Feb 6 2014

Is surgery really the best way to deal with obesity?

I received an e-mail message from Dr. Justine Davies, the editor of The Lancet Diabetes & Endocrinology, announcing a series of review articles on bariatric surgery for treatment of obesity.

Bariatric surgery, she says,

is the most effective treatment for both obesity and type 2 diabetes. In many people with type 2 diabetes, bariatric surgery not only limits disease progression, but also reverses complications.

She asks: So why is this procedure not being used more often to treat
patients with obesity?

Bariatric surgery has substantial benefits in terms of weight loss, metabolic status, and quality of life. It is safe and effective, and the future savings made through prevention of comorbid diseases could counterbalance its high cost. The surgery should, therefore, be available as an option to use when appropriate, and not only when all other options have been eliminated. Bariatric surgery offers a real opportunity for preventing comorbid diseases and complications of obesity. If it is only used as a final resort, this opportunity will be missed.

I can think of several good reasons: pain and suffering, treatment complications, questionable long-term prognosis, and cost, for starters.

Prevention is a better option.

If only we knew how….

Here are the papers:

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  • MargaretRC

    I couldn’t agree more. I can’t believe anyone would suggest that surgery is the best option.

  • Monique Centrone Stefani

    Patients tend to be highly selected for surgery, not only on the basis of BMI but also on factors such as psychological readiness and other health problems. (My sister screens people in a large bariatric practice). In that situation, which is probably also the case with many of the positive studies, it isn’t incredibly surprising that the surgeries have good outcomes (with “good” being somewhat subjective because some side effects are not trivial). What scares me about the process of revising guidelines is the following, taken from the article above “Are criteria for bariatric surgery fit for purpose?”: “As mentioned, the NIH is hesitant to contemplate new guidelines without relevant level-1 evidence, but in the face of convincing clinical findings, are RCTs really needed to establish when to use bariatric surgery rather than conventional care?” Seriously??? Thankfully, the NIH is upholding scientific standards or our population would be stuck between food companies happy to have people addicted to their product with the consequences of obesity and a growing industry of bariatric surgeons willing to help us solve that problem. Why are they suggesting that they and the services they provide are beyond the need for RCT’s? That is problematic. Expanding criteria for surgery without RCT’s would be criminally negligent. Good clinical evidence suggests RCTs are needed.

  • Janeth Ibarra

    Surgery is not and should not be a solution for obesity. So it is not the better solution. If surgery was the solution for obesity anyone would eat healthy meals anymore. Instead, they would believe there is a solution for the situation. So people who are fighting against obesity would lose faith and people who are trying to be healthy won’t no longer do anything for it. If surgery was the better solution people would just go to the painful process as many times.

  • http://herohealthroom.com Luke Jones

    Definitely agree. Modern medicine definitely does great things when it comes to acute problems, but I think the general approach to chronic conditions can be a bit behind the times…

    Surely removing the source of the problem is better than trying to patch it up with scalpels and gastric bands.