Obe­sity surgery fig­ures es­ca­late

Soar­ing num­bers of obe­sity op­er­a­tions are fu­elling con­tro­versy over pro­ce­dures. Lyn­nette Hoff­man re­ports

The Weekend Australian - Travel - - Health -

IF there was a diet to be tried — fad, phar­ma­ceu­ti­cal, al­ter­na­tive or oth­er­wise — chances are Mi­caele Lalot has given it a go. From hyp­no­tism to pro­grammed meals and pre­scrip­tion pills, the 43-yearold mother of three says she strug­gled to con­trol her weight for 20 years with no longterm suc­cess, un­til she fi­nally re­sorted to gas­tric band surgery two years ago.

By then, Lalot weighed 110kg, and was get­ting heav­ier — and with a body mass in­dex of 40 she was mor­bidly obese. Her blood sugar and choles­terol lev­els were poor, and a fam­ily his­tory of di­a­betes and heart dis­ease loomed large in the back­ground.

‘‘ Af­ter 20 years I was re­signed to the fact that I was al­ways go­ing to be a large lady — but when I re­alised my choles­terol and blood sugar were up, I de­cided I had to do some­thing dras­tic,’’ she says. ‘‘ I didn’t want to be giv­ing my­self nee­dles for the rest of my life.’’

While most band­ing pa­tients lose an av­er­age of about 60 per cent of the ex­tra weight they’re car­ry­ing, Lalot lost even more. In the 12 months fol­low­ing her surgery, she dropped from 110kg to 60kg — and so far she’s kept it off. Her post-surgery BMI of 21 falls right in the mid­dle of the healthy range and her blood sugar and choles­terol have re­turned to nor­mal. Latest fig­ures show Lalot is far from alone. This week, health fund MBF re­leased fig­ures show­ing claims for obe­sity-re­lated surgery had more than dou­bled in five years — and the cost had nearly tripled.

MBF said while it only re­ceived 459 claims for obe­sity surgery in 2002, by last year that num­ber had soared to 1102 — and the cost shot up from $2.4 mil­lion to $6.9 mil­lion.

The na­tion’s big­gest private fund, Med­ibank Private, said its fig­ures rose even more dra­mat­i­cally, from 641 to 1521 over the past five years — in­clud­ing a 12 per cent in­crease last year alone. The cost in­creased at an av­er­age rate of 36 per cent each year. Both funds ex­pect the in­creases to con­tinue. ‘‘ We’re in­ter­pret­ing this as a di­rect mea­sure of the sever­ity of obe­sity in Aus­tralia,’’ MBF’s chief med­i­cal of­fi­cer Chris­tine Ben­nett said. ‘‘ The surgery is clin­i­cally in­di­cated when other meth­ods have been un­suc­cess­ful — it’s a life­sav­ing op­er­a­tion and we’re not sug­gest­ing it’s be­ing done in­ap­pro­pri­ately.’’

Not ev­ery­one is con­vinced.

Con­sumer health ad­vo­cate Michele Kosky, of the Health Con­sumers’ Coun­cil in West­ern Aus­tralia, is con­cerned mar­ket forces may drive up the num­ber of op­er­a­tions when they may not be in the pa­tient’s best in­ter­est.

‘‘ Medicine is not quar­an­tined from the mar­ket econ­omy that we live in,’’ Kosky says. ‘‘ Clearly, for some pa­tients lap-band­ing surgery is im­por­tant as a last re­sort treat­ment. But there is wide­spread mar­ket­ing of this pro­ce­dure in a way that re­minds us of cos­metic surgery — and that might sug­gest a com­mer­cial im­per­a­tive rather than a clin­i­cal de­ci­sion shared with the pa­tient.’’

There have also been re­cent con­cerns over one type of obe­sity surgery — a rel­a­tively rare and dras­tic op­er­a­tion known as bil­iary pan­cre­atic di­ver­sion. The Week­end Aus­tralian last week re­vealed an in­quiry has been launched by Queens­land au­thor­i­ties into th­ese BPD pro­ce­dures in the state, fol­low­ing a cam­paign by the daugh­ter of a wo­man who died in hor­rific cir­cum­stances four months af­ter the pro­ce­dure.

But in gen­eral, and es­pe­cially in re­la­tion to the much more con­ser­va­tive gas­tric band­ing pro­ce­dure, ex­perts say surgery is safe and ef­fec­tive.

In Lalot’s case, the post-surgery regime was a chal­lenge at first. She was forced to have noth­ing but liq­uid for the first two weeks, then mushy food like mashed potato or yo­gurt for an­other two weeks. But af­ter nine months Lalot says she was back to eat­ing what­ever she wanted — just smaller por­tions.

‘‘ I used to have maybe four slices of pizza, and then an hour or two later I’d have two more slices,’’ she says. ‘‘ Now I eat one slice of pizza, maybe two, and I’m full. I feel very con­tented af­ter­wards. There’s no go­ing back — and I never feel like I’m go­ing with­out.’’

As­so­ci­ate pro­fes­sor John Dixon, head of clin­i­cal stud­ies at Monash Univer­sity’s Cen­tre for Obe­sity Re­search and Ed­u­ca­tion, says that only a tiny mi­nor­ity of ex­tremely ded­i­cated obese peo­ple are able to lose large amounts of weight through lifestyle changes. Few man­age to lose more than 10kg.

About 95 per cent of the weight-loss surg­eries per­formed in Aus­tralia are ‘‘ gas­tric band­ing’’ op­er­a­tions, in which keyhole surgery is used to wrap a band around the up­per end of the stom­ach. Along with re­duc­ing stom­ach ca­pac­ity, this de­creases ap­petite by putting pres­sure on nerves in the stom­ach that di­rectly con­nect to the part of the brain that con­trols hunger.

‘‘ A per­son with a gas­tric band can eat ap­prox­i­mately what a two-year-old eats and not feel hun­gry,’’ Dixon says.

While there are risks as­so­ci­ated with any ma­jor surgery, gas­tric band­ing is sig­nif­i­cantly less risky than other weight loss surg­eries that are some­times per­formed — such as more in­va­sive pro­ce­dures in­clud­ing gas­tric by­pass surgery, where the stom­ach is sta­pled, and BPD, where much of the stom­ach is re­moved along with part of the in­tes­tine so that fat can­not be ab­sorbed.

Pa­tients are likely to lose more weight faster with th­ese more com­plex op­er­a­tions, but the risk of com­pli­ca­tions is much greater.

Though rare in Aus­tralia — about 400

Pic­ture: Tony Phillips

Health­ier, hap­pier: Mi­caele Lalot with grand­chil­dren Si­enna and Bran­don. Lalot has shed 50kg since the pic­ture be­low was taken

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