search of cash cows in the weight loss space, drug companies have, in recent years, discovered new chemical pathways for suppressing appetite. The latest wonder drug on the U.S. market, as of 2021, is semaglutide, the âfoundational moleculeâ (in the words of its manufacturer, the Danish multinational Novo Nordisk) of Wegovy,18 an FDA-approved, preÂscription-only injectable medication for âchronÂic weight managementâ in adults. Semaglutide is a âGLP-1 agonist,â meaning that it mimics âthe action of GLP-1, a naturally occurring [gut] hormone that helps to regulate blood glucose levels.â19 Simply stated, semaglutide results in âdramatically slowed digestionâ and thereby reduces âhunger, appetite and cravings.â20,21
Novo Nordisk also makes an injectable drug for âlong-term weight lossâ in individuals as young as twelve (âSaxenda for teensâ), featurÂing another GLP-1 agonist called liraglutide.22 And, as it happens, three other similar Novo Nordisk drugsâFDA-approved for type 2 diabetesâalso result in weight loss: Ozempic (a semaglutide injectable for adults), Rybelsus (semaglutide tablets for adults) and Victoza (a liraglutide injectable for anyone age ten years and up).23,24 Wegovy contains a somewhat higher dose of semaglutide than Ozempic, but other than that, there is little difference between the two drugs.
Despite uncertainty about insurance coverÂage and a monthly cost of one thousand to fifteen hundred dollars,25 Wegovy came out of the gate with a bang, with the co-director of NIHâs ofÂfice of obesity research telling the press that it is âa very exciting time in the field.â26 In 2022, Novo Nordisk experienced some temporary âsupply stumbles,â but it was able to relaunch Wegovy in the U.S. in 2023, and as of the first quarter, the company was happily giving credit to Wegovy for a meteoric 124 percent year-over-year increase in âobesity care sales.â27 By the second quarter, Wegovy sales were up 543 percent, prompting Novo to upgrade its profit expectations for 2023.28 Describing the situation as âWegovy takes all,â the trade rag FiercePhÂarma dubbed Novo the king of âthe burgeoning obesity scene.â10
Wegovy is far from the whole story for Novo, however. Even with the supply reset, âhuge demandâ for the drug reportedly made it difficult for the company to keep up, with Novo even putting its Wegovy advertising âon holdâ while a company spokeswoman complained, âWe canât make enough.â26 Fortunately (and probably not coincidentally), Novo had Ozempic waiting in the wings. In a February 2023 blog titled âWhat happens when a drug goes viral?â, Harvard professor Robert H. Shmerling, MD, described how social media posts by influencers and celebrities sharing their successful weight loss with Ozempic turned âa side effect into a selling point,â triggering an explosion in off-label prescribing,23 notably via telehealth.29 By March, CNN reported, sales of Ozempic were at âan all-time high,â and Novo was recording the same magnitude of sales spike for Ozempic (a year-over-year increase of 111 percent) as for Wegovy.29
Both sales surges ended up in the same placeâwith shortagesâleading Shmerling to scold health care practitioners sternly about âprioritiesâ and âirresponsible prescribing.â He also pointed out, however, that Novoâs adÂvertising for Ozempic had not been shy about publicizing the drugâs supposedly inadvertent impact on weight. In fact, using the marketing phrase âthe Ozempic âTri-Zone,ââ Novo openly touts its drugâs triple benefits of âimproved blood sugar control, lower cardiovascular risk, and weight lossâ; moreover, the company does not list weight loss as a possible side effect but instead relegates the statement âOzempic is not a weight loss drugâ to easy-to-miss fine print.23 At the same time, the company virtuously asÂserts that its products âare not interchangeable and should not be used outside of their FDA-approved indications.â30
Nonetheless, the media routinely refer to Ozempic as a âweight loss drug,â without undue protest from Novo. In July 2023, the public radio station WBUR reported that âNovo Nordisk spent millions for doctors to promote Ozempic [and] other weight loss drugsâ; in 2022 alone, the company shelled out eleven million dollars on âtravel and meals for thousands of doctors,â with WBUR querying the ethics and legality of the company âspending so much to talk to doctors about this type of drug.â31 An endocri nologist interviewed by CNN, who agreed that âadvertising around Ozempic took off in 2022,â likewise commented, âI think we really need to start questioning our ethics around this.â29
