Surgeons urge authorities to make weight loss procedures available in public health system

Updated

Two leading Sydney surgeons are calling on health authorities to make weight loss surgery available in the public health system to prolong people's lives and save the public purse from the costs of obesity-related illnesses.

In an editorial in the Medical Journal of Australia, Michael Edye, professor of surgery at the University of Western Sydney, and Dr Michael Talbot, senior lecturer in surgery at St George Hospital, said Australian patients were missing out on life-saving treatment because they could not afford it.

The procedures were the best treatment option for some patients, they said, and the cost of surgery would be offset by the savings accrued from not having to treat obesity-related conditions.

"There are certain individuals who are sick with their obesity," Professor Edye told AM.

"They're diabetic, they're suffering from kidney ailments, from eye disease, from nerve complaints related to their diabetes, and their lives will be shortened if they don't have something done.

"In these situations, surgery offers something that is truly life-prolonging."

Treatment centres offering surgery to public patients scarce

The doctors acknowledged that weight loss surgery was not the cure for the worldwide obesity epidemic but said it could play a key part in the nation's response.

"There's a whole lot of other conditions that I can treat in the public system where we make decisions to treat people because they are sick," Dr Talbot said.

It's frustrating when you have people who are in need and you are unable to treat them because relatively arbitrary decisions are being made. Dr Michael Talbot

"But if somebody presents with a severe medical problem intimately tied up with their weight problem, I'm not interested in treating their weight problem, it's their underlying illness that requires treatment.

"And it's frustrating when you have people who are in need and you are unable to treat them because relatively arbitrary decisions are being made."

Dr Talbot said he had tried to convince public health authorities to offer the surgery for the past eight or nine years but said negotiations never progressed past the opening dialogue.

Obesity treatment centres which offer weight loss surgery to public patients are scarce.

Professor Edye said there are only a couple in NSW, seeing just a handful of cases each year.

"That hardly touches the side of the bucket of this problem," he said.

"It's a huge problem and something more needs to be done to make it accessible to those people who are sick with their obesity."

State and federal responsibilities cloud issue

The surgeons said there are a number of reasons for the lack of progress in establishing world's best practice care for obese patients, the first being funding.

While hospital care is a state responsibility, the care of a chronic illness such as diabetes is covered by federal funding under Medicare.

"The connection between the two hasn't been made yet," Professor Edye said.

"So any savings in the long-term treatment of a diabetic, for example who's obese, who has an operation to reduce their weight and correct their diabetes, those savings don't transfer to the states that have spent the money on it."

The doctors said the second reason related to the way obesity is defined.

There is a prevailing view that obesity is a lifestyle disease and, as such, it is the responsibility of the patient to fix it.

"But that's not going to work," Professor Edye said.

"We know that only a small percentage of people who try to lose weight, once they've become overweight, will do so.

"Those who are sick with it, those who become diabetic will become very sick. They'll lose limbs, they'll be blind, they'll go onto dialysis because their kidneys don't work. These are the sort of people [that] we can prevent that from occurring [in] by selecting carefully and operating on them."

Professor Edye and Dr Talbot suggest forming multi-disciplinary teams to supervise the care of a candidate for weight-loss surgery to make sure it is the most appropriate use of resources.

"You treat the people who are already heavy health care consumers," Dr Talbot said.

"So, when you offer these people surgery there's an immediate expense but you get your return on your expense within a couple of years."

The two doctors rejected suggestions an expansion in weight loss surgery would provide a financial windfall for surgeons.

"This is not easy surgery," Professor Edye said. "This is complex surgery, stressful surgery. A small but significant number of patients get complications.

"So it's not without its dangers, and it's not something people embark upon because it's easy to do and it's profitable."

Topics: obesity, health, diabetes, diseases-and-disorders, australia

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