Conflicts of InterestObesitySurgery & Meds

“Surgery is better than dieting, says conflicted doctor”

I often write about conflict of interest and advise that we should all read articles with the approach – who stands to gain from this article?

The Sunday Times printed a story on the front page on 12 September 2010 of which they should be ashamed. It was entitled “Surgery is better than dieting, says top doctor.” The article quoted Nick Finer, indeed a well known and respected obesity expert, as saying “The only answer to Britain’s obesity epidemic is to offer surgery to anyone suffering from severe weight problems.” He suggested starting with the 1 million people with a body mass index greater than 35 and presumably working down from there. This would be phenomenally lucrative for pharmaceutical companies providing gastric bands, surgical equipment for the operations, drugs taken around the time of the operation, liquid diets (a pre-operation and often post-operation requirement) and, of course, the surgeons who perform these operations.

The real story is that a number of our national obesity experts (most that I have come across) have fundamental conflicts of interest, which should invalidate any so called expertise that they come out with. Why did the article not list Finer’s conflicts of interests? They are easy to find – they were listed in a February 2010 journal declaration:

“Nicholas Finer: Consultant for Novartis, Shionogi, Merck, Abbott, sanofi-aventis, Amylin Pharmaceuticals Ajinomoto and GSK; received lectureship fees from Abbott, sanofi-aventis, Roche and Novo-Nordisk; received grant support from Merck, Novartis, Roche, Alizyme, Pfizer, Johnson and Johnson, Abbott and sanofi-aventis; member of the SCOUT ESC receiving payment from Abbott (honoraria/travel expenses).”

Novartis (Novartis Nutrition) make Optifast : “OPTIFAST® is now being used to induce weight loss as needed before bariatric surgery in several bariatric surgery facilities. Novartis Nutrition has also introduced a brand new line of products, OPTISOURCE™, to help patients meet their special nutritional needs after bariatric surgery. Most of these patients require lifelong protein and vitamin/mineral supplementation after the surgical procedure.” This stuff costs $2500-3500 for a one year programme for one person – not sure if that was factored in to the cost benefit analysis?

Shionogi have two obesity drugs at various stages of R&D.

Merck, Pfizer and Sanofi-Aventis have Cannabinoid Antagonist products. These act to block the cannadinoid receptor 1 (CB1) and are claimed to decrease food intake and help regulate weight. (These try to work on the opposite basis of cannabis ‘giving the munchies’ and the psychological side effects are a concern).

A report about the USA obesity drug and bariatric surgery market lists:
– Alizyme as developing a lipase inhibitor (the goal of this is to stop fat being absorbed – as with the drug Orlistat/Alli. Absorption of fat soluble vitamins is impaired);
– GlaxoSmithKline under emerging drugs for a melanin-concentrating hormone antagonist;
– Amylin Pharmaceuticals as having an emerging Peptide YY3-36 drug;
– Amylin Pharamceuticals and Johnson & Johnson are listed as having other emerging drugs;
– Johnson & Johnson, Merck and Pfizer are listed as having delayed or discontinued drugs in this arena.

The companies profiled in the obesity drug and bariatric surgery market report are Abbott, GSK, Merck, Pfizer and Sanofi-Aventis. Roche make the drug sibutramine (withdrawn from Europe, earlier this year, following an investigation into heart disease amongst people taking the drug. It is still available in the USA). The report where Finer declared his interests was a study of the drug sibutramine and the conclusion was very favourable (would it be reasonable to suggest one would not be supported by a company if one were not supportive of their products?)

I saw Nick Finer present at the Wales National Obesity Conference in June 2010. He introduced me to a graph, for which I am most grateful, done by Marion Franz in 2007. This study reviewed 80 other weight loss studies based on the “eat less and/or do more” principle and this is where Finer gets his statistic quoted in the Sunday Times article: “the average long-term weight loss achieved by most obese adults who diet is 2-3%, so small as to be almost irrelevant.” This is correct. I have seen the study and I am hugely grateful to Elsevier for permission to reproduce the chart in my book “The Obesity Epidemic“. However, this evidence is for low calorie/calorie deficit dieting – it is not for low carb dieting and my own findings (reproduced in the book) are similar to those of Gary Taubes – an unavoidable conclusion that carbohydrate consumption is solely responsible for both fat storage (weight gain) and fat ‘un-stored’ (weight loss).

