The rising "obesity and diabetes epidemic" and weight-loss surgery are rarely away from our newspaper headlines and TV screens. As a weight-loss surgeon I frequently encounter hostile reactions from other clinicians and even patients themselves arguing against the very concept of weight-loss surgery. Most of the arguments revolve round similar themes and misconceptions including:
1. Obesity is not a disease, it's just a modern fad. One of the most commonly quoted myths is that obesity didn't really exist until the 1980's (often more crudely stated in the cliché "you didn't see any fat people during the Blitz"). Obesity has in fact been omnipresent in human history- indeed the first sculptural representation of the human form (the Venus of Willendorf) from 25,000 BC is of a clinical obese woman. What has changed, particularly in the last century has been the falling cost of food production- for example a loaf of bread in 1700 cost in today's money about £35. Hence the rising rates of obesity in the Western world are simply a reflection of the improving socio-economic standards of the population allowing more people to be able to afford to achieve their "obesogenic potential".
2.Weight-loss surgery is a cheat- all people need to do go on a diet. One of the most pervasive myths against the obese is the perception that all patients need to do is eat less and do more in order to lose weight. Whilst diet and exercise may be effective in preventing obesity and Type 2 diabetes in the first place, the sad fact is that, for the over one million adults in the UK who already have severe (or morbid) obesity, dieting and exercise programmes tend to be doomed to fail. The reason for this relates to permanent changes in the patients' physiology- in severe obesity the patient's "internal weight thermostat" is altered and the body essentially defends this new weight against any dietary reductions by increasing the levels of "hunger hormones". Whilst it is possible to try to counteract these hunger hormones through willpower alone, the vast majority of people cannot do so (in much the same way as the vast majority of people are not capable of running the 100 metres in under 10 seconds). Weight-loss surgery is simply a tool that helps people change their diet by altering their hunger hormone levels and allowing them to reset their physiology. An appropriate analogy would be with smoking- most people would be happy to give a smoker a nicotine patch to help them beat their smoking addiction - is there really a difference between a patch and a gastric band (which is after all just another device to help people kick another addiction)?
3. Weight-loss surgery is risky with poor long term results. Although patients do need to make short and long term adjustments following surgery, the horrors stories so beloved of the newspapers of "weight loss surgery gone wrong" are vanishing. According to the latest UK data the mortality rate following weight loss surgery is less than 1 in 1000. Recent innovations in improving the safety of surgery include better training of specialist surgeons and the development of newer operations- in particular the sleeve gastrectomy. This keyhole operation reduces appetite leading to weight loss but unlike the gastric band, no "foreign" device is left in the body. Moreover recently published data by consultant Mr Omar Khan and colleagues from St George's and Kings College have shown that sleeve gastrectomy surgery can not only cure diabetes in patients with this condition, but when performed on overweight but healthy people can reduce the future incidence of diabetes by 80%.
In short, weight-loss surgery is by far the most cost-effective and clinically successful treatment for patients with obesity, and can both cure diabetes and prevent its development. Yet despite this, less than 1% of patients in the UK who could potentially benefit from surgery actually undergo these life-changing operations. Indeed in the age of increasing financial pressures on the NHS, it is likely (at least within the NHS) that these numbers will reduce further. Weight-loss surgery has for too long been regarded as a slightly tainted procedure- something reluctantly offered to people who are considered to be undeserving of care. It is time we disregarded this outdated prejudice and promoted weight-loss surgery as the most effective investment in improving the health of the population.Suggest a correction