CHANGE

ARTICLE OF
INTEREST
ARTICLE OF
INTEREST
THE POLITICS OF OBESITY
Obesity is a complex illness and social issue and is increasingly prevalent
GEORGE HOPKINS
Obesity Surgery Society of Australia
& New Zealand, President
The growing incidence of obesity is one of the most
challenging threats to public health worldwide.
The World Health Organisation (WHO) estimates
that more than half the world’s adult population is either
overweight (39%) or obese (13%). Since 1980, the worldwide
prevalence of obesity has more than doubled and statistics
also show a significant increase in incidences of childhood
obesity.
Part of the problem is that we are eating more and doing
less. But there is also a problem with the way obesity is
perceived. It’s not seen as a chronic disease by policy makers
or the general public, and this is demonstrated by the fact that
more than 90% of the weight loss surgeries that are carried
out in Australia happen in the private hospital sector.
Obesity and other non-communicable diseases such as
cardiovascular diseases, cancers and diabetes are now the
world’s biggest killers, causing an estimated 35 million deaths
each year, 60% of all deaths globally, with 80% in low- and
middle-income countries. We need to stop seeing obesity as
an individual problem, which is up to the fat person to fix,
and start viewing it as a global health crisis.
In July this year, Harvard gastroenterologist Lee M. Kaplan
travelled to Australia for a range of speaking dates at some
of Australia’s biggest hospitals. His visit was a game changer,
because he highlighted the fact that while obesity can be
scientifically measured and estimated using a range of
biomarkers such as body mass index (BMI), these markers
should not define obesity.
It is a remarkably complex disease with wide patient-topatient
variability in responses to treatment options. Nearly
two million Americans now have a BMI of more than 50, and
there are 180 potential medical complications of obesity. The
goal then, is to match each patient with the treatment most
effective and suited to them.
The complexity of obesity
Obese patients who require surgery that is not weight loss
related should still be encouraged to reduce their weight
before surgery, especially if they have features of metabolic
syndrome. Prescribed low calorie diets can help achieve
preoperative weight loss.
A combination of preventative measures and an increase in
the availability of treatment options for those who are already
obese will help curb this disease. Examples of preventative
measures include better labelling on food packaging and
public education programs. There is evidence to suggest that
education programs can have a positive impact on physical
activity levels.
Where preventative measures have failed, there is strong
evidence to suggest that surgery is an effective intervention for
weight loss in the morbidly obese (BMI > 40), and that this
may reduce the long-term costs and health impacts of obesity.
Dr Kaplan points out that gastric bypass has the opposite
effect to restrictive dieting, with energy expenditure and
satiety going up, and appetite and stress response decreasing.
Providing access for weight loss surgery in public hospitals
seems a difficult commitment for policy makers. In the face of
overwhelming science this can be interpreted as a bias against
the obese, as it is so often viewed rightly or wrongly as selfinflicted.
The other consideration is the overwhelming numbers
that could and would stand ready for surgical treatment
whenever and wherever this service is offered. Our
experience at the Royal Brisbane & Women’s Hospital
certainly suggests that to manage the workloads and wait
times, very strict parameters need to be applied to eligibility
for surgical intervention. That said our clinics remain
saturated and intermittently closed to new case referrals.
Access Economics estimates that the number of obese
people in Australia is set to double by 2028 to almost 8
million. The medical, psychological and financial burden of
obesity, coupled with the failure of conservative measures
and the success of surgical interventions, is why weight
loss surgery must be considered part of the package in
addressing the obesity epidemic.
With Amy Kimber
52 SURGICAL NEWS OCTOBER 2015 SURGICAL NEWS OCTOBER 2015 53