Finer is quoted in the article as saying “Humans evolved in unpredictable environments where food was scarce and our bodies are programmed to maintain our body weight at all costs.” From this comes the recommendation that we should operate on 1 million of our fellow humans (for starters) to cut them open and make it such that they will never be able to eat normally, digest normally or absorb vitamins normally ever again.

There is no logic in this conclusion. Man and our ancestors have been on this planet since Australopithecus Lucy first walked upright an estimated 3.5 million years ago. We have had an obesity epidemic for about 35 years. Surely our first plan should be to return to what we ate for the 3 million, 499 thousand, 965 years before we got so fat we had to invent bariatric surgery?! How about humans return to eating what we evolved to eat? Meat, fish, eggs, vegetables, nuts, seeds and sporadic fruits if we were lucky?

The trouble is – there is no money to be made in advising the above. The ‘expert’ who advises a return to eating food – we shouldn’t need to call it real food – will receive no funding from food, drink or drug companies. The whole reason we have the processed food industry is because of the margin that can be made from man-made food in contrast to that which can’t be made from mother-nature’s food. And with the modern illness accompanying modern food and drink we have modern drugs – continually being developed to ‘treat’ the diabetes, obesity, cancer, heart disease, indigestion, irritable bowel syndrome, blood pressure problems and so on, which I am convinced are the result of that modern drink and food. What a wonderful symbiotic relationship between the food, drink and drug industries.

This is why the real story for Sunday’s paper should have been – citizens of the UK will never receive the right advice until so called experts cease to be conflicted. Or, at the very least, have to declare their interest up front so that we can see the promotion for what it is.

p.s. you may like to see another blog I did with death rates for bariatric surgery. I’m not sure if the funeral costs were also factored in to the cost benefit analysis study.

p.p.s Ajinomoto markets aspartame. Here’s Finer promoting aspartame. Here’s what an independent person has to say about aspartame:
Dr. Ralph Walton, Professor and chairman of the Department of Psychiatry Northeastern Ohio University Colleges of Medicine, undertook a comprehensive review of studies available for just one sweetener: aspartame. It was called “Survey of aspartame studies: correlation of outcome and funding sources.” The summary of the report stated: “Of the 166 studies felt to have relevance for questions of human safety, 74 had Nutrasweet® industry related funding and 92 were independently funded. One hundred percent of the industry funded research attested to aspartame’s safety, whereas 92% of the independently funded research identified a problem.” Walton’s overall conclusion was “We have also become much more sophisticated about the impact of a variety of toxins on psychological processes. I am convinced that one such toxin is aspartame.”

5 thoughts on ““Surgery is better than dieting, says conflicted doctor”

  • While surgery is impractical for the 66% of Americans (and probably almost the same number in the UK, and other parts of Europe catching up as well) who are overweight or obese, in fact, the ONLY success seen whatsoever in long-term weight loss is with gastric bypass surgery. (Lapbands are much less successful, have lots of failure problems and don’t seem to work long-term.)

    Many of us have seen with our own eyes, friends or neighbors or colleagues, who had this surgery and went from being extremely morbidly obese (you can’t even get surgery unless you are nearly 300 lbs) and over 1-2 years, went down in weight until they were normal, or even slender in size. This a simply incredible thing to witness, if you have never seen it you can’t possibly understand.

    One woman I work with has had the procedure (at a very reputable teaching hospital in the area), and literally went from over 400 lbs (I’m talking here, “circus fat lady” size) to a size 2 (US — don’t know what this is in British sizes, but VERY small) and perhaps 110 lbs — this is absolutely incredible, and basically the dream/fantasy of every overweight person (even those more moderately overweight) for which they would literally sell their souls or their children into slavery if it were possible to achieve!

    The only thing preventing 90% of Americans from having this is pure cost — it is not affordable without insurance, and insurance will not pay unless you are well over 100 lbs overweight. (You are probably also aware that quite a few Americans lack health insurance at all, which excludes them entirely from ANY elective surgery.)

    So despite how problematical it is, you can’t completely avoid talking about the ONE procedure which is actually 87% effective in creating massive permanent weight loss — when “diet and exercise” have an abysmal failure rate of 98%.

