Christmas is perhaps not the best time to focus on the health benefits of weight loss. Very few have the self-discipline to avoid the perils of over consumption at this time of year. However a study published in “The Public Library of Science – Medicine” yesterday suggests that bariatric surgery, the restriction or even removal of part of the digestive tract, may have significant wider health benefits for those who are seriously overweight.
The authors carried out a data review and concluded that “patients who had had bariatric surgery lost weight rapidly during the first four post-operative months (4.98 kg/month); their weight loss was sustained at a slower rate for up to four years. By contrast, there were no weight changes in the patients who did not have surgery.”
The surgery usually involves inserting a gastric band, which restricts the ability of the stomach to expand, thereby making the patient feel full when only eating modest amounts. In more extreme cases, the stomach can be by passed altogether.
The report noted that bariatric surgery was “associated with a lower risk of type 2 diabetes onset, hypertension onset, angina onset, myocardial infarction, and obstructive sleep apnea (a sleep disorder) onset, and with the resolution of both type 2 diabetes and hypertension in those who already had these conditions when they underwent surgery.”
Advocates of bariatric surgery have today suggested that if all 1.4m people in Britain classed as morbidly obese were offered bariatric surgery it would avert nearly 5,000 heart attacks and 40,000 cases of type 2 diabetes over four years. Media reports this morning included the assertion that a one off cost of £4,500 for each operation offered a significant saving to the NHS when compared with the cost of treating a morbidly obese person for the illnesses consequent upon their weight problems, such as diabetes and heart conditions.
Whilst there are undoubtedly health benefits for some patients who undergo this form of treatment, those arguing strongly for a more widespread use of surgery are perhaps understandably reluctant to mention in any detail the risks of the surgery itself. The cost of the operation may be £4,500 per patient but it is disingenuous to suggest that this represents the entirety of the cost of the treatment. There will be follow up appointments and in the case of the gastric band, in many cases further procedures to adjust the size of the band. Nor is there any assessment of the impact of surgery beyond 4 years, at which point weight loss is not necessarily sustained. Long term costs may arise from this form of treatment which are comparable with treating other underlying conditions and the savings may not be as great as advertised.
Cost is not of course the only factor. Health benefits in themselves are a laudable goal. The authors of the report do not seek to downplay the fact that the surgery is significant and carries risk. In the medical negligence field we are only too aware of the problems which can arise. Bariatric surgery is a relatively new discipline. Expertise is concentrated in some centres of excellence but there remain general surgeons in district general hospitals for whom such surgery is something they encounter rarely and thus who are less well equipped to deal with complications than their specialist colleagues. This, combined with the inherent and unavoidable risks of major surgery have lead to some very unfortunate and in some cases, tragic outcomes.
There is, as always, a balance to be struck, between treatment which has undoubted therapeutic benefits to some but presents risks to others.
If you have experienced difficulties arising from bariatric surgery and have questions you would like to raise, contact Chris Thorne, partner in the medical negligence team, on 0345 209 1460 or firstname.lastname@example.org.