Obesity surgery figures escalate
Soaring numbers of obesity operations are fuelling controversy over procedures. Lynnette Hoffman reports
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
Healthier, happier: Micaele Lalot with grandchildren Sienna and Brandon. Lalot has shed 50kg since the picture below was taken