LIFE-CHANGING âSIDE EFFECTSâ
According to an obesity medicine specialist interviewed by Forbes, semaglutide and liragluÂtide drugs âare designed to be taken long-termâ; in fact, when individuals stop taking the drugs, they typicallyâand rapidlyâregain most or all of the lost weight.21 However, an insurance inÂdustry analysis of U.S. pharmacy claims showed that only one-third of those who started taking one of Novoâs semaglutide or liraglutide drugs for weight loss were still taking it a year later, representing âa substantial drop in adherence compared to what was reported in clinical triÂals.â32 A clinical trial of Saxenda in obese teens (ages twelve to seventeen) found that one in ten adolescents taking liraglutide dropped out of the study due to adverse events (versus zero disconÂtinuations in the placebo group); two-thirds of the liraglutide group versus roughly one-third of the placebo group (65 vs. 36 percent) reported gastrointestinal adverse events.33
Indeed, the insurance analyst who exÂamined pharmacy claims speculated that one reason for the dropoff in adherence at one year might be the severity of side effects. The list adÂmitted to by Novo for semaglutide is daunting; it includes nausea, low blood sugar, dizziness, flu symptoms, a pounding heartbeat, vision changes, mood changes (including thoughts of self-harm), gallbladder and kidney problems, symptoms of pancreatitis and serious thyroid problems.34 Ozempic has a âboxed warningâ (formerly known as a âblack box warningâ) about thyroid tumor and thyroid cancer risks.35 The liraglutide drugs come with similar risks.36
Anecdotal information is starting to seep out about other serious life-changing effects from both short-term and longer-term use. DisÂillusioned consumers report dramatic impacts from both Wegovy and Ozempic, including a side effect not specifically mentioned in the drugsâ inserts: severe gastroparesis. Popularly referred to as âstomach paralysis,â severe gastroparesis is defined as 35 percent or more of food still being present in the stomach four hours after a meal, when ordinarÂily, less than 10 percent should remain by then. The FDA concedes that the agency has received reports of gastroparesis associated with both semaglutide and liraglutide, âsome of which documented the adverse event as not recovered after discontinuation of the respective product at the time of the report.â20
In a July news account, a thirty-seven year-old woman suffering from severe gastroparesis stated that she âstayed nauseated all the time, no matter how little she ate,â and had resorted to taking a prescription anti-nausea drug âlike it was candy.â20 When her stomach problems first surfaced, it took months for doctors to connect the discomfort to Ozempic and take her off the medication. She lamented:
âI wish I never touched it. I wish Iâd never heard of it in my life. This medicine made my life hell. . . . It has cost me money. It cost me a lot of stress; it cost me days and nights and trips with my family. Itâs cost me a lot, and itâs not worth it. The price is too high.â20
Even a year after discontinution, another woman described how she now vomits multiple times a day (so-called âcyclic vomiting syndromeâ), a condition so uncomfortable that she had to take a hiatus from her job.20
According to some reports, anesthesiologists are concerned about the rise in stomach paralysis because it can increase the risk of regurgiÂtation during surgery, even if the patient has fasted according to pre-op instructions. This, in turn, can send stomach acid into fragile lung tissue, which is not designed to handle acidic digestic juices. In one instance, an anesthesiologist discovered âa âmassive amountâ of undigested food in [the] stomachâ of a forty-two year-old who had had nothing to eat for eighteen hours but who had started taking Ozempic two months earlier.37 According to the alarmed physician: âWe had to stop the procedure, put a breathing tube in and another instrument into his lungs to clean the lungs from the food that he inhaled and aspirated. . . . [T]his was a potentially serious, potentially fatal complication.â
For its part, the FDA maintains that the drugsâ benefits generally outweigh the risks, while a gastroenterologist funded by NIH to study liraglutide unsympathetically suggests that the women experiencing severe gastroparesis âmay just be really unlucky.â20
