The New Old Age Blog: A Son Lost, a Mother Found

My friend Yvonne was already at the front door when I woke, so at first I didn’t realize that my mother was missing.

It was less than a week after my son Spencer died. Since that day, a constant stream of friends had been coming and going, bringing casseroles and soup, love, support and chatter. Mom hated it.

My 94-year-old mother, who has vascular dementia, has been living in my home in upstate New York for the past few years. Like many with dementia, mom is courteous but, underneath, irascible. Pride defines her, especially pride in her Phi Beta Kappa intellect. She hates to be confronted with how she has become, as she calls it, “stupid.”

The parade of strangers confused her. She had to be polite, field solicitous questions, endure mundane comments. She could not remember what was going on or why people were there. It must have been stressful and annoying.

That night, like every night since the state troopers brought the news, I woke hourly, tumbling in panic. As if it were not too late to save my son. Mom knew something was wrong, but she could not remember what. As I overslept that morning, she must have decided enough was enough. She was going home.

In a cold sky, the sun blazed over tall pines. As I opened the door, the dogs raced out to greet Yvonne and her two housecleaners. Yvonne often brags about her cleaning duo. They were her gift to me. They were going to clean my house before the funeral reception, which was scheduled for later that week. This was a very big gift because, like my mother before me, I am a very bad housekeeper.

Mom’s door was shut. I cautioned the housecleaners to avoid her room as I showed them around. Yvonne went to the kitchen to listen to the 37 unheard messages on my answering machine; the housecleaners went out to their van to get their instruments of dirt removal.

I ducked into Mom’s room to warn her about the upcoming noise. The bed was unmade; the floor was littered with crumpled tissues; the room was empty.

Normally, I would have freaked out right then. I knew Mom was not in the house, because I had just shown the whole house to the cleaners. Although Mom doesn’t wander like some dementia patients, she does on occasion run away. But I could not muster a shred of anxiety.

“Yvonne,” I called, “did you see my mother outside?”

Yvonne popped her head into the living room, eyebrows raised.“Outside? No!” She was alarmed. “Is she missing?”

“Yeah,” I said wearily, “I’ll look.” I stepped out onto the front porch, tightening the belt of my bathrobe and turning up the collar. Maybe she had walked off into the woods. The dogs danced around my legs, wanting breakfast.

I had no space left in my body to care. Either we would find her, or we would not. Either she was alive, or she was not. My child was gone. How could I care about anything ever again?

Then I saw my car was missing. My mouth fell open and my eyeballs rolled up to the right, gazing blindly at the abandoned bird’s nest on top of the porch light: What had I done with the keys?

Mom likes to run away in the car when she is angry. She used to do it a lot when my father was still alive — every time they fought. Since Mom took off in my car almost a year ago, after we had had a fight, I’d kept the keys hidden. Except for this week; this week, I had forgotten.

I was reverting to old habits. I had left the doors unlocked and the keys in the cupholder next to the driver’s seat. Exactly like Mom used to do.

“Uh-oh,” I said aloud. Mom was still capable of driving, even though she did not know where she was going. I just really, really hoped that she didn’t hurt anybody on the road. I pulled out my cellphone, about to call the police.

“Celia!” Yvonne shouted from the kitchen. She hurried up behind me, excited. “They found your mother. There are two messages on your machine.”

At that very moment, Mom was holed up at the College Diner in New Paltz, a 20-minute drive over the mountain, through the fields, left over the Wallkill River and away down Main Street.

Yvonne called the diner. They promised to keep the car keys until someone arrived. By that time, Yvonne had to go to work. She drove my friend Elizabeth to the diner, and Elizabeth drove Mom home in my car.

Half an hour later, they walked in the front door. Mom’s cheeks were rouged by the chill air and her eyes sparkled, her white hair riffing with static electricity. “Hello, hello,” she sang out. “Here we are.” She was wearing the flannel nightgown and robe I had dressed her in the night before. It was covered by her oversized purple parka, and her bare feet were shoved into sneakers.

