Mike Huckabee’s weight loss scam

(This is a long article, you can read the summary here)

“If a man’s dishonest to obtain a job, he’ll be dishonest on the job.”

Mike Huckabee

With Mike Huckabee’s sudden prominence in the 2008 GOP Presidential race has come greater scrutiny, of both the man and his record. Prominent in both his famous weight loss saga, and as such it too merits scrutiny.

In June 2003, Mike Huckabee was an obscure and obese (290 lb.) Arkansas Governor. By June 2004, Huckabee lost 110 lbs., which he attributed to diet and exercise. This feat naturally attracted media attention as a human-interest story, to which Huckabee added a public policy angle by also touting his anti-obesity public health initiative called Healthy Arkansas. This program included public service spots featuring a newly trim Governor Huckabee assuring Arkansans that if he could lose weight, so could they.

“That was me just over a year and a 105 pounds ago. Now if I can lose weight, anyone can.”

Huckabee was featured in a spate of articles and media appearances that gave him enough national awareness to launch his long-shot Presidential candidacy. According to the Washington Post ,

Huckabee’s signature issue is fitness and weight control, and his evangelism on these matters never strays far from his own example.

Huckabee wrote a book about using diet and exercise for weight loss, Quit Digging Your Grave with a Knife and Fork, featuring the obligatory before and after photographs on the cover and providing a rationale for a book tour and more media appearances.

The weight loss story remains part of the campaign’s narrative. Newt Gingrich, explaining Huckabee’s rise cites his “experience in health-care where…he lost 100 pounds and began exercising is personally a great story.” Huckabee’s campaign continues to tout that his
“efforts to improve his own health have received national attention. . . . [H]e lost 110 pounds,” and that he uses “his own life story to wage a war against the obesity epidemic in America.”

Huckabee attributes his extraordinary weight loss achievement to his rigorous adherence to principles of diet and exercise, the evidence for which consists entirely of Huckabee saying it is so, and media accounts that echo Huckabee’s claim.

When we hear, however, of the growing popularity of gastric bypass surgery, the thought occurs, what if that is how Huckabee lost his weight? Could he have had such surgery secretly? Would he then attribute the subsequent inevitable weight loss to his determination and discipline? Use his weight loss as a model for Government anti-obesity efforts? Author a fraudulent “How I did it” diet book? The media hasn’t as much as hinted at this possibility. Surely, such a scam wouldn’t be possible…would it?

At present, the media appear more interested in promoting rather than investigating Huckabee’s candidacy. This disinterest would obviously change dramatically should Huckabee secure the GOP nomination. The belated media scrutiny to which Huckabee would then be subjected might be well able to force Huckabee to admit mischaracterizing the source of his weight loss. The political impact of such a disclosure would be undeniably negative and possibly even disastrous to the GOP ticket (this is discussed further below).

Anything Huckabee has to reveal about his weight loss needs to happen prior to the primaries. The media isn’t going to do any investigating now, and so we must do the investigating for ourselves.

The medical case for bariatric surgery

What is somewhat unusual about the evidence for Huckabee having had gastric bypass surgery is that it is almost entirely medical. There is very little evidence of that type of by which political secrets are usually uncovered, e.g. witnesses, money trail, documents, etc. The lack of such usual evidence, however, might not preclude the possibility of bariatric surgery as much as it indicates that medical privacy has been well maintained.

A medical case can be as convincing as any other, as medical reasoning is not without rigor, and has recourse to medical literature. It happens that unexplained weight loss is a classic medical diagnostic problem, for which there are a myriad of potential diagnoses. We can apply diagnostic methodology to explain Huckabee’s >100 lb weight loss, which is relatively simple as we need consider only two explanations: Nonsurgical diet/exercise or gastric bypass surgery (the most popular form of bariatric surgery).

The first principle of diagnosis is the Law of Parsimony, a medical application of Occam’s Razor. The principle is to avoid making two diagnoses if one diagnosis adequately explains the symptom presentation. In applying the Law of Parsimony specifically to Huckabee’s weight loss question we gather what clinical findings we can, and ask whether bariatric surgery or diet/exercise best explains all these findings without needing to invoke further diagnoses or explanations.

To find these symptoms and findings we turn to the internet, where a surprising amount of material is publicly available owing mainly to Huckabee’s relentless obesity PR campaign.

