I subscribe to a handful of online medical journals and over morning coffee had to shake my head over comments made by professionals in response to an article about Bariatric Surgery being underused as a last resort rather than as an appropriate response when needed.

Carolyn Kay ‘Medical Professional’ wrote If it were possible to design a study where some people were treated with bariatric surgery and a control group treated with pretend bariatric surgery, what would the results be? Why not just do the dietary restrictions and forget the bariatric surgery? ”

I have an idea. Let’s enroll Carolyn’s father in a study where some people with heart blockages are treated with angioplasty & stents and a control group treated with pretend angioplasty & stents. Why not just do the dietary restrictions and forget the heart surgery!

 

More tidbits from ‘medical professionals”…

Carolyn Kay
02/03/14
“When all other options have been eliminated? WHAT? Change in diet has the same effect as surgery, without the threat of side effects. If people can’t change their diet to improve their health, they need psychological help, not surgery.”

She adds more, “I’m convinced that the reduction in disease symptoms with the surgery come from the dietary restrictions afterward, so why not just do the restrictions and forget the surgery? It’s insane to cut into people’s bodies unnecessarily.”

 

Not to be outdone…

TMACK pharmd
02/03/14
“Common sense versus the medical-industrial complex. Hmmmm…wonder how that will play out? Bariatric surgery has far too many powerful advocates (read surgeons, surgical clinics/hospitals/staff) and our diabetogenic/obesigenic food industry is so entrenched we will never overcome this paradigm. This procedure will eventually be exposed as analogous to blood-letting and mercurial therapy for our century.”

 

Do these professionals think that anyone would have a bariatric procedure as plan A without having spent years doing everything they could to fight the long slow slide into morbid obesity? No one takes major surgery lightly or has organs cut and rearranged as a first resort! All who have had bariatric surgery have had someone ask in all seriousness ‘Did you try dieting instead of surgery?’, to which it takes every ounce not to blast them with sarcasm or a punch in the nose.

With all due respect, the level of bariatric ignorance is disturbing. It’s well documented that Bariatric surgery creates metabolic changes and actually cures diabetes in a majority of the cases where it was present.

This shows that we must be our own medical advocates and not blindly take the word of someone because they have letters after their name. There are ‘educated dummies’ in all fields of business. It is sad when a medical journal comment section is simply a higher level of Twitter. This is why I believe it is important to know my medical team and discuss their medical point of view towards bariatric surgery and aftercare. All people deserve to be respected by their physician and staff and it appears by their comments that these folks would be looking at someone who chose bariatric surgery with disdain.

 

 

Then, just when I thought all was lost, someone aware of medical facts appeared and took on the ‘low information’ folks. Bravo Diana!

Diana Cox
02/07/14
“Good grief the ignorance is thick here. Do you not understand that bariatric surgery (not counting the pointless lapband) induces METABOLIC changes that make it possible for dietary modifications and exercise to actually work? And to provide long-lasting results? There is an over 95% recidivism with diet and exercise alone, when the patient starts out with morbid obesity. What kind of medical people are you, if you think you should prescribe a treatment with a documented NINETY FIVE PERCENT FAILURE RATE?? Bariatric surgery isn’t perfect, but it has a FAR higher success rate than diet and exercise. The MOST effective procedure, the duodenal switch, has a 98% CURE rate for type 2 diabetes; 80+% remission in hypertension and lipidemias, and a 12+ year rate of maintenance of 75% excess weight loss. Please try not to speak outside your area of expertise in response to science you obviously don’t understand. Diana Cox, PhD (medical biochemistry and molecular biology) and 10.5 years post-duodenal switch.”
The original article upon which they commented:
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The Lancet Diabetes & Endocrinology, Volume 2, Issue 2, Page 91, February 2014
doi:10.1016/S2213-8587(14)70020-8
Copyright (c) 2014 Elsevier Ltd All rights reserved.

Bariatric surgery: why only a last resort?

In 2008, the number of adults with obesity exceeded 500 million, with one in three people worldwide–some 1.4 billion individuals–overweight or obese. Around 64% of the UK population and 69% of the population of the USA are overweight or obese. The most effective treatment for obesity is bariatric surgery. So why is this procedure not being used more often to treat patients with obesity? In fact, according to English Hospital Episode Statistics data, there has been a fall of 10% in the number of these procedures being performed between April, 2012, and March, 2013, despite the continued rise in obesity incidence.

Obesity is a cause of many of today’s common health problems including type 2 diabetes and cardiovascular disease–of which 44% and 23% of cases, respectively, are attributable to overweight or obesity–impaired mobility, sleep apnoea, increased bone load, and psychological distress. In an ideal world, obesity could be tackled exclusively through prevention. However, once people have obesity, this state is difficult to reverse.

Bariatric surgery procedures have evolved over the past two decades, and are now considered to be a safe and effective treatment for obesity. Bariatric surgery not only induces weight loss, but also improves metabolic status. Patients with diabetes who have bariatric surgery can experience remission and existing diabetic organ damage can be reversed. Although there are risks entailed in bariatric surgery, the alternatives–antiobesity and antidiabetic drugs–are not without adverse effects, and some common antidiabetic drugs actually induce weight gain.

Despite the fact that early intervention is known to be important to prevent the development of obesity-related comorbidities, bariatric surgery is almost always used to treat patients who have severe obesity and progressive comorbid disease. Part of the barrier to the use of this surgery early in the disease course is that people who could benefit from the surgery do not fit the eligibility criteria. In the UK, NICE recommends that bariatric surgery only be offered to individuals whose BMI is greater than 40 kg/m2, or greater than 35 kg/m2 in the presence of substantial comorbidities, who have tried and exhausted all non-invasive treatment options. In the USA, use of bariatric surgery is largely guided by an NIH position statement from 1990 which restricts surgery to the same BMI criteria. Are patients who might benefit most being excluded from surgery, and would the short-term costs of treating these patients actually be outweighed by the long-term savings?

Even with the current strict criteria, a recent estimate suggests that more than 5% of the population of England–some 2 000 000 people–could be eligible for surgical intervention, which would be at considerable cost to the health service. However, a recent modelling study suggests that gastric bypass surgery can lead to a reduction in lifetime health-care costs of around 30%, and an increase in quality-adjusted life years for people meeting the current criteria. Reduced incidence of obesity-associated diseases, and improvements in patients with existing comorbid diseases, could lead to diminished health service demand and reduced costs.

However, expanding the eligibility criteria for bariatric surgery is a moot point when even people who meet the criteria are denied access to treatment. In the UK, NICE recommends that bariatric surgery only be provided if the patient is receiving or will receive intensive management in a specialist obesity service. However, the Royal College of Surgeons and the Metabolic Surgery Society have recently warned that, because these services are not available in all areas, a barrier to treatment could exist for people who otherwise meet the criteria for surgery. This situation has created a so-called postcode lottery for treatment. In the USA, the insurance-based health-care system means that socioeconomic barriers exist to treatment, despite the fact that obesity is highest in those with low socioeconomic status. For complex reasons, a racial disparity in referral rates for bariatric surgery also exists in the USA, and this issue should be addressed.

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.”