What we can learn about weight loss from Al Sharpton

What we can learn about weight loss from Al Sharpton

However you see the Reverend Al Sharpton, one thing is certain: you see less of him now. His Twitter pic tells you he is proud of his 167-pound weight loss. Good for him, he should be.

If you care about health, the disappearance of the Sharpton-of-old is worth mention. His story teaches us a lot, and, if one dares to look a little deeper, bigger lessons bulge out. Surely this is more than just a weight loss story.

The obvious question: How did he lose the weight?

Yes, of course, we all want to know about the process of shedding 160+ pounds. But I ask you to call time-out and first look carefully at the pronoun in the six-word question. The pronoun of note is he. “He” lost the weight. No doctor or nurse or bariatric surgeon lost his weight; “he” did. That’s huge.

The second notable thing Rev. Sharpton said was that he decided to lose weight. Note the verb: decided. His caregivers didn’t decide: nether did his friends or co-workers. Simple verbs can be quite important for health. His action to choose is also huge.

Third, the process of his weight loss is a recurring one that I see often. Rev. Sharpton gave up red meat: he ate plants, and stopped eating late at night. In reality though, he ingested far fewer calories. And like most people who remain thin, he adhered to a regular exercise schedule, the key adjective being “regular.”

It is most important to note what he did not include in his regimen: bariatric surgery, medical therapy or fad diets.

I read, study, and think a lot about public health and human behavior, and whenever a Sharpton-like story comes up, I have trouble understanding why this message of simplicity, common sense and personal responsibility doesn’t stick. Such a message is neither mean nor complicated.

Recently, I read a Harvard professor’s take of the obesity epidemic. He pointed out something that Rev. Sharpton figured out: one has to learn how to live with constant exposure to excess calories. In science we call it equilibrium. The answer to curbing obesity is not banishing McDonald’s, Papa John’s or Coke.  The answer is choosing wisely — for yourself. That’s what the reverend did. He decided. He nudged himself. This is what all people who succeed in achieving a balanced healthy life do.

The New England Journal of Medicine recently featured a perspective piece on training physicians to manage obesity. It was a good article that urged academic centers to better educate young doctors on the biology and psychology of obesity. That’s reasonable: I’m very open to improving my motivational skills. (Based on how often patients adhere to my advice, my nudges need improvement.) The underlying problem with this article, however, is its premise: doctors do not manage obesity. Patients do, like Al Sharpton did.

If you do not yet consider me insensitive, unsympathetic or naive; if you haven’t clicked away in disgust, I have a little more: What I found most remarkable about the Sharpton story is something he said about the perception of his health.

In this short video interview, Rev. Sharpton tells how his weight loss caused concern among his friends. They thought he was sick. The perception being that skinny people are sickly. (This happened to me in cardiology fellowship in the 1990s when I lost 40 pounds. More than one colleague worried I had AIDS.) Rev. Sharpton had a wonderful answer to these concerns: “They should have thought I was sick when I weighed 300 pounds; that’s when I was sick.”

I’ve written before about our distorted perception of what is a normal weight. Changing the default of what America sees as healthy should not be underestimated. It is neither normal nor healthy to be jiggly or sedentary. I saw three patients today with pre-hypertension. Each one could have been put on medicine. But each was overweight, and I am convinced that if they decided, they, not I, held the key to better health. You bet I told them that.

What are we thinking? As a nation, a strong and proud nation, it is imperative that we harden up a little. The case of Rev. Sharpton — his decision and his action plan — supports my thesis: Health comes not from health care, but from within. From simple verbs.

I hope the influential leader uses his influence to promote such an important and just public health message.

John Mandrola is a cardiologist who blogs at Dr John M.

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  • Suzi Q 38

    I think that he method of weight loss is fantastic.
    He should be congratulated.
    I have difficulty congratulating a person that has taken the easier way out and opted for the bariatric surgery.
    He is a fine example of the enormous amount of weight he had to lose, and how he lost it…day by day, pound by pound.

    • Guest

      Bariatric surgery is not always the easy way out. If you start out with a BMI of 55, you cannot realistically diet that away. You need something to set you on your way. Bariatric surgery is like declaring bankruptcy on your weight for those who are hopelessly obese. It allows them to start afresh.

      • rbthe4th2

        Study came out recently that those who had surgeries lost an average of 57 pounds more than those who dieted & exercised. Again, not knocking how Rev. Sharpton did it, he and any one else who loses it and keeps it off, CONGRATULATIONS!!

