Can bariatric surgery turn the tide on Britain’s obesity crisis?

An “emotional eater” since childhood, Claire Parker was 44 when she had a gastric bypass, where a small part of the top of the stomach is stapled in order to restrict food intake. The National Institute for Health and Care Excellence recommends that anyone with a body mass index above 30 is suitable for surgical intervention; hers was more than 10 points higher by the time she sought medical help, the bypass decreed the most likely to yield significant reduction to her 30st weight. But complications soon arose: “I didn’t even know what the word ‘bariatric’ meant,” she recalls of her initial consultation.

The treatment – and subsequent outcome – was “never as it should have been.” Parker received no counselling prior to the procedure and, in its immediate aftermath, found her stomach had been stitched (rather than stapled), sewn so small that she could not even swallow water. So began a year of hospital visits, several of which involved procedures to stretch the space surgeons had left, which perforated her stomach.

It was “a terrifying time, for me and my family,” Parker recalls of the 2009 operation that left her “nearly dying” and considering legal action against the hospital. In the first four months post-surgery she lost eight stone, in a large part driven by sheer inability to eat; in the intervening years, she estimates that she has put around half of that back on. Statistics on recidivism for weight loss surgery vary widely due to the range of procedures it can involve and the definition of ‘failure,’ with research placing this between 25 and 70 per cent.

“It scares me,” Parker admits of the reported push for increased surgery access, as this may well belie the complexities of the condition: obesity nor the diseases it can engender happen suddenly and, without addressing the underlying issues fuelling a troubled relationship with food nor providing aftercare once surgery has been carried out, the drive may prove fruitless.

That’s how Lisa Seagrove, who lost no weight following a gastric band operation in 2014, feels. The sense that she was on borrowed time in dealing with weight problems that had persisted since childhood led her to pay for private treatment. The physical complications that followed caused the now 31 year old pain so “horrendous, I thought my stomach was tearing”; that, coupled with an absence of psychological assistance before or after the surgery, left her seeking to reverse it by the time her first post-operative year ended.

“It was awful,” she remembers of a time where she could eat only 5 pence piece-sized mouthfuls of food that were to be chewed 20 times. No drinks were to be consumed during mealtimes, as they would move food lower down in the stomach, reducing feelings of fullness. “I followed the rules,” Seagrove says, but “I can’t say I lost any weight whatsoever.”

Gastric or ‘lap’ (laporoscopic) band surgery sees a silicone ring placed around the upper part of the stomach, which is then filled with saline in later follow-up appointments in order to maintain its restrictive properties; her agony, on top of hearing “horror stories” of people developing heart complications as a result of the surgery, pushed her to get the band removed. “If anybody’s going to have it done they would need some kind of psychological testing,” she says now, adding that when you “get that stage where you feel there’s no other way [but surgery] it’s a really desperate place to be.” 

Seagrove still “tortures myself every day” over what she eats. But the oft-repeated mantra that diet and exercise can solve all weight-related ills is “a misconception” – many are simply beyond that, Prof Rubino says. “People for whom obesity requires surgical intervention are people for whom there is no alternative… Lifestyle intervention is always useful and appropriate even in patients who have had surgery, but they are not a replacement.”

Del Singh has found the combining of the two transformative. But it was only being “fortunate enough” to pay for a £10,000 private operation that would change his life; at 52 and weighing 24st 5lbs, an NHS doctor said the surgery could only be state-funded if he passed the 30st mark. “Many people are not [able to pay] so they miss out,” he says. “Or they are told to go away for 24 months and ‘prove’ they can lose weight to qualify for NHS surgery, which is mad as if people could lose weight and keep it off just by dieting we wouldn’t need [it].” Resolving the underlying eating issues people have and providing techniques for tackling them would be a far more potent means of recourse. 

Singh had a BMI of 53.3, was taking medication for high blood pressure, cholesterol and lower back pain and “had just wandered into the minefield of type 2 diabetes,” he remembers. “I was a walking heart attack waiting to happen and I was costing the NHS a fortune.” Within 12 months of his gastric sleeve operation, which reduces the stomach’s capacity to around 15 per cent, he lost 10st and soon after, came off all of the pills he was taking; he has since climbed Mt Kilimanjaro and last year ran the London Marathon. 

He acknowledges that “gastric surgery isn’t a magic bullet” but echoes Prof Rubino’s belief that it remains “the best long term solution for maintaining weight loss”, adding that government proposals followed through quickly “will change lives and save lives.” Yet without a joined-up approach, in which patients are given the requisite pre- and post-operative tools to manage their weight, reducing it cannot alone turn the tide on such a complex crisis. 

Source Article