Huckabee’s medical history

All diagnosis starts with the medical history the patient provides. Huckabee denies surgery and gives a history of diet/exercise, but is a vague historian. His weight loss performance is world class; he lost 75 lbs, 0.4 lbs. per day, for 6 months. Huckabee attributes his amazing success, after multiple diet failures, to his enrollment in the University of Arkansas Medical Center (UAMS) Weight Control Program, directed by endocrinologist Dr. Philip Kern. The UAMS program involves an initial liquid diet, followed by gradual reintroduction of a normal but caloric restricted diet. Huckabee states he was enrolled in the program, but provides no details of his experience. You’d expect his “How I did it” diet book to divulge a helpful diet technique or two—e.g. estimation of calories consumed and expended. But no, the book is a compilation of homilies bereft of detail, almost as if it was someone else that was enduring a daily deficit of 1400 calories.

Perhaps the UAMS program could fill in the detail? No, the UAMS program is even less specific than Huckabee. The Weight Control Program website has a few expired links to Huckabee media features, but no account from UAMS. Dr. Kern says little, aside from participating in some of Huckabee’s media events, praising Huckabee as a model patient and noting that his results were highly atypical for the program.

Huckabee has certainly been appreciative of Dr. Kern’s efforts. In 2007, Governor Huckabee allocated $1 million in Arkansas general funds to endow the Dr. Philip Kern Chair at UAMS.

Denial of having bariatric surgery

Huckabee has generally avoided the subject of bariatric surgery, including not mentioning it in his weight loss book. Neither have the media had the temerity to ask Huckabee about surgery, so intent have they been to credulously report the inspiring diet/exercise story. Nonetheless, Huckabee has specifically denied non-diet/exercise weight loss on at least three occasions.

CNN’s Medical Correspondent Sanjay Gupta, M.D., specifically asked Huckabee how he lost his weight:

GUPTA: Listen, you know, a lot of people watching. And obviously, it’s a dramatic amount of weight that you lost. How did you do it?

HUCKABEE: The old fashioned way. First of all, I had to learn that it was a change of lifestyle. And my goal wasn’t to lose weight. And that’s why this time I was successful, as opposed to previous times in my life. And I would lose weight, but then gain it back and add some to it … When I did those things, the weight took care of itself. And I became a normal person in terms of my body weight.

Bariatric surgery has become more established in recent years, but it as yet can in no way be construed as the old fashioned way, and so this must count as a bariatric denial.

Huckabee volunteered that he did not have bariatric surgery, while speaking at the LIVESTRONG Presidential Cancer Forum:

HUCKABEE: We do the same thing for bariatric surgery, which I know there are very few states that will actually provide. For us, it was a three-stage level.

MATTHEWS: What is bariatric?

GOV. HUCKABEE: That’s to assist with weight loss for people who are morbidly obese. … I was able to go through a program that was largely behavior modification through our med school. You know, I changed my lifestyle but I’ve had friends for whom that didn’t quite work and they went the route of the surgery. The surgery is still incredibly better than allowing people to go for the rest of their lives which, by the way, will be dramatically shortened and more expensive, without some type of intervention and that’s why the more that we can do to curb it, the better.

In a 2006 Newsweek “Live Talk” Internet chat, Huckabee was asked by a participant:

Moorhead, MN: Mr. Governor, I have lost 180 pounds myself. I did consider surgery but did not go that route. Did you also consider surgery before undertaking the task at hand?

Mike Huckabee: I never considered it even though some close friends of mine have done it and most successfully. It was a matter of fear for me—I don’t like doctors slicing on me unless it’s the only option! (Just a personal thing!)

So Huckabee is on record as specifically denying having gastric bypass surgery, unless he wishes to invoke Clintonian dodges (“I never considered it, you see, I just went and did it”).

Most interesting was the ambiguous statement elicited by the website Calorie Lab when it asked Huckabee’s spokeswoman, Alice Stewart, by email whether Huckabee had had bariatric surgery. She responded:

“Even if Governor Huckabee had lost weight by having bariatric surgery, there would be no shame in that,” says Alice Stewart, press secretary for the Mike Huckabee Exploratory Committee. “[But the] fact is that the governor’s weight loss program was very well documented by the media. Steve Barnes of Time Magazine interviewed the governor as well as his doctors.”

This curious response reads more like an admission of bariatric surgery than a denial.