As bad as gastroparesis is, suicidal ideation may lead to an even worse outcome. Reuters reported in July 2023 that the European MediÂcines Agency (EMA) is investigating both Ozempic and Saxenda due to âreported thoughts of self-injury.â38 Although the EU product inserts do not list suicidal thoughts as a possible side effect, the U.S. insert for the similar drug Wegovy includes instructions to prescribers to keep an eye out for such thoughts. The FDAâs adverse event reporting system includes, according to Reuters, at least sixty semaglutide-related reports of suiÂcidal ideation since 2018 and at least seventy liraglutide-related reports since 2010. A portfolio manager and Novo Nordisk shareholder quoted by Reuters comments, âa low incidence of suicidal thoughts might be acceptable for a drug against Type 2 diabetes but not for a weight-loss drug.â The Saxenda clinical trial with teens (published by a group of authors with significant Novo Nordisk conflicts of interest) reported one suicide in the liraglutide group but assessed it âas unlikely to be relatedâ to the drug.33
Other slightly more humorousâbut not reallyâside effects reported for Ozempic (and also Wegovy) are âOzempic faceâ39 (described as a âgaunt and skeletonizedâ face that can âmake someone look older than they areâ), âOzempic fingerâ (shrinking fingers that no lonÂger hold rings) and âOzempic buttâ (a âsaggier-than-normalâ rear end). A news story notes that âwhen weight loss is fast, it can make it tough for your skin to keep upâ; a dermatologist explains, âRapid weight loss does not allow collagen and elastic fibers to adjust to this lack of support and results in severely sagging skin.â40 As a Forbes writer flippantly puts it, âsuch rapid weight loss can throw you a curve ball of sorts by making you lose some of your curves.â30 The medical communityâs recommendations to deal with the embarrassing sagginess include skin-tightening procedures and plastic surgery.
WHATâS NEXT?
Recognizing that the nausea experienced by 44 percent of Wegovy users deters many from sticking with the drug on a long-term basis, biotech firms are hot to develop a âWegovy-likeâ drug âwithout the downside of nausea.â41 One firm is tinkering with an approach that would disrupt the bodyâs mitochondria. (What could possibly go wrong?) As various companies indicated to Reuters, âthe huge amount of atÂtention the obesity market is receiving due to Wegovyâs success could be a game-changer for their own drug development prospects,â including opening the door to massive infuÂsions of venture capital.41 An investment banker excitedly stated, âItâs absolutely possible that in 5 to 10 years weâll see over a hundred biotechs working in this area.â
Nothing daunted, Novo Nordisk is now plugging the cardiovascular benefits of semaÂglutide and liraglutide. The announcement of âpositive dataâ from a clinical trial triggered a 17 percent jump in Novoâs share price, with the financial press explicitly attributing this âupsideâ to Wegovy.28 Novo and its fleet of beÂholden researchers are also enthusiastic about other potential applications of the drugs for conditions ranging from polycystic ovary synÂdrome to addiction and dementia, and numerous clinical trials are underway.42 One researcher states, âIn some ways there is a sense that some of this might be too good to be true. But. . . any potential benefits should be investigated.â42
Lost in all the excitement about âgame-changersâ and âdrug development prospectsâ is (as Morris noted in his 2005 book) any meanÂingful discussion of food and nutrition. This was not always so. Historians observe that the famed Banting Diet43 conceived of by William Banting (1796â1878) was the first high-fat, low-carb diet, with a booklet that was âso popularâ it went through ten editions over four decades.9 However, when contemporary South African scientist Tim Noakes updated the Banting Diet in his book The Real Meal Revolution, his counÂtryâs âdiet dictocratsâ persecuted him for his common-sense (but to them, contrarian) view that âwhat you eat has a bigger impact on your weight than how much you eat.â44,45
