When I saw this article in the NYT last week, I let out a deep and heavy sigh.
The article starts out with discussing a particular kind of weight loss surgery that I’d written about critically a few years back, regarding a kind of contraption that ultimately served as a kind of doctor-approved bulimia, which allows the patient to enjoy all of the bingeing but with none of the effects, because the food skips the digestive tract and is exported out of the body by alternate means. Ahem.
From the NYT article:
Recently, 45 international medical and scientific societies, including the American Diabetes Association, called for bariatric surgery to become a standard option for diabetes treatment. The procedure, until now seen as a last resort, involves stapling, binding or removing part of the stomach to help people shed weight. It costs $11,500 to $26,000, which many insurance plans won’t pay and which doesn’t include the costs of office visits for maintenance or postoperative complications. And up to 17 percent of patients will have complications, which can include nutrient deficiencies, infections and intestinal blockages.
It is nonsensical that we’re expected to prescribe these techniques to our patients while the medical guidelines don’t include another better, safer and far cheaper method: a diet low in carbohydrates.
First, let’s talk about why bariatric surgery—also known as “weight loss surgery”—is successful in curbing the negative effects of, quite frankly, a bad diet.
Type 2 diabetes is something that happens in direct relation to your diet. When you consume something that converts to sugar during the process of digestion, your pancreas reacts by releasing something known as insulin into your blood stream to help store the sugar as energy (read: body fat) for later use. Your pancreas expects there to be a general baseline level of sugar in your blood; when it goes up above that baseline, the pancreas springs into action. Consuming large amounts of sugar—or things that quickly convert to sugar in the blood stream, like white rice, white breads, and so on—at a time, however, shifts that baseline. Your body gets used to a new standard for how much sugar should be allowed in the blood stream before the pancreas springs into action, ultimately no longer responding to blood sugar levels that are, by any other standard, exceedingly high.
But sugar contributes to other “shifts” in your body, too—namely, by shifting your understanding of how much sugar is enough. Often, people who consume large quantities of sugar find themselves slowly consuming more and more of it—because, at a certain point, it stops being about a “flavor” and starts being about chasing a “feeling”—which ensures that the amount of sugar in the blood stream constantly grows…further impacting the way your pancreas defines “oh, it’s time to send out more insulin!”
This is why doctors tend to guess that people who appear to be overweight in a particularly non-muscular kind of way are either diabetic or “pre-diabetic.” Certain conditions tend to follow behind certain habits.
Weight loss surgery tends to help people with this because it immediately reduces the amount of food you can eat, almost instantaneously, at any time. If it cuts down on how much you can eat, it also has the added side effect of cutting down on how much sugar you can consume in one sitting. For some, this means their pancreas can re-learn what healthy blood sugar levels look like, and can help you defeat type 2 diabetes. For too many, however, their pancreas has been battered and bruised (metaphorically speaking) for far too long, and may be too late. As the article mentions, because the person has to artificially adjust their own blood sugar levels by injecting insulin or taking medications, the ultimate cost of this kind of care can be thousands of dollars a year.
The article goes on to draw some major conclusions about Big Pharm(TM) impacting the way diabetes care is handled all in the name of increasing insulin sales and, by extension, stuffing their pockets.
“At the annual diabetes association convention in New Orleans this summer, there wasn’t a single prominent reference to low-carb treatment among the hundreds of lectures and posters publicizing cutting-edge research. Instead, we saw scores of presentations on expensive medications for blood sugar, obesity and liver problems, as well as new medical procedures, including that stomach-draining system, temptingly named AspireAssist, and another involving “mucosal resurfacing” of the digestive tract by burning the inside of the duodenum with a hot balloon.”[source]
I don’t disagree with it. I don’t even doubt it. However, I have to say…I think it misses an important point.
Our relationship to sugar has changed. It’s not merely an “occasional treat” anymore. It’s not even a thing you can enjoy “in moderation” anymore. It is everywhere—in your seasoning salt (it’s seasoning salt! not seasoning sugar! wtf?!), in your salad dressing, in your marinades, in your sauces for your stir fry… it is everywhere. For the average person, it is downright unavoidable.
The unavoidable nature of sugar results in people consuming it less out of desire for it, and more out of habit. When I talk to people and ask them why they go to McBurgerby’s for lunch instead of packing their own, they often shrug their shoulders and reply, “I don’t know, it’s just a habit.” In other words, it’s not being recommended by doctors that people stop the sugar because, quite frankly, doctors don’t have the tools necessary to guarantee their patients’ success.
If we look at the idea of “habits” in a practical sense, they are behaviors that your mind has learned can result in a favorable benefit. When combined with auto-pilot, which is basically a way of saying “doing something without thinking,” and you’re left with people who wind up consuming large quantities of sugar without even thinking twice. What doctor is trained to help deal with that?
Sugar is our collective habit. And some people suffer greater than others, and get far less of the help they truly need: therapy to help what’s contributing to the habit, guidance to help them find healthy ways to avoid engaging the habit, resources to scope out what’s feeding the habit inadvertently, and encouragement to help them when the going gets tough. What doctor has a squad to help give that kind of care?
And, if they do, how many people’s insurance will cover it?
People don’t get this kind of care from a doctor, though. Insurance doesn’t cover it. If someone’s life is on the line, and weight loss surgery can save it, then guess what? It’s not merely “giving in to Big Pharma.” It’s saving that person’s life in a way that a mediocre healthcare system could not.
I am alllll about doing the hard work of improving our health as non-invasively as possible. I am. But I am also realistic about the fact that there are people who don’t realize how close they are to the edge who need the help that medical intervention can provide. I’m also very clear on how much our health care system would need to advance to help as many people as there are who truly need it. I’ve never had weight loss surgery, but I’ve had clients who had and, though it definitely had its own complications, that blood work? That was proof that their lives were saved.
We have to stop using the snarky and dismissive tone when we talk about medical intervention, because it spills out into the way we talk about people who need and take advantage of it. We snark surgery recipients because we treat it as “unnecessary,” but we have no idea how close they might’ve been to one of the many edges our food system pushes us toward. And, until we get real about our health care system, we need to admit that the obvious answer is no longer the most viable one.
Despite that, the entire essay is an invaluable read, much of which only reinforces what I’ve said here over and over again: a healthy diet is completely and utterly transformative. Give it a read, it’s worth your time.