I started laughing as soon as I saw her. I couldn’t help it. Elizabeth and Mom started laughing too. “You had a big adventure,” I said, hugging them both. “How are you?”

“I’m just marvelous,” said my mother. Mom always feels great after doing something rakish. We settled her on the sofa with her feet on the ottoman. By the time I got her blanket tucked in around her shoulders, she had fallen asleep.

Elizabeth couldn’t stop laughing as she described the scene. “Your mother was holding court in this big booth. She was sitting there in her nightgown and her parka, talking to everybody, with this plate of toast and coffee and, like, three of the staff hovering around her.”

The waitress said Mom seemed “a little disoriented” when she got there. Mom said she was meeting a friend for breakfast, but since she was wearing a nightgown and didn’t know whom she was meeting or where she lived, the staff thought there might be a problem. They convinced Mom to let them look in the glove compartment of the car, where they found my name and number.

It was then that I realized I was laughing – something I’d thought I would never be able to do again. “Elizabeth, Elizabeth, I’m laughing,” I said.

“Ha, ha, ha,” laughed Elizabeth, holding her belly.

“Ha, ha, ha,” I laughed, rolling on the floor.

And she who gave me life, who had suffered the death of my child and the extinction of her own intellect, snoozed on: oblivious, jubilant, still herself, still mine.

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A slick stereotype: L.A. drivers unable to handle the rain

Far removed from the many SigAlerts and traffic accidents caused by the rain, umbrella-toting pedestrians stroll on the Huntington Beach Pier before dawn on Thursday. (Mark Boster / Los Angeles Times / November 29, 2012)

By Kate Mather, Los Angeles Times

November 29, 2012, 7:56 p.m.

You know what they say: L.A. drivers can't handle the rain.

Many motorists didn't disprove the stereotype Thursday as rain slickened roadways and snarled the morning commute. The California Highway Patrol reported more than three times as many accidents (294) between 12:01 a.m. and 4:30 p.m. Thursday than in the same time period a week ago (90), on Thanksgiving.

Although there were some morning crashes that shut down area freeways — including a jackknifed big rig on the 5 Freeway in Glendale and a fatal crash on the 134 in Toluca Lake — CHP Officer Ed Jacobs said most were single-car spinouts.

"People are driving too fast for the roadway," Jacobs said. "Slow down. It's really simple. There is no other thing to do."

Of the many jokes about the storm shared via social media, many focused on traffic.

"Los Angeles + rain = Carmageddon," @Nick_Favorite wrote.

"The only thing worse than LA drivers? LA drivers in the rain," @LiliannaEvelyn said.

But drivers, beware. More wet weather is in store for California through the weekend. Forecasters said scattered showers should persist as a series of storms passes through the area, the strongest of which should hit Sunday afternoon and evening.

Jacobs called the number of reported accidents "huge" but said it was typical for a rainy day in Los Angeles.

But is it proof L.A. drivers can't handle the rain?

"You'll have to draw your own conclusion on that one," Jacobs said.

kate.mather@latimes.com

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New Camera Snaps All-Sky Auroras in Full Color

Capturing a multicolored, all-sky image of the auroras that decorate Earth’s polar skies is now possible.

Normally, studying these shimmering phenomena means taking multiple images of an aurora, using different filters that block or image different wavelengths. Now, a camera with tunable liquid crystal filters can capture many colors at once, a team of space-weather researchers reports Nov. 29 in Optics Express.

Called NORUSCA II, the camera also takes pictures of the entire sky. Scientists are hoping that such precision aurora-imaging will help them better understand and classify the celestial light shows.

The team tested the sky-gazing camera at the Kjell Henriksen Observatory in Svalbard, Norway, during the auroral season of 2011 and 2012. On Jan. 24, 2012, an enormous solar flare flung a blob of charged particles in Earth’s direction. The skies over Svalbard lit up as the particles struck Earth’s atmosphere, producing a bright green aurora and intense geomagnetic storm.