        • Suzi Q 38

          Yes, if they KEEP it off, but too bad many regain it back, just like any other drastic diet.

          • rbthe4th2

            Could you please define “many”? The below cross section of studies show up to 20% gain weight back. Could you define “regain it back”, because if you’re talking about all of it, it seems 5-10 pounds or so is the average back. That’s not “many” or “most” of it, because that’s less than 1/2 to 3/4 of the people. More than half keep it off. I include a study of those 10 years out and it also addresses the “easy way out” subject.

            “Most patients experience something I call ‘the creep,’” she said. “They creep up another five to 10 pounds. Eighty percent will experience this creep and level out again, but about 20 percent will continue to creep up.”

            The procedure itself is not a quick fix; a number of habits have to change as well, if the weight loss is to be permanent, and as many as 20 percent of people will gain a significant amount of weight back, People magazine reported.

            The failure rate when all patients are followed for at least 10 years was 20.4% for morbidly obese patients and 34.9% for super obese patients.

            Patients may lose up to 50 percent of their pre-op weight, but then, estimates Anchorage surgeon John Snyder, about 20 percent will regain a significant amount.

            Patients who undergo primarily restrictive procedures usually gain around 8 to 10% of their weight back. Malabsorptive procedures such as duodenal switch surgery have been shown to result in greater maintained excess weight loss over the long-term. After any weight regain, patients who undergo malabsorptive procedures experience at least 10% to 15% greater excess weight loss than restrictive procedures.

            The patient view of the procedure has changed. It’s still seen as effective, but the very public struggles of some celebrities to maintain weight losses has sent the message that this is not an easy way out. Patients still need to make difficult changes in diet and physical activity. It never really was the easy way out, but that was how some perceived it.

            Based on mice, rat, and human studies on gastric bypass surgery, the average weight regain may fall into a range of 5 to 15 percent of excess body weight loss.

          • Suzi Q 38

            No I won’t define “many,” because I don’t have the stats like you do. Thanks for checking on them for me.

          • rbthe4th2

            I understand that you don’t like it. That’s a personal thing. That’s fine. What I’m asking you and others, is to consider maybe these people didn’t like it either but thought here is the only chance I have, failed at other attempts, to make things better. I can see these people having hard enough troubles trying to stay on eating restrictions, etc. without getting negativity from others just because they don’t like it and think they could it by diet and exercise. Apparently these people have to prove and have done diet and exercise and it just didn’t work for them, contrary to your feeling that they could have. Maybe you have that ability but they don’t. As someone else mentioned, what about drugs or alcohol? If someone had to resort to this to get rid of that addiction, would you treat them the same way?
            With the resources there, can you please do the work to prove out 20% fail at diet & exercise? I’ve seen it a lot more, 95% failure rate within a year, from the 2009-11 timeframe.
            I’ve also given you a resource that shows 10 years out.
            Plastic surgery is covered by no insurance that I know of. Where did you get the resources to say it is? I ask you because you have an opposing viewpoint and I was looking to see if I had missed data somewhere, or it was anecdotal.
            Again, the choice that they can’t eat as much and/or extra skin is made known to these people. They sign some sort of an agreement or disclosure contract, at least from everyone I have heard of.
            Actually 100 pounds overweight is on the smaller end, if what I hear is correct.
            I also want you to see that the work out there is contrary to your beliefs. I’m sorry, I would be willing to accept your viewpoint, but when there isn’t data to back it up, it makes it an opinion.
            How about that I’ve shown you what the data is out there, you can look through it. For those friends of yours who have gained the weight back, what about going to their surgeon or whoever else they’re supposed to go to, and see what can be done at that point? I don’t know if its revision (I’ve heard in one study a 10% revision rate for the sleeve) or whether they just need support for diet & exercise.
            PubMed and Medline are excellent resources. They’re the ones I use to help my docs with.

          • Suzi Q 38

            “Plastic surgery is covered by no insurance that I know of. Where did you get the resources to say it is?”
            What do you mean, for the excessive fat removal after the fast weight loss?
            I don’t recall saying that it was covered at all. In fact, I am fairly sure it is NOT covered, as my family member would have scheduled the fat removal surgery ASAP if it was.

          • rbthe4th2

            Oh ok, my apologies.

