A RECENT recommendation that the long-term obese would be better served with surgery than trying to diet sent ripples through the medical world.
In York, doctors and successful dieters expressed doubt that there was any alternative to old-fashioned diet and exercise, saying that while surgery may provide an immediate fix to weight-related problems it did not address the psychological and social causes of over-eating.
However, the report from the National Bariatric Surgery Registry said by the time they reach surgery, around two-thirds of severely obese patients will have three or more associated diseases.
Dr Brian McGregor, vice-chairman of the North Yorkshire branch of the Local Medical Committee, said that while there were obvious benefits in surgery for some obese patients, the country needed to radically change its attitude to diet and exercise.
But weight-loss surgery is on the rise and many view it as a quick fix for the greedy.
You don’t need to be a celebrity to have weight-loss surgery, but certain slimline famous faces are high-profile proof of the benefits of going under the knife to improve health and appearance.
Fern Britton has shed more than five stone, Shameless actress Tina Malone lost ten stone and former TV presenter Anne Diamond is six stone lighter, all after having gastric bands fitted.
The number of weight-loss operations, also known as bariatric surgery, performed in England has increased massively from 238 in 2000 to 4,619 in 2009 and, according to the recent report published by the National Bariatric Surgery Registry (NBSR), the results of such surgery are impressive.
Within a year, patients lose more than half of their excess weight and four in five no longer suffer from associated conditions such as diabetes, high blood pressure and high cholesterol.
However, after losing five stone himself through a change of lifestyle, Dr McGregor said there was evidence that some patients who underwent surgery ended up putting the weight back on.
He said: “You are not changing their mindset. It’s not dealing with their behavioural approach to food.
“Diet and exercise are as effective as surgery and, in a lifelong case, you are changing the way people live their lives.”
He added: “”We don’t, at the moment, have a society which actively promotes exercise.
“We don’t have employers who encourage membership of gyms. Most of us don’t schedule exercise.
“I would prefer to see a change in culture – surgery is medicalising the problem.”
Despite this, bariatric surgeon Alberic Fiennes, president of the British Obesity and Metabolic Surgery Society, says people are prejudiced against obesity and that surgery is viewed as the luxury solution to a self-made health problem.
“Appealing to people with obesity to exercise willpower to lose weight is like asking somebody to hold their breath for ten minutes,” he said.
“Severe and complex obesity should be seen as an organic disease.
“There’s good evidence that one particularly important signalling mechanism relating to appetite suppression and the control of diabetes and metabolism is permanently suppressed or lost in people with severe and complex obesity.”
But certain types of surgery restore that signal, he points out.
Virtually everybody who comes forward for surgery has had a desperate time struggling with a weight problem, Fiennes stresses.
Consultant bariatric surgeon Richard Welbourn, author of the NBSR report, says weight-loss surgery has “staggering” outcomes for patients, but stresses that it isn’t an easy option.
“There’s a lot of prejudice against this area of medical problems,” he said.
“People assume obesity is about gluttony and it’s self-induced, but then so are smoking and drinking-related health problems, and some driving accidents, and we pay for all those things.
“As surgeons, all we’re offering is a mechanism to get people off medication, restore health, get people off benefits and back to work, and to improve their quality of life. The risk of doing nothing is probably greater than the risk of the operation.”
But the experts may still have some way to persuade the public, in particular those who lost large amounts of weight through diet and exercise.
York slimmer Eric Mair, who weighed 22 stone before shedding nine-and-a-half stone in six months through regular exercise, said: “Doing that has made my life so much better. An operation is just ridiculous.
“If you are giving somebody an operation and you aren’t changing their mindset, they will carry on eating.
• Bariatric operations are by no means a magic bullet. As well as the normal risks of surgery, there can be complications including gastric band slippage, gallstones, a blockage known as a stomal stenosis after gastric bypass, and the development of food intolerances. However, in most cases the benefits of surgery outweigh the risks.
Gastric bands
• About a fifth (21 per cent) of the UK’s NHS weight-loss operations are gastric band surgery.
• During the surgery a band is fitted around the top of the stomach. The stomach above the band stretches a little after eating, sending a signal to the brain that the stomach is full much quicker than normal.
• There should be steady weight loss of around 1lb-2lb a week.
• Weight loss will take two or three years, generally stabilising at 50 to 55 per cent of the excess weight.
Gastric bypass
• About two thirds (67 per cent) of the UK’s NHS weight-loss operations are gastric bypass.
• A more complicated operation than gastric banding, this involves a small pouch being created at the top of the stomach, which is connected directly to the middle portion of the small intestine, bypassing the rest of the stomach and the upper part of the small intestine.
• Weight is lost in the first year, faster than with a band, and around 60 to 70 per cent of excess weight is lost.
• After the operation the hormones which control appetite and satiety begin to work differently and patients begin to feel full again.
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