Relative incidence of diet/exercise vs. bariatric weight loss

All medical diagnosis starts first with the recognition that common things happen commonly. In considering different diagnoses, it is best to favor that which more commonly occurs. So, the first thing to consider is the incidence of >100 lb. weight loss for exercise/diet and bariatric surgery respectively.

Greater than >100 lb. weight loss with diet/exercise is rare, and even rarer is keeping it off. The reason that Huckabee’s story garnered so much media attention was that it was “man bites dog.” Partly as it is so rare, there are no incidence numbers, but a reasonable estimate of the number of people in the U.S. each year who through diet/exercise lose >100 lbs. is fewer than 1000.

On the other hand, the number of people in the U.S. in 2003 who had gastric bypass surgery was estimated at 102,000. So, if all we know is that someone rapidly lost 110 lbs., the chances that it was through gastric bypass surgery are about 100 to 1. So, before we even start considering the particulars of Huckabee’s story, in comparison to relatively commonplace bariatric weight loss, the diet/exercise diagnosis an many times less common, and thus less likely.

Weight loss pattern highly consistent with bariatric surgery

Just as it is said that once is a fluke; twice is a coincidence; three times is a pattern, so too does it seem unlikely that that diet/exercise should be able to match the characteristic weight loss pattern of bariatric surgery in terms of rapidity, amount, and maintenance.

The graphs below are from a large Swedish study in demonstrating the weight loss in 4047 obese subjects evenly divided between surgical and nonsurgical subjects. The nonsurgical group, on average, had almost no weight loss. The surgical group had weight loss that was rapid, large, and lasting.

The first graph demonstrates the pattern, upon which Huckabee’s weight loss has been superimposed in the the second graph. Starting at 290 lbs., Huckabee 75 lbs. in 6 months and 110 in one year. Since then he has regained 12 lbs. The weight loss pattern of gastric bypass surgery is so highly characteristic and differs so markedly from the diet/exercise as to almost represent a signature. Huckabee’s rate, amount and persistence of weight loss follows exactly gastric bypass surgery’s unique pattern.

Rapidity of weight loss

The New York Times reporters expressed astonishment at the rapidity of Huckabee’s weight loss, stating he had been “shedding weight so rapidly that it was as if he simply unzipped a fat suit and stepped out.”

The NYT’s amazement is because such rapid loss is so atypical for a diet and exercise regimen, in which a favorable 6 month weight loss is 5-10% of body weight, a far cry from Huckabee’s 26%. Huckabee’s 75 lb. in 6 months was at a clip of 0.4 lbs/day, a 1400 calorie daily deficit.

A study of an appetite suppressant that enrolled 605 obese subjects in a 2 year weight loss program demonstrates rapidity typical for nonsurgical weight loss. The study scattergram above displays the weight loss achieved at 6 months among the 605 patients of various starting weights in the study. From his starting weight of 290 lbs (134 kg), Huckabee lost 75 lbs (34 kg) in 6 months. Huckabee’s rapid weight loss experience is distant from all of the study’s 605 subjects.

Amount of weight loss

In the appetite suppressant study, which is typical for diet/exercise studies, the average weight loss at two years was only 9.5 lbs., the maximum weight loss of any participant in both the placebo and the drug group was 58 lbs. and 101 lbs. respectively. In the amount of weight loss, Huckabee’s 110 lbs. likewise easily surpassed all 605 participants.

Maintenance of weight loss

Huckabee has largely maintained his now normal weight for nearly 4 years. This is characteristic for gastric bypass, but not so for diet/exercise regimens. The vast majority of those who lose weight through diet/exercise regain weight. For example, in a University of Kentucky study, in which subjects lost more than 100 lbs., 49% of that was regained after 5 years.

Weight regain typical for diet/exercise is demonstrated in the graph here. Study participants on average regained 29 lbs. of their initial 48 lb. weight loss.

In maintenance as well, Huckabee’s experience differs markedly from diet/exercise regimens.

In rapidity, amount, and maintenance of weight loss, Huckabee’s weight loss demonstrates the exact pattern of gastric bypass surgery, which for each parameter differs markedly from diet/exercise.

Physical appearance after bariatric surgery

Some medical conditions affect the appearance of a patient in a characteristic way; recognition of the appearance facilitates rapid diagnosis. Such appearances often have descriptive names, such as the famous Pink Puffer and Blue Bloater of emphysema and chronic bronchitis respectively. The distinctive bariatric appearance does not yet have an alliterative appellation (Sallow Sagger?), but is nonetheless distinctive and recognizable.