Charged particles colliding with different gases in Earth’s atmosphere produce the multicolored auroras. For example, oxygen atoms can glow green or red, depending on their altitude. Hydrogen and helium high in the ionosphere can produce shimmering blue or purple. Nitrogen? Red, violet, or blue.

The new camera captured these swirling lights using many different wavelength channels; individual frames from the Jan. 24 event have been stitched together in the video above. And the camera is sensitive enough to see daytime auroras, like the reddish lights flickering across the sky on Dec. 29, 2011 (video below).

Videos: Optics Express, Vol. 20, Issue 25.

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Adkins explains Confederate flag earpiece

NEW YORK (AP) — Trace Adkins wore an earpiece decorated like the Confederate flag when he performed for the Rockefeller Center Christmas Tree Lighting but says he meant no offense by it.

Adkins appeared with the earpiece on a nationally televised special for the lighting on Wednesday. Some regard the flag as a racist symbol and criticized Adkins in Twitter postings.

But in a statement released Thursday, the Louisiana native called himself a proud American who objects to any oppression and says the flag represents his Southern heritage.

He noted he’s a descendant of Confederate soldiers and says he did not intend offense by wearing it.

Adkins — on a USO tour in Japan — also called for the preservation of America’s battlefields and an “honest conversation about the country’s history.”

___

Online:

http://www.traceadkins.com

Entertainment News Headlines – Yahoo! News

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Medicare Is Faulted in Electronic Medical Records Conversion

The conversion to electronic medical records — a critical piece of the Obama administration’s plan for health care reform — is “vulnerable” to fraud and abuse because of the failure of Medicare officials to develop appropriate safeguards, according to a sharply critical report to be issued Thursday by federal investigators.

Mike Spencer/Wilmington Star-News, via Associated Press

Celeste Stephens, a nurse, leads a session on electronic records at New Hanover Regional Medical Center in Wilmington, N.C.

Centers for Medicare and Medicaid Services

Marilyn Tavenner, acting administrator for Medicare.

The use of electronic medical records has been central to the aim of overhauling health care in America. Advocates contend that electronic records systems will improve patient care and lower costs through better coordination of medical services, and the Obama administration is spending billions of dollars to encourage doctors and hospitals to switch to electronic records to track patient care.

But the report says Medicare, which is charged with managing the incentive program that encourages the adoption of electronic records, has failed to put in place adequate safeguards to ensure that information being provided by hospitals and doctors about their electronic records systems is accurate. To qualify for the incentive payments, doctors and hospitals must demonstrate that the systems lead to better patient care, meeting a so-called meaningful use standard by, for example, checking for harmful drug interactions.

Medicare “faces obstacles” in overseeing the electronic records incentive program “that leave the program vulnerable to paying incentives to professionals and hospitals that do not fully meet the meaningful use requirements,” the investigators concluded. The report was prepared by the Office of Inspector General for the Department of Health and Human Services, which oversees Medicare.

The investigators contrasted the looser management of the incentive program with the agency’s pledge to more closely monitor Medicare payments of medical claims. Medicare officials have indicated that the agency intends to move away from a “pay and chase” model, in which it tried to get back any money it has paid in error, to one in which it focuses on trying to avoid making unjustified payments in the first place.

Late Wednesday, a Medicare spokesman said in a statement: “Protecting taxpayer dollars is our top priority and we have implemented aggressive procedures to hold providers accountable. Making a false claim is a serious offense with serious consequences and we believe the overwhelming majority of doctors and hospitals take seriously their responsibility to honestly report their performance.”

The government’s investment in electronic records was authorized under the broader stimulus package passed in 2009. Medicare expects to spend nearly $7 billion over five years as a way of inducing doctors and hospitals to adopt and use electronic records. So far, the report said, the agency has paid 74, 317 health professionals and 1,333 hospitals. By attesting that they meet the criteria established under the program, a doctor can receive as much as $44,000 for adopting electronic records, while a hospital could be paid as much as $2 million in the first year of its adoption. The inspector general’s report follows earlier concerns among regulators and others over whether doctors and hospitals are using electronic records inappropriately to charge more for services, as reported by The New York Times last September, and is likely to fuel the debate over the government’s efforts to promote electronic records. Critics say the push for electronic records may be resulting in higher Medicare spending with little in the way of improvement in patients’ health. Thursday’s report did not address patient care.