          • Suzi Q 38

            “…..I can see these people having hard enough troubles trying to stay on eating restrictions, etc. without getting negativity from others just because they don’t like it and think they could it by diet and exercise.”

            No, after having them forge ahead and go through the surgery, I would not say anything negative. They have been through enough.

            Eating and not exercising ever the years got them there, though. Also there are smokers who have lung cancer…or people with hypertension who love salty foods…etc.
            Why go point it all out? We all have done things or eaten things that were not in our best interests.
            Believe me, I have seen what my friends and family members used to eat before they had the surgery. My motto was: “Watch your OWN plate.”

            It has been hard to complain that no matter what diet they were on or what they ate, they just had no idea why they miraculously gaining weight. I challenged them to write it down on a piece of paper and think about it at night, and make adjustments for the next day.

            I asked if they could take a walk in the morning before work, and in the evening before or after dinner. “No way”, they said. It was too early, or too cold. I pointed out that they could join a gym and exercise inside….I could go on and on.

            They must be unlike the patients you are thinking of, but my guess is that they have some similar stories to tell.

            Well, relative and friend are slowly gaining their weight back, they are probably stretching their reduced stomachs out and are able to retain more of their foods. One relative was about 275 + pounds to start, lost about 100 pounds, and now she has gained about 60 of it back. Ditto for my friend at work. She loves to eat and hates to exercise. Tough combination. It is sad, because it is not as if they walk with canes and walkers or are in wheelchairs and/or are bedridden. They can exercise, but they choose not to do so.They sadly have thought the bariatric surgery was their only option.
            They went for it, and are regaining their weight back.

            What next? another bypass??

            I will read more of your studies. Thank you for sending me the links to the articles.

            It is O.K. not to agree.

          • rbthe4th2

            Absolutely! A lot of them admit that. Or at least, I’m sure they’ve had to.

            I’ve seen the smokers issue the hard way. Lost 2 family members and a car buddy is going through stuff because of it.

            Getting them to write it down may or may not help. To be honest, some people may believe what is on TV or any other place they read. They may eat no fat cookies, which are full of sugar, and think they’re ok. I’ve seen people eat a salad with a lot of creamy dressing with a large Coke. Maybe they think they cancel each other out, as I’ve heard this. (And yes, I’ve met some gullible people in my lifetime, as I’m sure you have also.) While yes, there are excuses, those people who don’t make them or use the surgery to help them with the food problem, at least they’ve tried. Maybe not all, but that’s a big percentage willing to do something drastic enough to save themselves.

            As for excuses on not exercising, I won’t go there. I’ve seen as much as you have. One of my friends and I, we’re what they call “crazy”. We do triathlons, running, swim meets, you name it. All the ones I know who’ve had the surgery are all walkers or do some sort of strength training, yoga, whatever those dance aerobics classes are. I think they get the recommended amount of exercise per week.

            It is very sad. Then again, can they be put back to their doctors, or to someone other than an RD? I’ve found RD’s to be useless, because about the only thing they know how to deal with is diabetes. Even then, I know a couple of diabetics who I can’t begin to believe the diets they got from their RD’s. What about a psychologist that deals with weight issues? Are they a special type of psychologist? There’s also some of the internal medicine people that say they deal with non medical weight loss. There’s a triathlete who does that, a friend of mine knows them and has talked about them. Where your friends are, can you research someone like that? I am sure I can ask my friends, they might be able to tell me to tell you what to look for.

            At least you are willing to help. The other answer, have you talked to these people and seen whether they realize you might be giving up on them because they’ve given up on themselves? Or what about asking them to visit someone on what behaviors or triggers their food issue and see about replacing some of those things. I can’t imagine, that if they have small stomachs and are making them big, they’re eating the right foods. I can tell you intimately about malnutrition and what it does to the body. I would think they’d be prime candidates for that.

            Definitely on the last one. For me, its just I’d rather take the 80% who do get well, and then we put the other 20% into some sort of program or counseling. Definitely if it is on their list to do so. I have it a bit easier as I have a supportive group(s). They do a bang whiz up job on telling you your faults LOL.