The bariatrics’ distinctive appearance

The bariatric look includes muscular atrophy, lumpy distribution of fat, sallow redundant skin, and thin sparse hair. It results from the extremely rapid loss of fat and muscle due to the caloric deficit enforced by the miniscule gastric pouch, as well as the malabsorbtion of protein, vitamins, minerals and nutrients caused by the operation’s bypass (hence the name) of about 6 feet of small intestine. This malnutrition manifests in unfavorable and recognizable skin and hair changes.

The singular and recognizable appearance is evident in photographs of bariatrics (including Huckabee), but best appreciated in person. Rolling Stone writer Matt Taibbi was struck by Huckabee’s appearance and somewhat uncharitably described his reaction:

Huckabee, who in recent years has lost 100 pounds, has the roundish, half-deflated physique of an ex-fatty. With his button nose and never-waning smile, he looks slightly unreal, like an oversize Muppet. I was so taken aback by his appearance that I checked his hands to make sure they had the right number of fingers.

People who lose a large amount of weight through diet and exercise lose weight more slowly and without nutritional deficiencies and, thus, don’t have this appearance. To some extent, diet/exercise weight loss looks like the person has done something, bariatric looks like something has happened to them.

These two photographs demonstrate the changes between 2002 and 2005 (thankfully, that is snow, not dandruff in 2005). Note the hair thinning, and change in skin color, from ruddy to sallow. Muscle wasting is indicated by the concave region between the eyes and ear where the temporal muscle has atrophied. If you hadn’t seen Huckabee since 2002, in 2005 you would not exclaim to him “Hey…you look great!”, but rather inquire “So…are you doing okay?”

These photographs demonstrate the rapid skin and hair changes Huckabee underwent. In April 2003, Huckabee has relatively thick hair and a ruddy complexion. In August 2003, two months into his weight loss, his skin is paler, and his hair is thinning. In 2006, his skin appears sallow and waxy, and his hair sparse. A video shot in 2007 reveals the extent of hair loss on top and a general thinning.

In this photograph from the 2005 Little Rock Marathon, Huckabee demonstrates the characteristic bariatric washed out appearance, with pasty skin, sparse hair, atrophic musculature, and irregular fat retention. The appearance differs markedly from the look of vitality expected from weight loss resulting from healthy diet and vigorous exercise. Posing next to a hale 62 year old, it is the 49 year old Huckabee that appears spent.
Those who lose weight through diet and exercise may have redundant skin, but not the changes in muscles, skin and hair. Again, Huckabee demonstrates the characteristic bariatric changes that are not expected with diet/exercise, and thus requires another diagnosis or explanation.

Diet habits consistent with bariatric surgery

Bariatrics have a specific diet necessitated by the miniscule gastric “pouch” that starts out the size of a golf ball and eventually expands to hold only one cup. Specific bariatric dietary requirements also include increased protein and decreased fats to compensate for malabsorbtion. They also have specific “eating goals” (e.g., taking 30-45 minutes to eat each meal, eating slowly, taking small bites).

Details on Huckabee’s diet are found in the numerous human-interest stories his weight loss spawned. He does not eat at banquets and receptions. At events, he will have special food supplied for him from a cooler kept in his car or does not finish his meals. He eats six small meals per day. Avoidance of restaurant-type banquet meals is telling because such meals create difficulties for bariatric surgery patients. These diet peculiarities bear little resemblance to maintence of weight loss, but tally quite well with characteristic bariatric limitations.

Huckabee’s endorsement of bariatric surgery

Huckabee is certainly knowledgeable about bariatric surgery, coverage for which Huckabee provided Arkansas State employees. As he told interviewer Margeret Warner:

We did weight loss programs. We covered those. Because we found that, even at the point of bariatric surgery, which is pretty expensive, most people can’t afford it—it scared me to death—but, you know, a lot of people, they’re morbidly obese. They need it. There’s a 60 percent to 80 percent financial return in terms of fewer health care costs after the surgery than there were with a person who has a situation of being morbidly obese.

That Huckabee championed bariatric surgery as Governor offers political cover should his own surgery ever be revealed.

(The Governor is incorrect on the costs as well. Post-bariatric patients are more costly because, with their many complications, their hospitalization rate doubles for 3-5 years after the surgery).

