Weighing up weight loss surgery
It will be no surprise to hear that we are in the midst of an obesity epidemic. We have the third highest rate in the developed world, with a staggering 32 per cent of Kiwis classified as obese, and another 35 per cent overweight.
That leaves less than a third of our adult population living within the healthy weight range. This has huge social and medical implications and ismassively expensive – figures from 2009 estimated that obesity cost New Zealand between $700-800 million a year, in health care and lost productivity, and undoubtedly that figure will have risen since then.
The solution is far too complex for me to debate in this forum – multifactorial problems usually require multifactorial solutions, so addressing personal obesity issues, without looking at the wider picture of societal, legislative and cultural pressures, is unlikely to be effective, and is unfair. If we live in a country where soft drinks are cheaper than milk, and fast-food outlets operate on every corner (particularly near schools), then pointing the finger at any one person is easy, but not helpful or accurate.
There are lots of unknowns around the issue – but one thing we do know is that obesity surgery (bariatric surgery) is successful, and likely to be far more so than diet or lifestyle interventions. But it is not without risk, and requires a lifelong commitment by the individual and the healthcare team. So if this is something you are considering, here are some facts about what is available in New Zealand, and what you should think about before committing: ❚ Weight loss surgery is designed for those people who are morbidly obese, and have been unsuccessful at keeping weight off by any other method. In numerical terms, that means people who have a BMI of 40kg/m2 or higher.
❚ People who are in the mild to moderate obese range (with BMIs of 35-40) may also benefit if they have a co-existing health condition such as diabetes, sleep apnoea, or arthritis. A study in Sweden showed a 72 per cent remission rate in diabetes two years after weight loss surgery, as well as a reduction in overall mortality of around 29 per cent. If you consider the cost of diabetes alone to our health system, this in itself is a pretty compelling argument.
❚ In New Zealand, weight loss surgery is not available in all centres, so check the Ministry of Health’s website, or talk to your GP to find out where your nearest specialist team is located. It is important that you get your surgery performed by someone who has plenty of experience in this field, as complications can and do arise. There are options for getting the surgery funded on the public system, if you meet the BMI and other criteria, but private surgery is also available.
We only have three types of bariatric surgery available at present, although there are plenty more procedures being used
overseas. Current options are:
Adjustable gastric banding
This surgery places an adjustable band around the upper stomach, creating a pouch with a 15-30ml capacity. The band is filled or emptied by adding or removing saline via a port underneath the skin. The extra volume in the band suppresses your appetite, but the effect can wear off so intermittent refilling of the band is usually required. It can be reversed by removing the band. This method is not as successful as the other two in terms of weight loss.
Sleeve gastrectomy
This irreversible operation removes around 3⁄4 of the stomach, and creates a long sleeve or tube in its place.
Roux-en-y gastric bypass
This involves changing the passage for absorbing food, and creating a small pouch in the stomach with a very narrow outlet. This not only reduces appetite, but also reduces the absorption of food and hence the calories going into the body.
It is usually possible to do all of these procedures via keyhole, rather than big open surgery. This makes recovery quicker. Complication rates vary from 4 to 25 per cent in the first six months following surgery, and depend on both the type of procedure used, the degree of follow up care, and individual risk factors. Prior to any surgery all of these risks should be fully discussed with you, so you can weigh up the potential risks and benefits.
Ongoing input is required for life from your healthcare team, partly to provide psychological support, diet and exercise advice, but also to avoid nutritional deficiencies in the future.
For more information, visit healthnavigator.org.nz.
❚ Dr Cathy Stephenson is a GP and a forensic medical examiner.