Tuesday, 28 April 2009

Dr. Super, the obesity slayer

The Hospital is a Channel 4 programme which questions whether the NHS is "being asked to pick up the pieces of an increasingly self-destructive society". The show interviews consultants, surgeons, nurses and midwives about the problems they face in treating illnesses and their symptoms that we have, they seem to suggest, brought on ourselves.

Last night's episode
was a re-airing of the final in the series, and examined "the cost of Britain's increasingly obese teens."

At Heartlands Hospital in Birmingham, younger and younger patients are being referred for help in tackling their weight and, increasingly, they are asking for a gastric band.

While doctors and dieticians see the £6,000 operation as a last resort, some patients seek them as an 'easy' solution to their weight problem. But NHS weight management clinics can only help those who help themselves, and health professionals are hampered by young patients who don't tell them the truth about what they are eating.

Now, while it might be useful and interesting to examine health care provision from the point of view of the providers and the challenges they face, I have trouble understanding how health professionals are the ones 'hampered' by unsuccessful treatment. Ultimately, it's the patients who have to suffer the effects of failed care, even if, as the show suggests, it's their own fault for lying. But this is just the tip of the iceberg of how problematic I found this show.

The programme was set up as a look at two different approaches to NHS-assisted weight loss. They interviewed professionals at the weight management clinic who are responsible for referring patients for the gastric band surgery, if they find it is indicated. If they do not so find - if they think the patient's lifestyle doesn't support it, or that he might see results from a less drastic method, they support the patient in a programme of weight loss through diet and exercise. The other angle was an interview with Dr. Paul Super, a surgeon who seems to have a bit of a reputation for churning out gastric band surgeries by the hundreds each year. His philosophy seems to be that obesity is expensive and ugly, and that all fat people should just have a gastric band operation so they could stop costing the NHS money and just stop being unhealthy and unattractive. This man was a real gem. I could barely take my eyes off him.

The staff at the Center, though earnest, weren't exactly writing any journals with their methods. They did explore the patients' psychological histories and relationships in order to create a more complete picture than "you're fat because you eat too much", but once they had gained that information, I'm not sure they quite knew what to do with it. In at least one case, where they discovered the woman had started binge eating after her family had been abandoned by their father, they kept checking on her progress with that relationship as well as with her diet and exercise; and the mere fact that they seemed to care and were willing to talk about it rather than simply scold her for overeating appeared at least in the short term to help motivate her in her efforts.

But in general, the system seemed to be that they would either (a) recommend the surgery and then send the patients home to lose some of the weight first, through diet and exercise; or (b) not recommend the surgery and send the patients home to lose weight through diet and exercise. And since most fat people have tried exactly that a gazillion times before, the only difference here is that now they get to show up at this clinic every few weeks to be 'assessed'. Still, if a patient doesn't dread these appointments, but instead finds the doctor understanding and the environment reasonably stress-free, then I suppose it's better than the alternative. And a couple of the doctors seemed to really want to be warm and understanding. So that was something.

Dr. Super, on the other hand, the belly-reducing surgeon extraordinaire, was - in short - a real a*shole, and really did no favours for the 'surgeons are jerks' stereotype. Below are some of the many awesome Dr. Super philosophies on fat people and their really fat fatness.

Back, beige food!
Between surgeries, the doctor stops for his regular lunch of a can of tuna - it's convenient, tastes great, and has no carbs. Carbs are evil, you see, and are just hiding in the shadows waiting to make you fat. But you can detect them and foil their plan. How? Easy. They're all beige!

Listen to this guy

So no pasta, rice or potatoes. Because they're beige. But you don't get beige meat, so that's fine. Or beige fish, so we can eat...wait....um...

And notice how he shames his own colleagues about eating crisps, sneering at them and taking their food so he can prove what undisciplined slobs they are. "That's right...go on eating your crisps (you big fattie)!" How much fun must this man be to live with? Thankfully, his colleague seems not to give a crap about him and his colour-coded diet. But this is certainly not a healthy approach to food for a doctor who focuses on nutrition to have, outlawing an entire food group and advocating a can of tuna for lunch. Now there's no denying that some food is not generally healthy if we consume too much of it. I'm no fan of a steady diet of processed junk in crinkly bags. But there is nothing wrong with rice and potatoes, as long as you don't first deep-fry them and then coat them in equal layers of lard and white chocolate. And all food can be consumed as part of a healthful diet. It's the categorization of some foods as good and others as bad that leads some to diet-binge cycles. I dare say Dr. Super has issues with food.

They're fat AND they lie
Another part of the programme that struck me - in fact this caught my attention in the clip advertising the show - was the disgust with which Dr. Super condemned patients for lying about their diet. This is not a direct quote, but he sneers something to the effect of: "They'll try to convince me that they only have a salad for lunch. They lie! But the scales never lie." One of the patients at the weight management clinic acknowledged that when she first saw a doctor there, she did lie, because she was embarrassed about the volume and nature of the food she consumed. And this is to be expected. But eventually, she felt safe and encouraged enough by her doctor to be honest in her journals. The doctors there realize that even this is a process, and allow this trust to evolve naturally. Not Dr. Super. He just snickers and hauls the fattie onto the scale so he can yell "Salad my ass! Look! You weigh a tonne!"