Opportunity for surreptitious gastric bypass surgery

If Huckabee were to have had gastric bypass surgery, he would have required opportunity to disappear from public view during a brief hospitalization and recovery. One such opportunity is evident in public notices in the Arkansas Democrat-Gazette.

Huckabee dates the onset of his weight loss to June 2003. In 2003, Huckabee attended the Council of State Governments’ spring meeting, held May 15-18, in St. Thomas, Virgin Islands. The Arkansas Democrat-Gazette reported on May 21 that Governor Huckabee was extending the trip to include a personal vacation with an indeterminate return date, adding portentously:

“The governor chooses for his office not to disclose all of his travel plans”

This absence must have been unusual, because in his 10 years as Governor, this is the only article in the Arkansas Democrat-Gazette archive that refers directly to Huckabee’s vacation plans.

Huckabee, thus, had the opportunity to leave the Virgin Islands on Sunday, May 18, for any destination (including Arkansas), where he could have had bariatric surgery on Monday, May 19, followed by several days of hospitalization and recuperation. However, former Arkansas Governor Frank White died unexpectedly Wednesday, May 21, which necessitated Huckabee’s public return on Thursday. Huckabee attended White’s lying in State in the Capitol Rotunda on Friday and spoke at the funeral on Saturday, May 24. The Arkansas-Democrat Gazette reports no Huckabee appearances the subsequent week until addressing high school students Saturday May 31st, except for Memorial Day services Monday, May 26,. On June 1, Huckabee attended a conference in Mississippi.

With laparscopic bariatric surgery on Monday May 19, Huckabee is likely to have been discharged from the hospital on Wednesday, the average hospital length of stay for such surgery being 2.5 days. Gov. White’s death necessitated public appearances on Friday and Saturday. Laparoscopic surgery patients ambulate the day of the procedure and recover rapidly, so by Friday, Huckabee would have been able to appear in public without noticeable difficulty.

Subsequent hernia operation

In March 2005, Huckabee had surgery to repair a Spigelian hernia of the abdominal wall. Spigelian hernias occur naturally, are not associated with bariatric surgery, and are located in the mid abdominal region. Spigelian hernias are quite rare. How rare? At the Mayo Clinic, only 3.8 Spigelian hernia operations are performed per year; only 479 Spigelian hernias have been reported in the world medical literature; out of a thousand abdominal hernias, only one to two are Spigelian hernias. Spigelian hernias are located in the abdomen near the belly button, close to where incisions are made for either open or laparoscopic bariatric surgery.

In contrast to the rarity of Spigelian hernias, post bariatric complications requiring surgery are very common, especially incisional (or ventral) hernia repair. Overall, 15% of bariatric patients will require surgery for a incisional hernia in the first three years, an additional 5% will need a laparotomy, and 5% will undergo a wound revision.

A Huckabee disclosure of an incisional hernia operation would be tantamount to admittance of previous bariatric surgery. On the press release, therefore, his surgeon needed to provide a naturally occurring hernia diagnosis that has a surgical repair resembling that of an incisional hernia. Among naturally occurring abdominal hernias, a Spigelian hernia is the type of hernia that most closely resembles an incisional hernia, as it is in the lower abdomen instead of the groin.

Due to their rarity, there is no estimate of the annual incidence of Spigelian hernias, but if we generously attribute Spigelian hernias to be 2% as common as the 1 in 500 person incidence of inguinal hernias, the annual chance of having a Spigelian hernia is one in 25,000. This chance is infinitesimal in comparison to the approximately 10% incidence of bariatric complication requiring surgery in the first two years. All else being equal, a repair of a post bariatric incisional hernia is thus 2,500 times more likely than a nonbariatric Spigelian hernia.

The particulars of Huckabee’s operation provide further bariatric surgery connections. The Baptist Health Hospital at which the Spigelian hernia repair was performed is Arkansas’ only Bariatric Center of Excellence, and was performed by a surgeon whose partner is a leading Arkansas bariatric surgeon.

Participation in a marathon

Huckabee makes much of the fact that he has completed several marathons, as if these feats are impressive enough by themselves to substantiate the exercise basis for his weight loss. It is possible to lose weight through exercise such as running, but examples of marathon runners who have sustained >100 lb. diet/exercise weight loss are scarce. It is much more common for bariatrics to find that the massive bariatric weight loss allows them for the first time to exercise. This corresponds with Huckabee’s story, related in his book and elsewhere, in which he describes beginning to exercise only after he had already achieved significant weight loss. Bariatrics that run, and even run marathons, are not particularly difficult to find.

