Obe­sity surgery fig­ures es­ca­late

The Weekend Australian - Travel - - Health -

gas­tric by­pass surg­eries and fewer than 100 bil­iary pan­cre­atic di­ver­sion surg­eries were per­formed last year — th­ese pro­ce­dures have gar­nered at­ten­tion in re­cent weeks, in part due to the Queens­land in­ves­ti­ga­tion and the cam­paign by Leesa MacLeod, the wo­man whose mother, Ur­sula, died.

The risk of death from gas­tric by­pass surgery is about 10 times higher than in gas­tric band­ing, which has about the same risk as surgery to re­move the gall blad­der, Dixon says.

Ex­perts say the soar­ing num­ber of gas­tric band­ing surg­eries has been spurred by sev­eral stud­ies that demon­strate sub­stan­tial health ben­e­fits and cost ef­fec­tive­ness.

‘‘ One of the most dra­matic out­comes is that di­a­betes im­proves or re­solves com­pletely by go­ing into re­mis­sion,’’ Dixon says. About 75 per cent of pa­tients ‘‘ lose their di­a­betes’’ when the weight dis­ap­pears, he says. Other re­search has shown sig­nif­i­cant im­prove­ment in sleep ap­noea, in­fer­til­ity, choles­terol lev­els, blood pres­sure, de­pres­sion and over­all qual­ity of life ( MJA 2005;183(6):310-314).

A Swedish study pub­lished in the New Eng­land Jour­nal of Medicine last month (2007;357:741-752,818-820) tracked mor­tal­ity among more than 4000 obese pa­tients, roughly half of whom re­ceived obe­sity surgery while the rest had con­ven­tional lifestyle and phar­ma­ceu­ti­cal treat­ment. Pa­tients who had the sur­gi­cal in­ter­ven­tions had sig­nif­i­cantly lower mor­tal­ity rates.

‘‘ It’s a proven method that has been shown to re­duce mor­tal­ity and dis­ease, so it re­ally should be the treat­ment of choice,’’ says Ian Cater­son, pro­fes­sor of hu­man nu­tri­tion at Syd­ney Univer­sity.

But it doesn’t come cheap. The av­er­age cost of such surgery is about $7600, ac­cord­ing to fig­ures from Med­ibank Private, and when you fac­tor in ad­di­tional post­op­er­a­tive care and fol­low-up it can be higher.

But that has to be weighed against the cost of man­ag­ing obe­sity-re­lated dis­eases, which was es­ti­mated at nearly $11,000 per pa­tient per year by Di­a­betes Aus­tralia in 2003, and now hov­ers around $16,000 a year.

Not only are more peo­ple be­com­ing obese each year, but the num­ber of ex­tremely obese peo­ple at the top end of the spec­trum is also in­creas­ing, mak­ing early pre­ven­tion all the more im­por­tant, says Boyd Swin­burn, pro­fes­sor of pop­u­la­tion health at Deakin Univer­sity and di­rec­tor of the World Health Or­gan­i­sa­tion’s Col­lab­o­rat­ing Cen­tre on Obe­sity Pre­ven­tion.

‘‘ Surgery is an im­por­tant strat­egy to help those in­di­vid­u­als who are al­ready obese — they can’t be ig­nored. But at a pop­u­la­tion level it’s a bit like putting an am­bu­lance at the bot­tom of a cliff. Even if it’s a very good am­bu­lance, it’s bet­ter not to have to use it in the first place,’’ he says.

Gas­tric bands are no won­der-surgery. Fol­low-up is in­tense, par­tic­u­larly in the first year, and pa­tients have to watch care­fully how they eat. About 10 per cent of pa­tients need the band sur­gi­cally read­justed in the first 10 years, usu­ally be­cause the way they ate has caused their stom­ach to stretch. Bands can also slip or erode, and not all pa­tients lose as much weight as they hope, though most do.

Far from a quick fix, Cater­son says proper screen­ing is es­sen­tial to en­sure pa­tients hav­ing the surgery are com­mit­ted and re­li­able and will fol­low post-surgery guide­lines, and to make sure no ma­jor psy­cho­log­i­cal is­sues are un­der­ly­ing their obe­sity. He also stressed surgery should only be used in ‘‘ the worst cases’’.

Guide­lines by the Na­tional Health and Med­i­cal Re­search Coun­cil rec­om­mend the surgery be re­stricted to peo­ple over 18 who have a body mass in­dex of more than 40, or greater than 35 along with other health prob­lems. They should also have al­ready tried con­ven­tional weight-loss tech­niques with­out suc­cess.

Not­with­stand­ing Kosky’s con­cerns that this may not al­ways be hap­pen­ing, oth­ers — Cater­son, Swin­burn and Dixon in­cluded — say that even with the rapidly ris­ing num­bers of peo­ple ac­cess­ing surgery, there are many more who could ben­e­fit from it, if they could af­ford it. Of all the obe­sity-re­lated surg­eries last year, fewer than 1000 were funded un­der the pub­lic sys­tem.

Pro­fes­sor Paul O’Brien, a bari­atric sur­geon and di­rec­tor of the Cen­tre for Obe­sity Re­search and Ed­u­ca­tion at Monash Univer­sity, is among those push­ing for more pub­lic fund­ing.

‘‘ It’s the most pow­er­ful way that we have to help peo­ple lose large amounts of weight — it’s like find­ing a new an­tibi­otic,’’ O’Brien says. ‘‘ There are 2 or 3 mil­lion Aus­tralians that would ac­tu­ally ben­e­fit from the pro­ce­dure, so we should be treat­ing 50,000 to 60,000 peo­ple a year, par­tic­u­larly in the pub­lic hospi­tal sec­tor. But in re­al­ity, very few pub­lic pa­tients get ac­cess.’’

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