      • Suzi Q 38

        Yes, at what price?
        How many have died soon after, and how many have gone through the arduous and riskly surgery, only to regain the weight within 5 years?
        I am not sure of what Mr. Sharpton’s BMI was, but maybe it was nearing 50 if he lost 167 pounds by eating a little meat and mostly plants (veggies and fruits). Anecdotal at best, but a good result, just the same. Ditto for the resuts with bariatric surgery.
        I probably know of 5-6 people that have had the surgery.
        Three have regained their original weight within 5 years. Another had passed away soon after the surgery, and two others are struggling with their weight like the rest of us. They can’t eat decent stuff like lettuce, as it is hard for them to digest. As usual, just off the top anecdotal stories, but that surgery is tough to celebrate if the patient dies.

        I want to hear stories of them living another 40 years, keeping it off without problems. Now that would be a success.

        Yes, when you are dealing with people that are so huge (I have watched the stories on television) that they can’t get out of bed, I guess it would be considered a success if they live at least a couple of years after.
        It doesn’t look like success for several of my friends and family that have had this surgery because IMHO they had less than 100 pounds to lose.

        Tell them to diet and exercise.

        • rbthe4th2

          Ok, can we go from anecdotal experience to the stats?

          Six thousand one hundred eighteen patients underwent primary bariatric surgery. Eighteen deaths (0.3%) occurred within 30-days of surgery. The most common cause of death was sepsis (33% of deaths), followed by cardiac causes (28%), and pulmonary embolism (17%). For one patient cause of death could not be determined despite examination of all available information.
          This study confirms the low 30-day mortality rate following bariatric surgery. The recognized complications of anastomotic leak, cardiac events, and pulmonary emboli accounted for the majority of 30-day deaths.

          The risk of death at experienced bariatric surgery centers is less than 0.3% (1 per 300 patients). – See more at: http://www.wpahs.org/specialties/bariatric-surgery/risks-and-complications-bariatric-surgery#sthash.XtQJPloG.dpuf

          • Suzi Q 38

            http://www.bmj.com/content/347…Conclusions Compared with non-surgical treatment of obesity, bariatric surgery leads to greater body weight loss and higher remission rates of type 2 diabetes and metabolic syndrome. However, results are limited to two years of follow-up and based on a small number of studies and individuals.

            I appreciate the diligence you have provided to make your point.
            You did leave out the rest of the conclusion, which is a significant point. The fact that the results were limited to two years of follow-up and based on a small number of studies and people. I notice that one study measured only the 30 day post surgery mortality rate. Surely there were others that died after….

            Definitely it can stave off a variety of metabolic and other conditions. However, so can traditional weight loss, day by day, meal, by meal, and pound by pound. No surgery and adverse effects or death after the surgery…even if I take your 0.3 number, this was for 30 days after the surgery. What about people who died 2, 3 , 6, months or a year after? Were they included? Not if this study was conducted by surgeons. I have found that if physicians want a certain outcome for any particular study, they can attain it.
            When I have time, I will read through more.
            I appreciate our discussion, and you certainly have made some good points.

            I will acknowledge that if 80% are pleased, who am I to “rain on their parade.” Good for them.
            They made it. Hope it stays that way and they are happy.

          • rbthe4th2

            Yes, I’m sure but not of the surgery. I would suspect that 30 days out, probably after that, is when medicine would say that all is well and nothing after that could be due to the surgery. Probably any surgery.

            The only reason I make it is I looked into it. I encourage people to do so. If there are facts and data out there that I don’t know about, hey I want someone to let me know! You could have had other data that was more recent or something so that’s why I ask.

            To be honest, I have one study listed over a 10 year period, and those results tend to align pretty well with the rest. You do have 1 portion that goes to 30% but I would need to see a little more on that. If you lose 150 pounds, gain back 15 (which is more than the 5-10 pounds listed), and that’s all you gain back, who is to say that’s bad? That’s still a 135 pound weight loss to the good. I’d take that!!

            The surgery works in a different way. See http://directorsblog.nih.gov/2013/07/30/new-take-on-how-gastric-bypass-cures-diabetes/, http://www.medscape.com/viewarticle/808483, and it seems to indicate that the body responds differently to the surgeries than it does diet and exercise. “Interestingly, patients with obesity-related diabetes who undergo Roux-en-Y gastric-bypass surgery for weight loss can often discontinue their antidiabetic medications before they are discharged from the hospital, the authors note. Investigators have hypothesized that the “cured” diabetes might be due to changes in hormones, fat, or muscle cells. However, the current study revealed that in rat models of this surgery, the small intestine appeared to play a hitherto unrecognized role: it altered the way it processed glucose after the bypass surgery.”

