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WLS: more barriers to rational decision making

Yesterday, I discussed some reasons why the FDA's approval of lap bands for people with lower BMIs is problematic, and I focused on medical blackmail and fat hate (both imposed and internalized) as issues that prevent people from making informed, rational decisions about weight loss surgery.

There are a couple of other factors that I didn't address directly, but it would be a mistake to think that they can't have a strong and sometimes dominant influence on decision making. I'm talking about doctors' advice and social pressure, both from peers and from the media. For people whose health may not be perfect, they become even more influential.

There's a lot of WLS marketing out there; a lot of positive buzz. The media loves a good weight loss story, especially if it involves some kind of penance: starvation, extreme and uncomfortable exercise, or (better yet!) actual cutting, which is ironically characterized as an "easy fix."

Since both they and, in the case of the lap band, drug companies stand to make a lot of money through weight loss surgery, doctors tend to be well informed on the (sketchy) conclusions of the short-term research that supports WLS and not so well informed on the research that hints at the its real risks and its increasing failure rate over time, both for weight loss and diabetes treatment. Their advice may also be influenced by fat hatred, the media, and industry marketing. In other words, it's likely to be biased. However, patients have reason to trust their doctors' advice. Doctors are experts on health, after all.

People who are only a few years past the surgery, who have had no immediate complications and are still alive, are often thrilled with the effects and have not yet had to deal with the long term problems. These people can be downright evangelical, and will encourage others to ask for the surgery. (My advice is to tell them "I want to hear your opinion about this in 5 or 10 years; then I'll feel better informed.")

If the media, your doctor, and your friends are encouraging you to get this surgery, you've been told that it will probably take you out of a group that's routinely disrespected and discriminated against, and you feel like your real life can't begin until you're thin, then it becomes difficult to say "no."

So, to summarize, it is difficult for people to make informed, rational, independent decisions about weight loss surgery because:

  1. Doctors sometimes withhold treatment pending major weight loss, effectively blackmailing people into WLS
  2. Because of internalized fat hatred, "Doing it for yourself" might as well mean "Doing it against yourself"
  3. Medical advice is commonly based on poor quality and biased research and may also be influenced by the profit motive
  4. Peer pressure from people in the "honeymoon period" after the surgery can be influential
  5. And of course, it's hard to resist the Fantasy of Being Thin.

(Did I miss anything?)

In theory, I think that people should be able to do what they want with their bodies. I really do. However, in today's social climate around weight - especially for women* - this is like legalizing heroin. It has the potential to do so much damage and ruin (even end) so many lives.

* According to this excellent article on Women's ENews, 80% of lapband recipients are women.

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