On the Wise Traditions Podcast, Dr. GuillÂermo Navarrete has argued for the importance of context when educating people about weight and nutrition, stating: âThe only way to get people to a safe place where they lose that weight and keep that weight out forever is that you teach them first whatâs the problem and why it is a problem. . . . If you identify that whole industry, not just that food or the cookie. . . and why is that industry powerful, you will understand why.â46 He emphasizes, âModern diseases are caused by modern food and modern habits.â Over the years, the Weston A. Price FounÂdation has often adopted a similar big-picture lens when discussing the food industry favorites that are contributing to weight gain in America and around the world: monosodium glutamate (MSG),47 soy (used to âfatten fish, poultry and animals quickly and profitably for marketâ),48 sodas (including âdietâ sodas),49 reduced-fat milk50 and industrial seed oils.51
Discussing her weight-loss âformulaâ (âPurge, Splurge, Fast and Lastâ), Sally Fallon Morell also emphasizes personal responsibility:
âLong-term, permanent weight loss requires a complete change in lifestyle, including rejection of all processed foods, adopting a schedule of regular meals and, above all, dedication to nutrient-dense foods. If your diet is not supplying all the vitamins and minerals your body needs, the urge to eat will eventually overcome the best of intentions and the strongest willpower.â52
Real, nutrient-dense foods include healthy fats like butter, olive oil, lard, coconut oil and duck fat; pastured meats, organ meats and eggs, fish and artisan cured meat products such as bacon, salami and patĂŠ; bone broth; raw milk and other high-quality dairy products such as raw aged cheese, kefir and yogurt; whole grains (properly soaked, sprouted or fermented); genuine sourdough bread; natural sweeteners; and fermented vegetables, condiments and beverages. Ultimately, one of the strongest advantages of this type of diet is that it is satisfying. Bone broth, for example, âimproves the digestibility and assimilation of food, giving the body the critical message that it is deeply nourished, happy and full.â53 As Navarrete observes, âWhen you do the right thing, what the body needs, deserves and is willing to absorb and use, the body will say âthank you.â The way your body says âthank youâ is by getting healed from diseases or getting to the right weight.â46
SIDEBAR
BUMMER BARIATRIC SURGERY
Although drugs like Wegovy have been hogging the weight loss headlines, many overweight individuals choose to go the bariatric surgery route. According to the American Society for Metabolic and Bariatric Surgery (ASMBS), there are a lot of weight-loss surgery options to choose from! The most common (59 percent of all weight-loss surgeries)54 is the gastric sleeve procedure (âsleeve gastrectomyâ), which permanently removes about 80 percent of the stomach, âleaving a tube-shaped stomach about the size and shape of a bananaâ55 so the person can only eat one-half cup of food at a time.56 According to the ASMBS, five and a half times more gastric sleeve procedures were performed in 2021 versus 2011.57
Other less sought-after procedures include Roux-en-Y gastric bypass (RYGB), one anastomosis gastric bypass (OAGB), single anastomosis duodenal switch (SADI), biliopancreatic diversion with duodenal switch (BPD/DS), endoscopic sleeve gastroplasty (ESG), gastric band surgery, gastric balloons and finally, revisional bariatric surgery (RBS) to ârepair or change a previous weight loss surgery.â58 RBSârepresenting about 11 percent of bariatric surgeries54âitself is increasingly comÂmon but introduces further complications in at least one in ten patients; researchers also report that the âdurabilityâ of its effects âremains questionable.â59
Gastric sleeve surgery is associated with a high rate of ârecidivismâ (weight regain).60 Itâs estimated that 20 percent of sleeve recipients also experience other long-term complications, including ongoing nausea and indigestion, âfood intolerÂance,â gallstones, stomach ulcers, acid reflux, sagging skin, abdominal scarring and malnutrition resulting from a reduced ability to absorb nutrients and calories. Some of these problems then require additional interventions.61 Evidence points to other alarming long-term or fatal outcomes from various types of bariatric surgery62: gut leakage63 and fistulas64 that can lead to sepsis65; permanent colostomy (an opening in the abdominal wall âfor poop to come outâ66); dependence on daily intravenous nutrition67; liver damage68; and premature death.69