            If so, the above explains why diet and exercise are not as effective, and probably will never be, compared to surgical alteration or removal of organs.

            Btw, found http://topsurgeoninamerica.com/images/swedish_bariatrics_study.pdf, Lifestyle, Diabetes, and Cardiovascular Risk Factors 10 Years after Bariatric Surgery: The prospective, controlled Swedish Obese Subjects Study involved obese subjects who
            underwent gastric surgery and contemporaneously matched, conventionally treated
            obese control subjects. We now report follow-up data for subjects (mean age, 48 years;
            mean body-mass index, 41) who had been enrolled for at least 2 years (4047 subjects)
            or 10 years (1703 subjects) before the analysis (January 1, 2004). The follow-up rate for
            laboratory examinations was 86.6 percent at 2 years and 74.5 percent at 10 years.
            After two years, the weight had increased by 0.1 percent in the control group and had
            decreased by 23.4 percent in the surgery group (P<0.001). After 10 years, the weight had
            increased by 1.6 percent and decreased by 16.1 percent, respectively (P<0.001). Energy
            intake was lower and the proportion of physically active subjects higher in the surgery
            group than in the control group throughout the observation period. Two- and 10-year
            rates of recovery from diabetes, hypertriglyceridemia, low levels of high-density lipoprotein
            cholesterol, hypertension, and hyperuricemia were more favorable in the surgery
            group than in the control group, whereas recovery from hypercholesterolemia did not
            differ between the groups. The surgery group had lower 2- and 10-year incidence rates
            of diabetes, hypertriglyceridemia, and hyperuricemia than the control group; differences
            between the groups in the incidence of hypercholesterolemia and hypertension
            were undetectable.

            Agree – Rev. Sharpton's weight loss is remarkable. Lots of kudos to him – and I'm sure he's a role model for the many African American men and women that are overweight and how they can overcome it.

      • Suzi Q 38

        “Bariatric surgery is not always the easy way out…..”

        After reading more about the life changes, adverse effects, pain, etc., you are right. It is not the “easy way out.” It is a far tougher alternative than diet and exercise.

        “……Bariatric surgery is like declaring bankruptcy on your weight for those who are hopelessly obese. It allows them to start afresh.”

        I never liked bankruptcy as a way of getting out of facing financial obligations. Sometimes, though, it needs to happen if there are extenuating circumstances.

        I guess there is a correlation here.
        Yes, they start afresh, but have a list of other problems.
        My friends are gaining their weight right back.

        I would rather regain the weight without having had the surgery, than regain it in spite of having this drastic surgery.

  • buzzkillerjsmith

    Good on Mr. S. then. But is again time to kill another buzz. Don’t listen to them. Listen to me.

    The statement that doctors should “manage” obesity translates into “family doctors and general internists should manage obesity.” I’m sure Dr. M. does great work but I am not sure that he has a detailed understanding of what we do for a living. He might or might not be familiar with the Yarnell et al article stating that primary care docs, if we did all that other people think we should do in terms of prevention, would spend about 7.4 hours per working day doing nothing but this. 7.4 hours.

    Perhaps these numbers are wrong. Maybe it’s half that or a third. Still, if you add in, let us say, diagnosis and treatment, and if you add in the admin burdens, and if you have even a passing acquaintance with arithmetic, you will realize the absurdity of it all.

    At bottom, we have a coordination problem. Each special interest group, and I’m talking about physician interest groups here, thinks its disease is the most important one and completely ignores the totality of the situation. It leaves us PCPs shaking our heads.

    We need more warm bodies doing this stuff if this stuff is to be done. I don’t see those warm bodies around these parts. And the same goes for the “team” that is going to get me and the likes of me to medical nirvana.

    Oh how easy it is to have others walk a mile in the shoes you think they should wear.

  • rbthe4th2

    I want to differ with a few things here:

    1) No doctor, nurse, bariatric surgeon, lost the weight for 11 friends of mine and 5 family members. Each person did it individually, whether it was by bariatric surgery, eating styles/rules, exercise, medication, diabetes, or one of a combination of the previous. No one can lose weight for another person, its medically impossible.

    2) Those people mentioned beforehand also decided they were going to lose weight, using any, all, or a combo, of the 5 listed methods in #1. Obviously, the diabetic ones are in a different class, but they too ended up losing weight from the other 4 items.

