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Health chat with Dr Anthony R Leeds
Title: Surgery for obesity
Interview with Dr Dimitrios Pournaras, Consultant bariatric surgeon, Bristol, England
The global scale of obesity and obesity-related diseases is huge and ever-increasing. There are over 650 million people with obesity a further 1.3 billion people with overweight and 10.5% of the global adult population has diabetes. In light of the vast numbers of people affected and the huge potential costs borne by healthcare providers, many proven methods of providing help to people with obesity are needed. These methods need to be effective, have a known safety profile, and be cost-effective.
In this episode Dr Pournaras describes the nature of bariatric surgery and why it is an option for treating people who are obese. It can improve all or most weight-related comorbidities but is especially beneficial as an effective treatment for recently diagnosed type 2 diabetes. It is the third option in the portfolio of available interventions: diet, medications and surgery, and is usually offered after conventional diet and weight-reducing medications have been used. Since obesity is often linked to more than one condition, many people undergoing surgery have a combination of conditions such as diabetes, hypertension, obstructive sleep apnoea, and an adverse cardiovascular risk profile. Surgery is likely to give rapid improvement in diabetes control, a drop in blood pressure, improved sleep, and in the long term reduced cardiovascular risk. These changes translate into the finding of a calculated extension of life of about three years following bariatric surgery, based on data from Sweden.
Many countries are now seeing a proportion of those who are obese become very heavy (super-obese) and become more severely affected by metabolic disease and sometimes increasingly disabled by mobility issues. There is an important place for bariatric surgery to help such individuals.
Some European countries undertake more surgery than others and Dr Pournaras discusses the reasons for this. Failure to recognize obesity as a disease in its own right may lead healthcare practitioners to deliver very effective treatment with medications for the effects of obesity (diabetes and high blood pressure) without addressing the true underlying causes.
Good preparation before bariatric surgery is important, as with all surgery, and some pre-operative weight loss will ‘shrink’ the liver by reducing its fat content, thus making the operative field easier to see. Metabolic state may also be ‘re-set’ and any sleep apnoea may be improved, thus increasing the probability of a good outcome.
Asked if there would likely be more or less bariatric surgery in twenty years’ time, Dr Pournaras said that he thought there would be more, but there would be more of every type of proven effective intervention including diets and medications.
Weblinks to useful resources are given below.
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Information resources: obesity and surgery
WHO
International Diabetes Federation
UK
Canada
Pakistan
India
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