Interestingly, studies also point to a higher risk of new-onset substance use or abuse (both alcohol and other subÂstances) in those who have undergone bariatric surgery, with researchers describing it as an âoverlookedâ iatrogenic (doctor-caused) complication.70 They point out that gastric bypass alters the way the body absorbs substances like alcohol, and some suggest that some form of âaddiction transferâ may also be occurring.71
Worryingly, bariatric surgeries have also trended upward in the teen and young adult population, and a recent study suggests that they can end up with weakened bones.72 As reported by Childrenâs Health Defense (CHD), the researchers found that the young people had âreduced vertebral bone strength and density.â73 Integrative pediatrician Dr. Michelle Perro told CHD that the research constitutes âyet another reason to call for an immediate cessation of barbaric bariatric surgery in children and address the real root causes of childhood obesity, and abandon Band-Aid solutions.â
SIDEBAR
BUMMER BARIATRIC SURGERY
Although drugs like Wegovy have been hogging the weight loss headlines, many overweight individuals choose to go the bariatric surgery route. According to the American Society for Metabolic and Bariatric Surgery (ASMBS), there are a lot of weight-loss surgery options to choose from! The most common (59 percent of all weight-loss surgeries)54 is the gastric sleeve procedure (âsleeve gastrectomyâ), which permanently removes about 80 percent of the stomach, âleaving a tube-shaped stomach about the size and shape of a bananaâ55 so the person can only eat one-half cup of food at a time.56 According to the ASMBS, five and a half times more gastric sleeve procedures were performed in 2021 versus 2011.57
Other less sought-after procedures include Roux-en-Y gastric bypass (RYGB), one anastomosis gastric bypass (OAGB), single anastomosis duodenal switch (SADI), biliopancreatic diversion with duodenal switch (BPD/DS), endoscopic sleeve gastroplasty (ESG), gastric band surgery, gastric balloons and finally, revisional bariatric surgery (RBS) to ârepair or change a previous weight loss surgery.â58 RBSârepresenting about 11 percent of bariatric surgeries54âitself is increasingly common but introduces further complications in at least one in ten patients; researchers also report that the âdurabilityâ of its effects âremains questionable.â59
Gastric sleeve surgery is associated with a high rate of ârecidivismâ (weight regain).60 Itâs estimated that 20 percent of sleeve recipients also experience other long-term complications, including ongoing nausea and indigestion, âfood intolerance,â gallstones, stomach ulcers, acid reflux, sagging skin, abdominal scarring and malnutrition resulting from a reduced ability to absorb nutrients and calories. Some of these problems then require additional interventions.61 Evidence points to other alarming long-term or fatal outcomes from various types of bariatric surgery62: gut leakage63 and fistulas64 that can lead to sepsis65; permanent colostomy (an opening in the abdominal wall âfor poop to come outâ66); dependence on daily intravenous nutrition67; liver damage68; and premature death.69
Interestingly, studies also point to a higher risk of new-onset substance use or abuse (both alcohol and other substances) in those who have undergone bariatric surgery, with researchers describing it as an âoverlookedâ iatrogenic (doctor-caused) complication.70 They point out that gastric bypass alters the way the body absorbs substances like alcohol, and some suggest that some form of âaddiction transferâ may also be occurring.71
Worryingly, bariatric surgeries have also trended upward in the teen and young adult population, and a recent study suggests that they can end up with weakened bones.72 As reported by Childrenâs Health Defense (CHD), the researchers found that the young people had âreduced vertebral bone strength and density.â73 Integrative pediatrician Dr. Michelle Perro told CHD that the research constitutes âyet another reason to call for an immediate cessation of barbaric bariatric surgery in children and address the real root causes of childhood obesity, and abandon Band-Aid solutions.â
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This article appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly journal of the Weston A. Price Foundation, Fall 2023
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