Friday, April 22, 2016

Correcting deficits in bariatric treatment

I am very frustrated with the state of bariatric treatment.  I'm not talking about surgery.

Surgery does not work for everyone.

First, doctors are reluctant to do surgery on people who weigh more than 400 lbs, lest the lungs of the patient collapse under the patient's own weight, while the patient is under anesthesia.

Second, people figure out how to eat past the surgery.  They gain the weight back. The problem is in the person's brain, not in their digestive tract.

Super morbidly obese people need rehabilitation.  I find that their treatment is often misguided.  I had a super morbidly obese friend die at top weight 800 lbs.  I saw numerous opportunities where he could have been saved, but medical personnel -- who were treating him improperly -- ultimately caused his death, when I feel that could have been avoided.

Here is a list of points that they apparently did not know.

1. Aquatherapy
            Fat is lighter than water, so bariatric patients can exercise normally in water, whereas they cannot on dry land.  I saw my super morbidly obese friend unable to lift his leg because of a several hundred pound grade 5 panniculus resting on it.  He could lift his leg fine if in water.
            Bariatric patients develop infections, both fungal and bacterial, in the folds of their skin.  Showers cannot adequately clean these areas.  Submerging in salt water is amazingly effective.  My friend’s final illness was triggered by bacterial infections in the folds of his skin.
            Doctors kept treating the fungus that they saw there, while not adequately treating the bacteria, which were more dangerous.
            He was in several rehab facilities specializing in bariatric patients, but none of those facilities had aquatherapy.
2. Food addiction
            Many bariatric patients are addicted to certain foods.  Common triggers for addictive behavior are: refined carbs (sugar, flour, starch), sweeteners mixed with fat, and salt mixed with fat.  Many dieticians cling to the false belief that overweight people can eat these foods in moderation.  The food addict can no more eat their trigger foods in moderation than an alcoholic can drink alcohol in moderation.  I have seen many abstinent food addicts relapse in hospitals because hospital dieticians fed them trigger foods.  In a weakened, helpless state, they ate those trigger foods.  This is appalling to me.

3. Restrictive diets
            People are overweight, because they are overeating.  They do not need to be put on a restrictive diet.  They need to be put on a normal, maintenance level food plan.  
            Restrictive diets result in starve/binge eating behavior.  People maintain the restrictive diet for a while. Then, when they get hungry enough, they binge.  This is a very effective way of gaining weight: yo-yo dieting.  Restrictive diets put the body into a low metabolism storage state.  In this state, the body gains more weight from a binge than it would if the person were eating normally.
            Super morbidly obese patients can die of an anorexia induced heart attack before they reach goal weight if they are eating a restrictive diet.  Fat is a symptom of past eating behavior, not of current eating behavior. 
            People lose weight faster on a maintenance level food plan, because their metabolism is more efficient.  Super morbidly obese people may actually have to eat more because of the extreme effort they are putting in to carry around hundreds of extra pounds.  They will still lose weight, because even if they’re eating 3000 calories they’re still eating a whole lot less than they have been eating.

4. Psychiatric
            The vast majority of people who are more than 100 lbs overweight have been severely abused as children, either violently or sexually or both.  Many have severe mental health issues such as bipolar, borderline personality, or schizoaffective disorder.  They are using food to medicate themselves for their severe mental health issues.  If they stop overeating without proper psychiatric support, they will very likely have a breakdown.  Trying to put a very overweight person on a weight loss diet without adequate psychiatric support is a recipe for doom.
            12 step programs use the 12 steps to deal with emotional problems, but that may not be sufficient for everyone. 

5. Prayer and Meditation
            The effect of prayer and meditation on the brain has been slightly, but not extensively, researched.  12 step programs are based on the belief that prayer and meditation are good for interrupting compulsive behavior. 

6. Lying on back
            Pregnant women are told to sleep on their left sides, because the weight of their pregnancy resting on the circulatory system can cause extensive health issues.  This problem is even worse for a super morbidly obese person who is more than 100 lbs overweight.  Yet such patients are routinely put on their backs. 
            My super morbidly obese person could not breath lying on his back, because of the weight of his body crushing his lungs.  Yet, the hospital where he died insisted on putting him on his back.  I believe that this decision was the direct cause of his death. 
            They had to entubate him.  Ultimately, they did a tracheotomy.  The surgery killed him, because he was too weak for surgery.
            However, even if he was breathing, lying on his back was still causing circulation to be cut off to the lower half of his body – and making his toes go black. 
            Another problem was that they were making insufficient efforts to turn him, because of his weight, and he was lying on bedsores that were big enough to put your fist in.

7. Restraints
            Another issue was that they put him in restraints, because he was trying to free himself from tubes, so he could roll over.  The restraints were too small and cut deeply into his wrists.  I found this appalling

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