Amazing all these drastic (gastric bipass is extreme enough) measures to control weight all because Americans don't know how to eat properly. 

This is the most ridiculously biased report, clearly manipulated by the bariatric surgeons who can't perform the duodenal switch (it is a more technically demanding surgery), and thus trying to influence people away from it.

There is NO mention in this summary of the many other published studies - studies going out 15 or more years! - of the benefits of the duodenal switch (DS)! Two years of comparison between the gastric bypass and the DS is extremely misleading, since the DS has FAR better long term results than the gastric bypass (and the lapband is essentially worthless after a few years for most people, if it works at all).

I am EIGHT YEARS post-op from my DS. It is the BEST thing that I've ever done for myself. I can eat VERY well - high protein, high fat, modest amount of carbs - and maintain my weight. I am a member of an online support board for all of the weight loss surgery types, and by FAR AND AWAY the happiest people on that board are the DS patients. Yes, we have to be vigilant about eating protein (oh, gee, steak, shrimp, chicken WITH the skin, ribs, hamburger, fish - not a problem!) and yes, we have to take a couple of handfuls of supplements (calcium, a couple of other minerals, vitamins - but NOT insulin, metformin, statins, hypertension meds, etc.), and we have to be diligent about getting labwork done regularly (I do it once a year) to make sure everything is at the right levels - but the complaints reported by this 2 year study from Norway (how experienced were these surgeons? I never heard of them, and I'm VERY aware of the good surgeons worldwide) are extremely rare among DS patients. The concerns expressed by the editor who wrote this article are preposterous.

Morbid obesity is a disease, one which is exacerbated by environmental factors. It is not a mental illness, it is a physiological one. The DS is the BEST treatment for morbid obesity in existence today. It is an essentially 100% permanent CURE for type 2 diabetes - something that CANNOT be said for gastric bypass, which doesn't have a very good long term success rate in keeping the weight off, and when gastric bypass patients regain, often the diabetes returns. The DS FIXES our broken metabolisms - broken by genetics and further damaged by years of dieting in an attempt to stop the inexorable weight gain. It is a FACT that most of us have "dieted our way into morbid obesity."

In the long run, the biochemical and metabolic lessons learned from the DS will be translated to medical treatments for morbid obesity, rather than requiring surgery. Until then, the DS is the BEST treatment in existence today, in particular for patients who can be responsible for using it wisely, and this article is a blatent misrepresentation of this fact.

SHAME on the researchers and especially the editor of this summary for this scientific dishonesty!

What's really amazing is how people can be duped into thinking long-term starvation and malnutrition is a 'healthier' way of life. Our society vilifies fat so much, that people readily allow doctors to mutilate their internal organs and often shorten their lives just so they can lose weight and escape the horrible stigma and prejedice against obesity. The majority of health care dollars spent on obesity don't result in weight loss or extended life, just people who become sicker and when they die their deaths are blamed on their weight rather than the horrible medical procedures used to 'cure' them. It's disgusting.

Sounds to me like the person who wrote this article is not only biased, but doesn't know wth they're talking about. Educate yourself before you talk out your ass. I had the DS, and I'm healthy as a horse, with labs to prove it.

I know of a woman who had the band surgery and she died of malnutrition. The surgeon did it wrong. The benefits for most people outweigh the ones that have health problems because of their weight. People that are fat is largely due to their microbial digestive populations and until science gets a handle on how to resolve it, surgery is all we have right now.

@JCA - The DS surgery is not a starvation or malnutrition surgery. Our labs are closely monitored to validate that we do have the appropriate supplements. We are probably healthier and more closely monitored than any normal weight person. It's definitely not taking the 'easy way out'. It's a way for people that have successfully lost, then regained weight over and over again using WW, Jenny Craig, etc.. but have chosen to quit yo-yoing. The up and down of weight loss is just as dangerous for our bodies. The DS is in fact life extending for people that have hypertension, diabetes, etc.. and this surgery does cure those issues. I would much rather take simple vitamins to remain healthy than to take high blood pressure pills or insuline. A skilled surgeon with DS (or any skilled Bariatric surgeon) properly screens candidates to ensure it's being done because of being moridly obese and not for pure vanity reasons.