That the amount of exercise should increase after bariatric surgery is borne out by the Swedish bariatric study, in which the proportion of in the bariatric group exercising increases from 55 to 90% after surgery, significantly surpassing the nonsurgical control group which remained unchanged (see graph).

Again, we find Huckabee demonstrating a finding entirely characteristic of bariatric surgery (increased exercise) that is atypical for nonsurgical weight loss.

In Huckabee’s marathon running photographs there is a possible clue as to his bariatric status.

A marathon runner expends approximately 2800 calories, and so to avoid hitting the hypoglycemic “wall”, marathoners commonly enhance bodily glycogen stores by consuming large amounts of carbohydrates (e.g. pasta) pre-race. Such ingestion might be difficult for a bariatric with his miniscule gastric “pouch,” and other malabsorption issues.

Since bariatrics cannot so readily “glycogen pre-load”, we might expect, therefore, that bariatric marathoners to run carrying readily available extra energy supplementation on their person, so as to enable frequently imbibe during the race to ward off and, if necessary, to treat hypoglycemia. When runners need carry extra items, they often use a special belt, such as the Fuel Belt.

On an organized marathon, in which energy bars and drinks are available at regular intervals, most runners have no need for the encumbrance of a Fuel Belt. One finds only
one marathoner, Huckabee, wearing such a belt in the photographs from the the 2005 and 2006 Little Rock Marathon (you may note a belt on #1368, he is an Board Member with the American Running Association, who is running with Huckabee). One can find, however, other bariatric marathoners here, and here also sporting a “Fuel Belt”.

Such Fuel Belts are not rare among regular marathon runners, and his wearing a belt doesn’t prove he is a bariatric. Such belts are, however, demonstrably more common among bariatric runners than among nonbariatric (and it is really difficult to find a belt so heavily laden as his). If 5% of nonbariatric runners and 40% of bariatic runners wear such belts it is one more statistical piece to add to the bariatric side of the balance, and it is one more coincidence added on to the diet/exercise ledger.

Medical privacy and keeping the surgery a secret

Huckabee would have the expectation that his operation and several days of hospitalization would be kept private. Within medicine, medical privacy is held to be a fundamental ethical obligation. Medical privacy since early 2003 has gained Federal protection, with HIPAA medical privacy regulations. These standards apply with equal force to both medical office practices and hospitals. Medical privacy is part of every hospitals accreditation, and like every hospital, the Baptist Health Hospital mentioned above has quite specific medical privacy regulations.

Still, some may doubt that Huckabee could have had surgery without the news getting “out.” If unsourced rumors are the criterion, it is “out.” There is no particular shortage of usually anonymous internet posts and blogs that purport in Arkansas it is “generally known,” Huckabee had gastric bypass surgery, or that it is known at which hospital or by which surgeon it was performed. Examples of these posts may be seen here, here, here, and here.

If Huckabee himself kept his surgery secret, a substantiated disclosure rising above the level of rumor would require a health care professional to identify him or herself while violating both medical ethics and Federal laws. It is thus not surprising that there are no identified witnesses. Should Huckabee should become the GOP nominee, however, the entire MSM and Democrat apparatus will available to reward and protect anyone who “steps forward”.

Fugitive from the Law of Parsimony

We’ve considered a host of clinical factors so as to determine whether each is best explained by bariatric surgery or diet/exercise. The findings are as follows:

• Huckabee’s vague history of diet/exercise doesn’t adequately explain his astonishing result.

• His spokeswoman gives an ambiguous denial.

• Massive and persistent weight loss with bariatric surgery is orders of magnitude more common than with diet/exercise.

• Huckabee’s weight loss record fits the pattern of gastric bypass surgery exactly for rapidity, amount and maintenance, and not at all like that of diet/exercise.

• Huckabee demonstrates changes in physical appearance that appear bariatric both in general and the specific (hair loss and skin changes).

• His particular diet habits are tellingly bariatric.

• Just prior to his rapid weight loss he took an unusual vacation with a furtive itinerary and end date.

• In 2005 he needed an abdominal hernia repair, an expected complication of bariatric surgery, and this was explained to be a Spigelian hernia, a vanishingly rare hernia type that is best explained as an apparent cover story.