Even those within the industry say the speed with which systems are being developed and adopted by hospitals and doctors has led to a lack of clarity over how the records should be used and concerns about their overall accuracy.

“We’ve gone from the horse and buggy to the Model T, and we don’t know the rules of the road. Now we’ve had a big car pileup,” said Lynne Thomas Gordon, the chief executive of the American Health Information Management Association, a trade group in Chicago. The association, which contends more study is needed to determine whether hospitals and doctors actually are abusing electronic records to increase their payments, says it supports more clarity.

Although there is little disagreement over the potential benefits of electronic records in reducing duplicative tests and avoiding medical errors, critics increasingly argue that the federal government has not devoted enough time or resources to making certain the money it is investing is being well spent.

House Republicans echoed these concerns in early October in a letter to Kathleen Sebelius, secretary of health and human services. Citing the Times article, they called for suspending the incentive program until concerns about standardization had been resolved. “The top House policy makers on health care are concerned that H.H.S. is squandering taxpayer dollars by asking little of providers in return for incentive payments,” said a statement issued at the same time by the Republicans, who are likely to seize on the latest inspector general report as further evidence of lax oversight. Republicans have said they will continue to monitor the program.

In her letter in response, which has not been made public, Ms. Sebelius dismissed the idea of suspending the incentive program, arguing that it “would be profoundly unfair to the hospitals and eligible professionals that have invested billions of dollars and devoted countless hours of work to purchase and install systems and educate staff.” She said Medicare was trying to determine whether electronic records had been used in any fraudulent billing but she insisted that the current efforts to certify the systems and address the concerns raised by the Republicans and others were adequate.

This article has been revised to reflect the following correction:

Correction: November 30, 2012

An article on Thursday about a federal report critical of Medicare’s performance in assuring accuracy as doctors and hospitals switch to electronic medical records misstated, in some copies, the timing of a statement from a Medicare spokesman in response to the report. The statement was released late Wednesday, not late Thursday.

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Most Americans Face Lower Tax Burden Than in the 80s

What Is Fair?:
Taxes are still a hot topic after the presidential election. But as a country that spends more than it collects in taxes, are we asking the right taxpayers to pay the right amounts?

BELLEVILLE, Ill. — Alan Hicks divides long days between the insurance business he started in the late 1970s and the barbecue restaurant he opened with his sons three years ago. He earned more than $250,000 last year and said taxes took more than 40 percent. What’s worse, in his view, is that others — the wealthy, hiding in loopholes; the poor, living on government benefits — are not paying their fair share.

Kirsten Luce for The New York Times

"I don't have the answer of where to pull back. I want the state parks to stay open. I want, I want, I want. I want Big Bird, I think it's beautiful. What don't I want? I don't know," said Anita Thole, a safety supervisor for a utility contractor.

“It feels like the harder we work, the more they take from us,” said Mr. Hicks, 55, as he waited for a meat truck one recent afternoon. “And it seems like there’s an awful lot of people in the United States who don’t pay any taxes.”

These are common sentiments in the eastern suburbs of St. Louis, a region of fading factory towns fringed by new subdivisions. Here, as across the country, people like Mr. Hicks are pained by the conviction that they are paying ever more to finance the expansion of government.

But in fact, most Americans in 2010 paid far less in total taxes — federal, state and local — than they would have paid 30 years ago. According to an analysis by The New York Times, the combination of all income taxes, sales taxes and property taxes took a smaller share of their income than it took from households with the same inflation-adjusted income in 1980.

Households earning more than $200,000 benefited from the largest percentage declines in total taxation as a share of income. Middle-income households benefited, too. More than 85 percent of households with earnings above $25,000 paid less in total taxes than comparable households in 1980.