The statistics quoted on the article aren't correct. Perhaps they should have reviewed the detailed sites regarding the DS surgery itself. It's a shame that this type of information is being so grossly misrepresented. I've been researching the procedure for 3 years now and I'm confident that it's the correct step for me to get healthy. Why have I been waiting for 3 years? Because I wanted to be sure it was a correct decision and because I have to self pay because my insurance won't cover it. So, on many levels, it's not a decision to be taken lightly.

I would like to echo what Diana Cox said above and then I would like to add:

Non-compliant patients of any bariatric surgery will run into trouble with their nutritional health. The DS is not for everybody but it is for those who have a quaifying BMA and/or co-morbidities and enough intelligence to to research the procedure and required aftercare and the diligence to follow the regime.

I cannot possibly know if I will live longer because I had the DS but it is my personal opinion that I very likely will because I was dying more every day as a morbidly (MORBID is the key root word here) obese person. I do know for sure that the quality of my life is vastly improved. I studied about the DS procedure for almost 15 years before I opted to do it and my only regret is that I did not do it sooner.

Your article here is very poorly vetted. I think you should retract it. I invite you to come to ObesityHealth.com and check out the various forums (related to all bariatric procedures) and see all the healthy and happy DS post ops and see how many miserable Band and RNY patients are fighting to get their surgeries revised to the DS.

I don't know enough about these procedures to have an opinion about which might be better.

But when I read the article, my reaction was certainly that the author was selling gastric bypass by trashing the DS procedure. Did come across as very biased.

This article points out the exact reason why a study such as this would never take place in the United States. It is MALPRACTICE plain and simple.

Let me preface my comments by stating I am a duodenal switch patient. I am also a board-certified physician (not a surgeon) and a major proponent of the duodenal switch.

There are major flaws with this study:

1. The length of the study is inadequate and leaves open-ended statement about not knowing what will happen over time. There are other studies in existence already that have results spanning 15+ years.

2. The participating surgeons admit they are inexperienced DS surgeons; therefore, intraoperative risks as well as postoperative complications are more likely for patients in the DS arm of the study.

3. The malabsorptions for DS vs RNY are completely different. The vitamin supplementation prescribed could have permanently harmed a DS patient because it violates standard of care. Since DS patients malabsorb 80% of the fat they consume, the risk of fat-soluble vitamin deficiencies (A-D-E-K) is substantial. Not only do the authors not supplement at the proper levels, but they do not indicate which form their vitamin supplements were dispensed. If those vitamins were dispensed in a oil base, then the patients were getting very little supplementation at all. Finally, any physician should check labs on bariatric patients frequently and adjust their supplements based upon those results. These patients were placed on an inadequate regimen to begin with and no such adjustments were made. Any permanent damage to patients in the DS arm as a result of this negligence should be grounds for a malpractice lawsuit.

4. The study clearly shows more weight loss with DS vs. RNY; furthermore, it shows more improvement in cardiovascular risk factors. It also clearly states that patients had equal quality of life regardless of procedure, yet it deemed DS inferior due to a short form that patients completed showing 1 out of 8 subjective symptoms ("bodily pain") appeared to be more improved in RNY patients.

5. The only reason malnutrition only showed up in the DS arm is the ignorance on the researchers' behalf in regards to supplementation needs to begin with.

Dr. Livingston is not a DS surgeon. His bias toward DS is understandable. Where are the viewpoints from a surgeon who does perform DS? There is no balance in this article and it is serves as a major disservice to the DS procedure.

DS is referred to as the platinum standard of weight loss surgery. I treat my obese patients naturally, medically, and am quick to refer for bariatric surgery when necessary. I have nine patients in my own practice undergoing DS in August and September of this year alone. My decision to recommend DS is based on data collected since this procedure was first offered in the US in 1988.

DS cured my diabetes. My preoperative weight was 342 lbs and my present weight is 164 lbs. I am normal weight and take no prescription medications. My labs are perfect because my supplementation regimen is adjusted based upon my labs which are done on a scheduled basis. My diabetes was completely resolved within two weeks of my surgery even though I still weighed 330 lbs. This alone indicates that my diabetes was not obesity-related, but also based on metabolic and hormonal abnormalities as well that DS corrected. I am not slowly dying; on the contrary, I am living life to the fullest for the first time in a long time.