    Also: there are incredibly important lessons to be learned from the success of gastric bypass surgery — for example, why does surgery (or lapbanding) “work” when we are always told that “hunger is in our head” or that food cravings come from “laziness” or “emotional problems from childhood”? If so, gastric surgery should not work AT ALL….in fact, what it suggests is that the basis of obesity is not in behaviors, personality, lifestyle or emotions but IN YOUR STOMACH, where glands produce the hormones of hunger and satiation.

    Fat people likely do not have defective “willpower” but defective stomachs.

  • I am someone who has had two gastric bands inserted at different times in my life. The first was when I was 19 yrs old and 10 months later I had lost 50 kgs. I physically couldn’t eat starchy carbs as they would not go through the band, I exercised lightly every day and my calorie intake could not have been over 1000 kcals a day (this was by choice as I was not hungry and my obsession with food vanished virtually over night). I then got very sick and had to have the first band removed as the inner tubing had kinked and the doctor could not loosen the band – it was a life or death situation as I could not eat anything or even drink milk! In the midst of my addiction, I begged my parents to allow me to have another band fitted as I knew I could not keep the weight off without this ‘crutch’. They agreed and I had another band fitted. I was 20 years old at the time of the second band and weighed approximately 85 kgs.

    During the next 3 years I attended a monthly support group for my doctor’s weight loss surgery patients which included gastric bypass patients mainly as well as gastric band patients. Some of these patients were 5 to 10 years post op and surprisingly for me were fighting the same demons that they had done their whole lives – their addiction to food. By then their stomachs had stretched out and they had never bothered to find out WHY they were eating the way they were and what made them crave etc. They were back to square one speaking about calories and ways to decrease their portions and make healthier choices etc, but they had permanently changed their bodies and their ability to absorb essential nutrients. It didn’t strike me then but in retrospect what any un-biased passer-by would think is “well why did they bother to have weight-loss surgery if they are talking about dieting and healthy food choices 3 years later and struggling to keep the weight off once more……?”

    I am now 27 years old and band free, and although I have put on all the weight I had lost initially with the band, I think I have learned a very valuable lesson…..that at some point everyone with a weight problem needs to face their demons and cut out the food groups that make us crave more. Surgery will not cure this and I can guarantee that you will be back to square one regardless of how much you can physically eat.
    Zoe, your book on the Obesity epidemic has enlightened me in so many ways and I thank you. The first thing I did after I read your book was buy a copy for my personal trainer and my naturopath as I NEED their support and therefore they need to be enlightened too. I now no longer feel guilty for cutting out food groups such as all carbohydrates, gluten, dairy and eggs (I have intolerance eggs, gluten and dairy). I feel great and 3 weeks after starting this new lifestyle I have lost 7 kgs and have actually been eating more calories than before! Armed with all my new knowledge I will start spreading the word to my friends and family. Thank you.

  • For 15 years I have been screaming from the roof tops that this low fat diet stuff is a load of crap. No one listened. All of my fat friends load up their shopping carts at the grocery store with anything and everything that has LOW FAT on the package. Then they take it home and sit down and munch away sometimes consuming the whole package in one sitting. They get fatter and fatter and fatter.

    Another one of my pet peeves is the word NATURAL. You see the word natural plastered all over processed food packages. Oh! It’s natural so it must be good for me. Excuse me. Arsnic is natural. Just what does this word mean when it is on food packages?

    It was a sad day when the powers that be came out with the food pyramid. I knew the first time I saw it that it was a recipe that would definately make me fat. I am talking about the American food pyramid. I am American and now live in the UK.

    I read the other day that when sugar was first introduced to Europe centuries ago, it was considered to be a drug. I think they had the right idea about it.

  • Keep up this good work, Zoe.

    I am full of admiration for your thoroughness and outspokeness and sheer good sense. I started using your book last March, and apart from the odd blip (crave sugar and its hard to avoid)am fitter and slimmer than I have been for a long time.

    Thank you very much

    Freda Waldapfel

    • Hi Freda – thank you very much for your lovely comment. There are more people conflicted than not conflicted so the nice comments are rare and very much appreciated!
      Keep up the fight against sugar addiction!
      Very best wishes – Zoe

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