    3) None of those 11 friends and 5 family members gave up red meat. Only one eats it once a week. Some eat fewer plants and more meat. They all had in common changing portion sizes, what they ate, and how it was cooked (if it was cooked). They modified, in some manner, consumption of particular beverages and changed to other beverages. Some used named diets, some prescribed diets by docs, some were just cutting out McD’s, but it works for them.

    4) Most, but not all, changed exercise habits or developed them if they didn’t have them.

    5) Not everyone has the same ability, acumen, education or personal weaknesses/strengths. I can stay away from pain killers in all but the most difficult circumstances. Some can’t. I don’t denigrate others for it, I try to give them the best support I can. So whether or not some people need surgery, psychotherapy, a broken & wired shut jaw, or can do it by getting up from the table makes no difference to me. What matters is that they did what they felt necessary to get healthy, and that they had my support in WHATEVER they felt necessary to take charge of their health.

    EVERY, and I do mean EVERY, person I know who had the bariatric surgeries is on lifelong diet & eating restrictions no different than someone who hasn’t had it. I’ve heard about those who “bypass” the “bypass”. So even if you do get surgery, its a help (I’ve heard it called a “tool”), its not the easy way out. These people still fight the same battle as others do. From what I understand, there is a “honeymoon” period, and after that first 6 months, 12 months, 18 months goes by, they fight the same battle as before.

    Even worse, I’m sure fighting the intolerance of others who don’t understand “why this message of simplicity, common sense and personal responsibility doesn’t stick” is probably just as cumbersome mentally to them. Maybe I can “nudge” you in the frame of mind: does it really matter HOW these people lose weight, as much as it does they DO lose it and become healthier? A coworkers’ Dad had to take ?psych drugs? so that he didn’t “hear voices”. Do I care he had to do that? No, I cared that the guy was happier, less troubled, and his family was the same way. If it is by whatever medication he had, so be it.

    A friend said they were diagnosed with a psych issue. I looked over the criteria, and didn’t see their personality in it. Some doc decided this in a session or two, even though we’ve known each other all our lives. My buddy said the medication they got made them feel better. I didn’t really see but a small change, but you know what? They were happy with it, so I am happy with it. If they feel it makes life easier for them, I don’t care. I care that they’re happy and feeling better.
    Bottom line: if a person can get healthier and they do, does it matter what the method is (as long as it isn’t by an eating disorder, you don’t get healthy by that)?

    Actually I am sicker now that I’m thinner than when I was larger. You can be sick at any size. I’ve got people who are healthy underweight, healthy and unhealthy at normal weight and/or overweight. I’ve seen a person who was 80 pounds overweight go thru the warm up of an aerobics class that a thin female couldn’t.


    • James_94

      I tend to agree with you. I don’t care how obese people get the weight off and keep it off. It’s all good.

      The emphasis on praising those who took it off “naturally”, through sheer willpower and self-discipline, strikes me as a little moralistic and puritanical.

      If there were a relatively simple operation we could do that would cure addicts of their frequently-fatal addiction to alcohol and other drugs, would we also see those who’d become healthy through those means as sort of “second class citizens” as compared to those who did it through sheer willpower and self-discipline?

      I don’t care HOW people get healthier. Just that they do. If advances in medical technology can help the process along at all, I think that’s awesome.

      • rbthe4th2

        I think there is more of an issue seeing that some people can and do ‘bypass the bypass’ that there is a problem. More than likely, the reason why people aren’t on a longer study frame is that they’re no longer seeing the original docs/surgeons doing the surgery, for whatever reason. The one study showed that the rate goes a small rebound, but that it stays off.
        I searched and it seems there is a place called obesityhelp and maybe they would be anecdotal, but there is a place to start for people who are farther out from surgery.

  • rbthe4th2

    Just a thought … it seems to me that you’re blaming the surgery for the problems that you’re friends have outside of surgery. With as many people who have success with it, why not work on those problems that don’t? No the surgery may not have helped your friends, but they were given the chance others did and were able to make a go of it. I don’t want to see any one dropped but if this surgery works for a lot, lets just do what we can to help those who have other issues outside of the surgery.
    Wouldn’t that be more fair about the surgery and those who get it?


  • querywoman

    Oh wow! There’s nothing like extreme weight loss to get a pat on the back from the medicos.
    How long has Al been at this new weight?
    Will he gain it all back in two years like most people do?
    We shall see!