My diabetes, hypertension, hyperlipidemia, and obstructive sleep apnea were killing me. I no longer suffer from any of those comorbid conditions. Conventional diet and exercise failed in my case. I did not "LET" myself go preoperatively out of choice. My obesity was not related to an eating disorder or an emotional disorder. There is more to obesity than overeating and there is more to weight loss than "eat less and exercise more". Type 2 diabetes is highly prevalent in my family (over 80% in my immediate family alone). I would be on an insulin pump by now with a dramatically decreased life expectancy if not for DS. Suggesting that DS no longer performed is the equivalent of signing an early death certificate for me.

This article should be retracted in its entirety. To suggest a procedure that provides a 99+% cure for type 2 diabetes be discontinued because of blatant physician negligence/incompetence in the referenced study is completely unfounded. DS should be making headline news for its scientifically-proven benefits.

Having DS is one of the best decisions I have ever made. I will continue to recommend it to my patients. I hope others will do their own research regarding this remarkable procedure rather than accept this article at face value.

This article points out the exact reason why a study such as this would never take place in the United States. It is MALPRACTICE plain and simple.

Let me preface my comments by stating I am a duodenal switch patient. I am also a board-certified physician (not a surgeon) and a major proponent of the duodenal switch.

There are major flaws with this study:

1. The length of the study is inadequate and leaves open-ended statement about not knowing what will happen over time. There are other studies in existence already that have results spanning 15+ years.

2. The participating surgeons admit they are inexperienced DS surgeons; therefore, intraoperative risks as well as postoperative complications are more likely for patients in the DS arm of the study.

3. The malabsorptions for DS vs RNY are completely different. The vitamin supplementation prescribed could have permanently harmed a DS patient because it violates standard of care. Since DS patients malabsorb 80% of the fat they consume, the risk of fat-soluble vitamin deficiencies (A-D-E-K) is substantial. Not only do the authors not supplement at the proper levels, but they do not indicate which form their vitamin supplements were dispensed. If those vitamins were dispensed in a oil base, then the patients were getting very little supplementation at all. Finally, any physician should check labs on bariatric patients frequently and adjust their supplements based upon those results. These patients were placed on an inadequate regimen to begin with and no such adjustments were made. Any permanent damage to patients in the DS arm as a result of this negligence should be grounds for a malpractice lawsuit.

4. The study clearly shows more weight loss with DS vs. RNY; furthermore, it shows more improvement in cardiovascular risk factors. It also clearly states that patients had equal quality of life regardless of procedure, yet it deemed DS inferior due to a short form that patients completed showing 1 out of 8 subjective symptoms ("bodily pain") appeared to be more improved in RNY patients.

5. The only reason malnutrition only showed up in the DS arm is the ignorance on the researchers' behalf in regards to supplementation needs to begin with.

Dr. Livingston is not a DS surgeon. His bias toward DS is understandable. Where are the viewpoints from a surgeon who does perform DS? There is no balance in this article and it is serves as a major disservice to the DS procedure. DS is referred to as the platinum standard of weight loss surgery.

I treat my obese patients naturally, medically, and am quick to refer for bariatric surgery when necessary. I have nine patients in my own practice undergoing DS in August and September of this year alone. My decision to recommend DS is based on data collected since this procedure was first offered in the US in 1988.

DS cured my diabetes. My preoperative weight was 342 lbs and my present weight is 164 lbs. I am normal weight and take no prescription medications. My labs are perfect because my supplementation regimen is adjusted based upon my labs which are done on a scheduled basis.

My diabetes was completely resolved within two weeks of my surgery. This points out that my diabetes was not completely weight-related, but also metabolic/hormonal. This is a very critical point because it suggests there are reasons for recommending DS besides morbid obesity.

I am not slowly dying. I am living life to the fullest for the first time in a long time. Diabetes, hypertension, hyperlipidemia, and obstructive sleep apnea were killing me. I no longer suffer from any of those comorbid conditions. Conventional diet and exercise failed in my case. I did not "LET" myself go preoperatively. There is more to obesity than overeating and there is more to weight loss than "eat less and exercise more". Type 2 diabetes is highly prevalent in my family (over 80% in my immediate family alone). I would be on an insulin pump by now with a dramatically decreased life expectancy if not for DS. Suggesting that DS no longer performed is the equivalent of signing an early death certificate for me.