Lower-income households, however, saved little or nothing. Many pay no federal income taxes, but they do pay a range of other levies, like federal payroll taxes, state sales taxes and local property taxes. Only about half of taxpaying households with incomes below $25,000 paid less in 2010.

The uneven decline is a result of two trends. Congress cut federal taxation at every income level over the last 30 years. State and local taxes, meanwhile, increased for most Americans. Those taxes generally take a larger share of income from those who make less, so the increases offset more and more of the federal savings at lower levels of income.

In a half-dozen states, including Connecticut, Florida and New Jersey, the increases were large enough to offset the federal savings for most households, not just the poorer ones.

Now an era of tax cuts may be reaching its end. The federal government depends increasingly on borrowed money to pay its bills, and many state and local governments are similarly confronting the reality that they are spending more money than they collect. In Washington, debates about tax cuts have yielded to debates about who should pay more.

President Obama campaigned for re-election on a promise to take a larger share of taxable income above roughly $250,000 a year. The White House is now negotiating with Congressional Republicans, who instead want to raise some money by reducing tax deductions. Federal spending cuts also are at issue.

If a deal is not struck by year’s end, a wide range of federal tax cuts passed since 2000 will expire and taxes will rise for roughly 90 percent of Americans, according to the independent Tax Policy Center. For lower-income households, taxation would spike well above 1980 levels. Upper-income households would lose some but not all of the benefits of tax cuts over the last three decades.

Public debate over taxes has typically focused on the federal income tax, but that now accounts for less than a third of the total tax revenues collected by federal, state and local governments. To analyze the total burden, The Times created a model, in consultation with experts, which estimated total tax bills for each taxpayer in each year from 1980, when the election of President Ronald Reagan opened an era of tax cutting, up to 2010, the most recent year for which relevant data is available.

The analysis shows that the overall burden of taxation declined as a share of income in the 1980s, rose to a new peak in the 1990s and fell again in the 2000s. Tax rates at most income levels were lower in 2010 than at any point during the 1980s.

Governments still collected the same share of total income in 2010 as in 1980 — 31 cents from every dollar — because people with higher incomes pay taxes at higher rates, and household incomes rose over the last three decades, particularly at the top.

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Kuang-hsun Ting dies at 97; bishop led Protestant church in China

Bishop Kuang-hsun Ting, who was one of the most influential Christian figures in China as the longtime leader of the country's government-sanctioned Protestant church, has died. He was 97.

Ting died Nov. 22 at his home in Nanjing, according to statements from religious organizations he led. A cause of death was not given.

For many years, Ting headed the Three-Self Patriotic Movement and the China Christian Council, the two government-sanctioned Protestant organizations that together form the official Protestant church in China. He was also the longtime president of the Nanjing Union Theological Seminary and helped launch the Amity Foundation, serving as board president of that social service organization until his death.

Ting's close cooperation with China's Communist Party and central government earned him both praise and criticism throughout his long career. Supporters said he had helped protect and promote the interests of Protestants in China, while critics accused him of being too close to the government and at times even joining in the persecution of unregistered or "house" churches.

"He has a positive legacy in many people's eyes because he pushed forward Protestant Christianity and its interests in China, albeit under the scope of the government," said Carsten T. Vala, an expert on Chinese Protestant Christianity who teaches at Loyola University in Maryland. "But he was also a lightning rod, seen by those in the house churches as having compromised by leading the Communist Party-controlled church."

As head of the official church, Ting was often in a tough position as he balanced religious and political demands, said Fenggang Yang, director of Purdue University's Center on Religion and Chinese Society.

"He had to make compromises, otherwise the Protestants could suffer even more," Yang said. "Did he personally totally agree with the government or government policy? Maybe not. I think he also tried to help the government-sanctioned churches and some house churches. But many house churches don't see it that way."

Born Sept. 20, 1915, in Shanghai, Ting studied at St. John's University in that city and was ordained an Anglican priest in 1942. He served as mission secretary for the Student Christian Movement in Canada and later studied at Columbia University and Union Theological Seminary in New York.