"Look how it wiggles!"
Following Dr. Super into surgery, we watch as he jiggles the belly of an anaesthetized patient and jokes to his colleagues that he can feel the ribs. You see, it's funny, because he can't possibly feel ribs in such a big, disgusting mass of flesh. See? Lawl?

The glaring absence in this piece is the lack of focus of both Dr. Super and the producers on the possible risks of the surgery. The surgeon seems to believe that this method is your proverbial magic pill, and actually says that all fat, young people should have it. Apart from filming one of the subjects after she has been fitted with the band and has some initial discomfort, and then acknowledging that her weight loss occurs at the same rate as another woman who opted for diet and exercise alone, the procedure is not presented as the life-altering decision that it is.

Later, fatties. I'm outie
At the end of the show, our lovable surgeon is leaning up against a wall in his hospital, and a large woman passes by escorted by two doctors. He has just been talking about when surgery doesn't work, and as she passes by, he snickers at the still fat woman and says, "That was one of mine. Life goes on," and lopes off into the sunset. And the sad lesson is, even our noble hero can't wrangle all the fatties. But he's going to keep on trying.


  1. Sounds like Dr. Super has a major eating disorder of his own and is so damn miserable about it that he has to take it out on other people.

  2. Man, it bugs my girlfriend *so* much when shows present WLS as being "the easy route". When she had it, she was over 500 pounds, and in a wheelchair from the pain in her knees and back. She used the surgery to kickstart her weightloss, and is now between 160 and about 180 mostly. She's quite public about it, and she's explicitly told me I can mention her story when it comes up, btw.

    Why isn't it easy? Because it only really restricts you from eating for the first several months (the kind she had, I mean, which is called RNY). Then the smaller pouch is stretched out, and you're back to needing constant discipline, daily exercise, and being wary of ulceration, strictures, and other unpleasant side effects. With all but the lap-band (which is only really effective for those with the least to lose, and is the only easily reversable one), it's a lifetime decision, too.

    She's also undergone extensive therapy to help her break some bad food habits (difficult childhood, tendency to eat very, very high-fat foods when stressed). They also don't often mention how bad the regain rate is for people having one form of WLS or another. Five years post-op, the regain rate is somewhere close to 80% - 80% of patients have regained up to two-thirds of the weight lost. My gf, through her hard work, has managed to avoid that, but it hasn't been easy at any point.

    She's fairly clear that it should be used only in the most extreme cases of overweightness, and only when someone truly understands the depth of the choice they're making, and that it means committing to a lifetime of eating differently. Because if the habits aren't changed, the weight will come back, and then you're the same size, only now you've got a messed-up digestive system.

    The surgeon in this show sounds like a butcher, who shouldn't be allowed near living patients. :/

    Fascinating post as always, ma'am.

  3. In the name of full disclosure, (i) the common WLS done by the NHS is the lap band, and (ii) I think Dr. Super only deals with patients who are referred, and he doesn't make the call himself. Otherwise I think we'd all have to walk around watching the shadows lest Dr. Super scoop us up in his net and drag us off to surgery.

    Cait, thanks so much for sharing your friend's story. I had no idea the regain rate was that high. And the fact is, you're right: there are so many other habits that often need to be addressed in order to not only aid weight loss but just to create all-round healthy individuals.

  4. A quick correction (she just arrived from Baltimore for the weekend - whydja think "500 Miles" is our song?): she points out that the regain is 50% at 5 years out, rising to 80% by 15 years out - "regain" as defined by "gaining back at least two-thirds of the weight lost".

    Also, that lap-band is one of the most difficult WLS to get, in terms of its value in losing weight. Because there's no intervention in intestine (where nutrients are absorbed into the body), all it does is mean you can't eat as much at one go (it makes the pouch smaller). You still absorb all the nutrients coming in.

    With the other types of WLS, the intestine is affected, and so there are varying types of malabsorptions (an intended effect), based on which particular surgery was done. In the case of RNY, it's proteins that are particularly bad, so she has to eat a diet that is very high in protein - approx. 8-10g for every 100 calories.

    Thanks for covering this stuff. It's important to make sure there is someone keeping an eye on these people, and their ideological campaign to eliminate fat(ties).

  5. I am sure this goodly gentleman (and I use the term loosely) feels he is doing these 'fatties' a service by way of his version of tough love with his army drill sergeant-esque kic-em-up-the-ass approach. But clearly (as was so eloquently pointed out by our mongoose) it is having the opposite effect i.e. the lying fatties are dehumanized to the point of lying even more.

    I can't shake the feeling that despite the obvious health benefits, what really gets this loser's goat is that some larger folk are happier in their own skin than he and his ego-driven anal retentive so-called campaign will ever be.


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