Gastric bands can be mental torture
SOlvINg our country’s obesity crisis through surgery is a nice idea. forget diets, willpower and treadmills: all you need is a scalpel-wielding doctor and, hey presto, problem solved.
As a society, we are undoubtedly groaning under the weight of the obese. But is surgery really the answer?
In a statement this week, clinicians and academics from a number of institutions and charities, including Diabetes UK, argued precisely this. They cited studies that have shown bariatric surgery — a term used to describe several procedures that result in weight loss, such as gastric bands — results in remission of type 2 diabetes by up to 50 per cent.
They claim that under clinical guidelines issued in 2014, up to a million people in Britain with diabetes are eligible for bariatric surgery, but the NHS is not offering the procedure as standard care.
The claim will heap further pressure on the NHS to increase this type of surgery at a time when many routine operations, such as cataracts and knee and hip operations, are being reduced. can this really be right?
The thing to realise is that surgery doesn’t itself reverse type 2 diabetes. By shrinking or removing parts of the stomach, it causes the patient to lose weight — and this can improve their diabetes. This will happen, though, regardless of the method by which someone loses weight.
If you read the statement, you’d be forgiven for thinking that surgery is the best way to lose weight.
However, as a doctor who specialises in eating disorders, I think the idea that diabetes can be ‘ cured’ by surgery is not just misleading but also dangerous. It gives entirely the wrong message to overweight patients.
Bariatric surgery may appear to be an appealing quick fix, but it is far from the panacea it is made out to be.
first, it must be noted that type 2 diabetes accounts for 90 per cent of all people with diabetes. Unlike type 1, which people can be born with, type 2 is, in the vast majority of cases, a disease of lifestyle. In type 2 diabetes, the body becomes increasingly resistant to the effects of the hormone insulin, so that the glucose stays in the blood — causing high sugar levels — rather than being taken up into the cells.
THe more obese you are, the more likely it is that the body will become resistant to the effects of insulin. By reducing someone’s weight, the body’s ability to respond to insulin and handle sugar can, for some people, return.
So yes, weight-loss surgery can have a positive impact on some patients, but there are better ways to reach the same end.
As well as surgery bringing the risk of nutritional and dietary issues, the rapid weight loss involved can result in large amounts of excess skin. However, even that pales into insignificance when you realise the psychological problems it can create.
Diabetes is merely a symptom of being obese, and examining the root cause why someone is obese is crucial. Though this might seem obvious — they eat too much — there are a variety of underlying reasons why someone does so, which surgery doesn’t address.
for a lot of people, there is a significant psychological component to their obesity. They may use food as an emotional crutch and over-eat as a way of coping.
After bariatric surgery, they are unable to turn to this familiar coping strategy. This leaves them in overwhelming distress, unable to deal with their emotions. Many patients have told me it feels as if they are being mentally tortured.
Depending on the exact opera- tion, as many as 20 per cent of patients will find ways around the procedure, such as continually snacking, and gain a significant amount of weight back. Some even liquidise junk food to get it into their shrunken stomachs.
This might sound extraordinary, but it only emphasises how these people had a profound problem with food before surgery, which an operation cannot hope to solve.
A study of 17,000 people who had undergone surgery showed that they are at higher risk of suicide — probably because of the psychological pressure of all the lifestyle changes that must be adopted post-surgery.
ReSeARcH has also shown a 50 per cent increase in drug and alcohol addiction postsurgery — likely new comforts in place of food.
Surely this shows that we are approaching the obesity epidemic in totally the wrong way. we need to treat a psychological problem psychologically, not surgically.
when people are taught alternative coping strategies, they cease needing to use food as an external crutch, and so lose weight anyway.
Their type 2 diabetes will also improve and may even reverse entirely, just as it does with surgery.
Of course, not everyone who is obese has psychological issues. Some simply make a choice to eat certain foods, or lack the motivation or knowledge to lose weight.
But if that’s the case, I don’t believe the NHS’s limited resources should be used as a substitute for willpower.
I would suggest an intervention called motivational interviewing, which involves gently getting the patient to understand the benefits of changing their behaviour.
Suggesting that the problem of obesity can be dealt with by a swoosh of the surgeon’s knife is not only naïve and expensive, it is totally wrong-headed.