Obesity surgery figures escalate
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.’’