This article should be retracted in its entirety. To suggest a procedure that provides a 99+% cure for type 2 diabetes be discontinued is completely unfounded. DS should be making headline news for its scientifically-proven benefits rather than being condemned based on a useless, short-term study.

Having DS is one of the best decisions I have ever made. I will continue to recommend it to my patients. I hope others will do their own research regarding this remarkable procedure rather than accept this article at face value.

I have been to 8 DS support groups within the last 10 months and not one person regrets getting their DS surgery! When I read through online forums it seems the same way, even the few who had complications from the surgery said that they would do it all over again in a minute because their quality of life is now so much better. When I read the boards about the other types of weight loss surgery the people are not as happy with their surgery. RNY'ers are complaining that they can't eat this or can''t eat that or they are dumping etc. Then the Lap band people, wow, I don't even know where to start with them....lets just say that many of them call it the CRAP BAND!

DianaCox said it best and if you do your homework before deciding on your surgery I am sure that you will agree with her as well. Nutrition is very important after DS as well as it is after RNY but the nutrition needs are not the same, Some nutritionist do not understand this so you have to be the type of person who is willing to invest the time to learn and follow through with your nutritional needs and then follow up with the lab work to see where you are. This is not hard but it is something that you must be willing to do before considering the DS surgery.

My DS surgery is coming up in two weeks and this story in no way is going to change my mind, I have done my homework on weight loss and know that the DS is the very best that is available!

This article is largely false. I would hope that any educated person research to find out what are the facts surrounding the DS procedure vs the RNY procedure instead of blindly going into any life altering surgery based solely on what an uninformed media representative or a surgeon with another agenda is publishing.

Where are the substantiated facts and published studies that support the "assumptions" of the author or Dr Liviningston? The basis of this article is biased to Dr. Livingston's expertise which IS NOT the DS. In my mind this hardly makes him qualified to report or even study this subject.

I have lived both the RNY and now the DS life style and can tell you from experience that the RNY procedure is far inferior to the DS. My quality of life has greatly improved since my revision to the DS. The many maladies that the article reports as complications with the DS are not specific to just the DS procedure. They can be prevalent with either RNY or DS. From my own experience, the complications I suffered from with the RNY were bowel obstructions, reactive hypoglycemia, vomiting, nutrient deficiencies, metabolic damage and weight regain. The article does not inform you that after roughly the 18 months to 2 year time period the malabsorption component of the RNY becomes extremely efficient and recovers much of the absorption capabilities that you had pre surgery which makes the RNY a "temporary" procedure for a large population of its patients. The good doctor did not bother to mention this in this article and there are substantiated statistics that support this statement if one were so inclined to do their research.

I revised to the DS to "fix" the complications listed above so that I could obtain my health again. Since my revision I have suffered none of the complications mentioned in the article, and in fact the DS is responsible for helping me overcome these conditions induced from the RNY so that I could get my life back from the damage the RNY imposed.

Knowledge is power and the lack of substantiated knowledge in this article is astounding. I can only advise anyone reading this to do your research and get the real facts before going into a decision that will change your life. True, the DS is serious business and should not be taken lightly. Malnutrition can occur if you do not supplement accordingly and stay up on your own health needs. This can be true for the RNY as well. Don't let ignorance become your deciding factor. Again, from my own experience I would not recommend the RNY procedure to anyone considering weight loss surgery.

It is articles like this that do a huge disservice to the medical community, reputable journalist and future weight loss patients who need fact based information.

the reporter fails to mention the post-op quality of life issues for the two operations.

the GB patient is unable to take NSAIDS (aspirin, ibuprofen) or similar pain relief for life for any arthritis , or coronary illness, now or in the future. That means NO BABY ASPIRIN to prevent heart attack, or stroke.

The DS patient is able to eat anything they choose, especially carbohydrates without fear of "dumping" as the fully functioning stomach still does its job of predigesting them before they enter the intestines where as the GB patient dumps his chime directly into his intestine raw and starts a syndrome leading toward a hypoglycemic event, which can be a medical emergency.

I had a DS 1year ago, resolve db 2, high blood pressure, high cholesterol, arthritic knees, lost 70 lbs, dropped from a bmi of 35 to 25, I eat normally what ever I choose, and don't diet. My vitamin regiment is moderately more than a pregnant woman's.