In the early 1950s, he was on the staff of the World Student Christian Federation in Geneva, then returned to China. In 1955, he was ordained an Anglican bishop, a title he retained for the rest of his life.

Richard J. Mouw, president of Fuller Theological Seminary in Pasadena and a friend, said Ting had helped create an indigenous Christianity in China.

"He tried to find a way in which the church could remain true to itself but be a partner to government and other cultural forces in China," Mouw said. He was "a deeply Christian person coping as best he could with the demands of government, while keeping alive the essentials of Christianity in China."

Ting's survivors include two sons.

rebecca.trounson@latimes.com

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Mercedes Rolls Out the Future of the SUV

LOS ANGELES, California – Geländewagen. It’s not an Austrian insult or some obscure epithet from the Eastern Bloc; it’s Mercedes-Benz’ iconic SUV. Originally crafted with a ruler and a chisel for military use, it eventually went on sale to civilians in 1979 and hasn’t changed much during its 30-plus-year run. Until now.

Mercedes knows that the G-Wagon will have to be updated at some point, and the Ener-G-Force concept gives us an indication of what the crew from Stuttgart is thinking for its next big and brash ‘ute – in the year 2025.

Like its forebear, this new G was originally envisioned by its Advanced Design Studio in Carlsbad, California, to be the mother-truckin’ ride for the Highway Patrol, and then toned down for use by Hollywood soccer moms and oil-rich Middle Easterners.

The lines and proportions are inspired by the original G, with an upright fascia, bulging wheel arches (housing 20-inch wheels and ultra-all-terrain tires) and flat roof. The LED headlamps form a perfect “G” in a nod to the concept’s heritage and the faux spare wheel well on the hatch opens up and extends outward to reveal a safety kit, tool box and other assorted off-road survival equipment.

As for the powertrain, we’ll have whatever Mercedes’ design team is smoking. Individual electric motors power each wheel – not that far-fetched – but a “hydro-tech converter” fueled by recycled water stored on the roof is transformed into hydrogen, which powers the space-age G for a claimed 500 miles of emissions-free motoring.

Less sci-fi is the roof-mounted “Terra-Scan” 360-degree topography scanner, which tracks the terrain ahead and automatically adjusts the spring and damper rates of the suspension to provide a silky smooth ride no matter what you’re driving on. Mercedes is actually working on a stereo camera-based system for future models that does just that, but the chances of it coming to the G-Class are about as good as the Ener-G-Force ever reaching production.

All photos: Alex Washburn/Wired

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Adele’s “21″ sells 10 million, Rihanna leads Billboard

LOS ANGELES (Reuters) – British singer and Grammy darling Adele reached the 10 million sales mark in the United States on Wednesday with her heartbreak album “21″ becoming the first by British woman to reach the milestone, Nielsen SoundScan said.

“21,” released in February 2011, produced the hits “Someone Like You” and “Rolling In The Deep” and became the top-selling album of 2011. Earlier this year, Adele swept the Grammy Awards with six, including song, record and album of the year.

“21″ became the third album to cross 10 million in 2012, along with Linkin Park‘s “Hybrid Theory” and Usher’s “Confessions.” But it is the only album to reach the milestone in less than two years in the last decade, Nielsen said.

“What an incredible honor,” Adele said in a statement. “A huge, huge thank you to my American fans for embracing this record on such a massive level.”

“21″ will receive the diamond certification from the Recording Industry Association of America, marking its 10 million milestone, joining the ranks of albums by artists such as Michael Jackson, The Beatles and Madonna.

“Adele‘s unique talent is a gift to music fans, and her success is certainly cause for a celebration of Diamond magnitude,” Cary Sherman, RIAA’s chairman & CEO, said in a statement.

Adele, 24, is enjoying the success of her latest single “Skyfall,” the official theme song for the James Bond film of the same name. It has sold more than 2 million copies worldwide. The singer also gave birth to her first child earlier this year.