• His marathon prowess is not so likely to be an example of exercise inducing weight loss, as it is the expected result of (bariatric) weight loss permitting exercise.

• While running marathons Huckabee is shown carrying that energy supplementation, that is both expected of, and associated with, bariatric marathoners.

• The lack of any identified witnesses to the bariatric surgery/hospitalization is adequately explained by medical privacy ethical standards as well as the rigor of Federal law.

In applying the above mentioned Law of Parsimony, it is evident that the one explanation of bariatric surgery readily satisfies every clinical finding. Diet/exercise alone is not sufficient to explain the findings; it must either string together a series of unlikely to rare findings (rapid, massive weight loss), and/or introduce new conditions and diagnoses (e.g. rare hernias, hair loss)
.
Ramifications of a Huckabee disclosure

If Huckabee the nominee is eventually forced to admit that he mischaracterized his weight loss saga, the magnitude of the negative political impact is unknown. Perhaps it wouldn’t much matter, voters would accept and forget. However, it doesn’t require an excess of imagination to think of what advantage it would provide the Democrats.

Regardless of what type of attack the they may wish to launch, be it against Huckabee’s veracity, integrity, credibility, qualifications, issues, health status, suitability for office, or even person, it would be facilitated by Huckabee’s acknowledgment of deception. A thousand articles would begin “Huckabee, who admitted deceit regarding his gastric bypass surgery…” and would follow with further accusations that the campaign would have to defend from back on its heels.

It is easy to see the lines of attack that flow directly from an admission of gastric bypass surgery, and that a Huckabee GOP Nominee could scarcely defend:

• Huckabee the former preacher even now has a perception of being an Elmer Gantry. Being the perpetrator of a diet scam will complete the template, which will be used endlessly.

• Democrat attack ad: “Huckabee’s Arkansas health plan was to secretly have gastric bypass surgery, and then blame Arkansans still obese for high health care costs.”

• The Democrats and media will find victims. Obese Arkansans will be interviewed, who felt humiliated for remaining fat after the Governor falsely claimed that his weight loss proved “anyone can”.

• Huckabee will have been shown to falsify his Presidential resume with his spurious weight loss achievement. People who falsify resumes are fired, not elevated to the Nation’s highest office.

• Bariatric surgery is associated with high rates of hospitalization, increased long term mortality, and anemia, osteoporosis, nutritional deficiencies, and neurological complications. These are conditions the public would rather their President not be at risk of, and the media will helpfully run features emphasizing these risks.

• Huckabee will have falsified his medical history to voters. Thompson admitted he had Non-Hodgkins Lymphoma, Giuliani prostate cancer and McCain melanoma. Bariatric surgery is of similar medical impact, and Huckabee has no excuse to hide his status from voters.

Trust but Verify

Huckabee is as eager as the other candidates to inherit the mantle of Ronald Reagan, whose famed adage was “Trust but verify.” Huckabee can embody Reagan’s axiom by making public medical information sufficient to disprove weight loss surgery, prior to the Republican primaries.

If Huckabee can substantiate his claim that he lost his weight the old fashioned way, then verification could only add to his stature, as losing 100 lbs and keeping it off through diet and exercise is such an impressive achievement that, if anything, Huckabee has been too modest.

If, on the other hand, Huckabee were to admit to having had weight loss surgery, the magnitude of the negative political impact is uncertain. Some might think it wouldn’t much matter, if that is the case there is no reason not to disclose it. If, on the other hand it were to matter a great deal, then greater is Huckabee’s duty to the Republican cause to disclose it now, so that the GOP nominee can be chosen fully appraised of each candidate’s political risks.

Methods of verification

There are several means by which Huckabee could verify his non-bariatric status. The gold standard would be to have a simple upper GI barium swallow X-Ray, which could be accomplished in less than 20 minutes at any outpatient radiology office.

If Huckabee has not had bariatric surgery, the result will provide absolute confirmation, which will only add to Huckabee’s credibility.

Huckabee probably had a barium swallow CT scan performed in 2005 to diagnose the hernia. That CT scan (report and films) would also show whether the upper GI tract is unmolested.

The hospital records from the Spigelian hernia operation would contain information, such as the operative report, and possibly laparscopic photographs, that should be able to settle the matter, although the X-rays would be more definitive.

In any case, the means exist by which the Huckabee campaign could, at any time and in less than an hour, eliminate all doubt for all time about Huckabee’s weight loss story.