I have some friends who have had various procedures, although none that I know of with DS. The ones with GB are miserable basically while proclaiming all the while how happy they are they had it done. One munches chips and other junk every time I see her, has no immune system, has a port she has to always have for infusions of iron, calcium, and who knows what else. She has almost died a few times from infections because the surgery wrecked her immune system...she lost some weight, but isn't healthy or slim, fit, or physically from what I see better off than where she started.

The one I know with the lap band has the oddest relationship now with food that I have seen. She has so many rules on what and how she can eat things that she is more obsessed now with food than she was before she had it. Must have everything with sauce or gravy to get it down, must not eat soup or all kinds of other things, but in the long run ends up eating small amounts at a time, but really unhealthy foods pretty often. I have another friend who had one who is doing better, but there is still the "I have the band and can't do this or that" all the time.

I wouldn't have a GB after knowing a few who had it, wouldn't do a band, don't know much about DS, and I am happy for those whose health has been restored and who are happy with their choices. I firmly believe psychological counseling is a must for anyone with these surgeries...that is so often where they fail since eating choices don't change much. Eating small amounts of chips all day of course is going to lead to problems.

Best wishes to you all:)

I just want to ditto what the other DSers have said. I'm healthy, happy and feeling fine.

I take a moderate amount of vitamins just a few more than a PG woman, I eat everything sans white flour and I don't vomit or have horrible gastric distress.

The study is flawed (see Steve's comments) and Dr. Livingston is a dummy...he has no idea what he's talking about. I wonder how many DS patients he's ever seen.

This article needs to be retracted or better yet, have a well respected DS surgeon respond. There are tons of studies that prove that the DS is a better surgery for long term weight loss and if performed correctly carries no more morbidity rates than those of other surgeries.

WOW, just wow! How ignorant! For anyone reading this crap please, visit dsfacts.com and obesityhelp.com, duodenal switch forum. You'll get the truth there. Actual people LIVING with the DS. This website is for all Weight Loss Surgery types. I guarantee the Duodenal Switch forum is where you'll find the HAPPIEST group of people. Then take a visit over at the revisions forum. The majority of patients looking for revision from a FAILED weight loss surgery are either Gastric Bypass or LapBand patients. NOT DSers! For God's sake people, please do your own research. Surgeons who don't perform this life changing, life saving surgery seem to like to bash it and that is what this is, IMO! Please, come talk to the people living and LOVING the DS life!

So let me get this straight - Regardless of which way you chose to mutilate your internal organs, you have to be put on a relatively strict diet, and your doctor has to watch your numbers like a hawk or you might die. So how is that lifestyle any better than living with diabetes? It sounds exactly the same to me. Worse, in fact, since after WLS, your organs are permanently mutilated. There is no going back to having a normal anatomy. Whereas study after study is revealing that diabetes and other weight related conditions can be controlled or even reversed just by getting your fat ass to a gym - EVEN IF YOU DON'T LOSE WEIGHT!

@harper-1234......let ME set YOU straight. I'm a 44 year old morbidly OBESE woman who could possibly out lift most men in a gym. I have a very muscular frame, I eat TWO freakin' meals per day, NEVER touch any carbonated beverages, avoid sugar at all costs and guess what? OMG I've lost 20 freakin' lbs in a year!!!! Geeeesh! As for getting my BIG FAT ASS to a gym....the doctors REFUSE to release my big fat ass to even WALK, because of all the health problems I have. Do I need to lose weight? Of course. Did I do this to myself....more than likely in some parts. Have I wised up, now that I know I won't live forever? Certainly.....I'm no longer 22 thinking I can fart rainbows and glitter and live forever. However, now that I'm old enough, and I might add, old enough not to be judging people that I have no clue about, I have severe health issues that prevent me from going to that gym and working my "fat ass" out. I'm a 5th generation FAT person.....some of mine is genetics, some metabolic and some just plain old bull, living like I shouldn't, like millions of others who don't end up like myself. Life's not fair sometimes, so some of us actually DO have to go out and have these types of "mutilating" surgeries, and watch our health for the rest of our lives......just like most normal people. READ UP ON DIABETES. I laughed at it once too....now my health is in a tailspin all because of my denial. I've researched weight loss surgeries for YEARS....almost ten, and out of all of them the DS has shone through. I'm willing to bet, that if it came down to YOU dying...say, your heart giving out...you'd be willing to have ANYTHING done in order to live longer and healthier. This same idea applies to all of us with fat asses too. Lots of love to you....