On the Billboard 200 chart this week, R&B star Rihanna scored her first No. 1 album with “Unapologetic,” selling 238,000 copies.

She held off new entries from “American Idol” winner Phillip Phillips, who landed at No. 4 with his debut album “The World From the Side of the Moon,” and country-rock singer Kid Rock, who rounded out the top five with his latest album “Rebel Soul.”

(Reporting By Piya Sinha-Roy Editing by Jill Serjeant, Grant McCool and Andre Grenon)

Music News Headlines – Yahoo! News

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Well: Weight Loss Surgery May Not Combat Diabetes Long-Term

Weight loss surgery, which in recent years has been seen as an increasingly attractive option for treating Type 2 diabetes, may not be as effective against the disease as it was initially thought to be, according to a new report. The study found that many obese Type 2 diabetics who undergo gastric bypass surgery do not experience a remission of their disease, and of those that do, about a third redevelop diabetes within five years of their operation.

The findings contrast with the growing perception that surgery is essentially a cure for Type II diabetes. Earlier this year, two widely publicized studies reported that surgery worked better than drugs, diet and exercise in causing a remission of Type 2 diabetes in overweight people whose blood sugar was out of control, leading some experts to call for greater use of surgery in treating the disease. But the studies were small and relatively short, lasting under two years.

The latest study, published in the journal Obesity Surgery, tracked thousands of diabetics who had gastric bypass surgery for more than a decade. It found that many people whose diabetes at first went away were likely to have it return. While weight regain is a common problem among those who undergo bariatric surgery, regaining lost weight did not appear to be the cause of diabetes relapse. Instead, the study found that people whose diabetes was most severe or in its later stages when they had surgery were more likely to have a relapse, regardless of whether they regained weight.

“Some people are under the impression that you have surgery and you’re cured,” said Dr. Vivian Fonseca, the president for medicine and science for the American Diabetes Association, who was not involved in the study. “There have been a lot of claims about how wonderful surgery is for diabetes, and I think this offers a more realistic picture.”

The findings suggest that weight loss surgery may be most effective for treating diabetes in those whose disease is not very advanced. “What we’re learning is that not all diabetic patients do as well as others,” said Dr. David E. Arterburn, the lead author of the study and an associate investigator at the Group Health Research Institute in Seattle. “Those who are early in diabetes seem to do the best, which makes a case for potentially earlier intervention.”

One of the strengths of the new study was that it involved thousands of patients enrolled in three large health plans in California and Minnesota, allowing detailed tracking over many years. All told, 4,434 adult diabetics were followed between 1995 and 2008. All were obese, and all underwent Roux-en-Y operations, the most popular type of gastric bypass procedure.

After surgery, about 68 percent of patients experienced a complete remission of their diabetes. But within five years, 35 percent of those patients had it return. Taken together, that means that most of the subjects in the study, about 56 percent — a figure that includes those whose disease never remitted — had no long-lasting remission of diabetes after surgery.

The researchers found that three factors were particularly good predictors of who was likely to have a relapse of diabetes. If patients, before surgery, had a relatively long duration of diabetes, had poor control of their blood sugar, or were taking insulin, then they were least likely to benefit from gastric bypass. A patient’s weight, either before or after surgery, was not correlated with their likelihood of remission or relapse.

In Type 2 diabetes, the beta cells that produce insulin in the pancreas tend to wear out as the disease progresses, which may explain why some people benefit less from surgery. “If someone is too far advanced in their diabetes, where their pancreas is frankly toward the latter stages of being able to produce insulin, then even after losing a bunch of weight their body may not be able to produce enough insulin to control their blood sugar,” Dr. Arterburn said.

Nonetheless, he said it might be the case that obese diabetics, even those whose disease is advanced, can still benefit from gastric surgery, at least as far as their quality of life and their risk factors for heart disease and other complications are concerned.

“It’s not a surefire cure for everyone,” he said. “But almost universally, patients lose weight after weight loss surgery, and that in and of itself may have so many health benefits.”

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