Bull@!$%#! Just plain and simple Bull@!$%#!!

Please people, do your own research!

Starvation? I had the DS procedure, and I eat very normal sized-meals. I can eat a burger and a few fries from Red Robin if the mood strikes - no starving, here!

Malnutrition? These surgeries do not cause malnutrition. They cause MALABSORPTION, which is NOT the same thing. It can potentially lead to malnutrition, but not if the patient is smart about eating and supplementing appropriately.

I'm so sorry you find people seeking the most effective solution to their problems to be "disgusting." Those who are (or have been) morbidly obese have damaged metabolisms, whether the metabolism was damaged before the obesity or a result of the obesity. Either way, it's damaged, and VERY few people who lose weight via just diet and exercise can actually maintain that loss in the long term (I believe the statistic is around 5% success for such), whereas DS patients see an average of 80% maintained excess weight loss even 15+ years after the surgery.

I had the DS almost 3.5 yrs ago. It cured my diabetes, high cholesterol and high blood pressure. My labs are better than they were before my DS. I'm healthier now and have a normal metabolism. Oh, yes the protein leak from my kidneys before my DS is back to normal too. My body responds better to vitamins than it did to all the prescription meds that I was on. I did my research on the DS, written by doctors that actually do the DS, with correct information about malabsorption and supplementation. I did research the gastric bypass, but there were too many parts that I couldn't live with, plus I wanted the surgery with the best cure rate for my diabetes. I have a quality of life that I didn't have when I was morbidly obese.

The reporter should have done his own investigation of the duodenal switch.

I've had the DS too! My labs are also great. The pain I had in my knees from premature arthritis when I was morbidly obese is now gone. I can walk up a flight of stairs without being winded. My high cholesterol is gone. My high blood pressure is gone...and actually averages now around 110/70. I can eat and eat and eat....I actually eat about 3,000 calories a day...but it is high protein low carb. IF I eat too many carbs (starches, noodles, breads, rice, etc.) I get gas, which is no big deal. I avoid those foods unless I am going to be at home. I take large quantities of supplements, which cost me about $60 a month. I have my labs monitored regularly as well as annual bone density scans. All is well and I am now enjoying life and participating in it...not just being a fat spectator on the side lines.

I think this report is biased. It takes a highly skilled and trained surgeon to perform this surgery, that is why there are so few DS surgeons. I researched the the Duodenal Switch (DS) and other weight loss surgeries for years before I chose the surgery I did. I had to go through counseling, psychological evaluations, multiple doctor visits (some with specialists) in order to get the surgery approved by my insurance company. What this article does not mention is the risks associated with obesity nor the risks or yo-yo or off and on dieting. I had lost over 100 pounds multiple times in my life only to regain it. This time it is staying off. The only positive thing that was stated in this article was: In this study, one-quarter of gastric bypass patients still had a BMI that high two years after surgery — versus none of the duodenal switch patients. There are several Gastric Bypass (RYN Roux-en-Y) patients that never meet goal or experience weight gain 5 to 7 years post-op. Many of them become depressed and feel they failed (when the surgery failed them), but the lucky ones learn they can undergo a revision procedure to the DS. They will NEVER regain the pyloric valve lost in the original procedure...unlike a 1st time DS patient that keeps their pyloric valve intact.

To the posters that lost a loved one that had weight loss surgery I ask you to consider this. There are risk involved ANY time you have ANY surgery including death. I'm sorry you lost someone you loved, but your loved one was willing to fight to the death to try for a healthier life. Please do not discourage others from trying to fight for that chance. So many obese people do not truly get to live life. We can not go to the movies and fit in a chair, or fit in a booth in a restaurant, cross our legs comfortably, climb stairs without getting winded, ride a roller coaster, have difficult times finding nice clothing to wear, we have social stigmas associated with our obesity, the list goes on and on.

I have the DS and I am far from starving myself. My health insurance paid far more money for my health care issues when I was 311 pounds (after multiple times of yo-yo dieting losing 100+ pounds) than they do now to monitor my labs.

Why did you have to get it in the first place?