According to the Centre for Disease Prevention and Control (CDC), around 93 million people suffer from obesity in the United States, which equates to one in four individuals. Obesity has been linked to a number of other illnesses, including diabetes, heart disease, bone, and joint problems, metabolic disorders, and even cancer. One of the options for those who are obese is bariatric surgery. However, access to this type of surgery is limited for many patients across the globe.
According to experts from The Ohio State University Wexner Medical Center and 45 other scientific societies from across the world, more patients should be given the option of choosing bariatric surgery to manage their weight.
The team of experts has suggested that bariatric surgery should be part of the national guidelines so that patients with chronic obesity and diseases caused due to their obesity could be able to choose this surgery. The experts presented their opinions at the 2019 Annual Minimally Invasive Surgery Symposium by Global Academy for Medical Education.
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Dr. Stacy Brethauer, a professor of surgery at Ohio State Wexner Medical Center's Bariatric Surgery Center of Excellence, explains that bariatric surgery is a form of early intervention into the obesity problem and like any other disease, it should also be on the table for patients suffering from obesity-related disorders:
Surgery is, by far, the most effective tool in managing or reversing Type 2 diabetes. Just as doctors wouldn't wait until a patient has advanced-stage cancer to treat their disease, patients shouldn't have to wait until they are severely obese to undergo surgery.”
Dr. Stacy Brethauer
Surgery ‘should be an option for patients who would benefit’
Bariatric surgery is a form of surgery where the insides of the stomach and the digestive system is made smaller to accommodate less food. This leads to changes in the digestive physiology of the body and also tips the energy intake and expenditure balance in favor of the patient.
“Too many [people] see obesity as a problem of willpower, and it's simply not. Patients must participate in their care by making healthy lifestyle changes, but the most effective treatment is often surgery, and that should be an option for patients who would benefit,” Brethauer added.
Under the present guidelines for the management of obesity, patients who want to undergo bariatric surgery to lose their excess weight need to meet certain criteria. These criteria, says Brethauer, were developed nearly thirty years ago and depend almost entirely on the Body Mass Index (BMI) of the patients.
For example, the 1991 National Institutes of Health Consensus Conference Guidelines states that patients would be chosen for bariatric surgery only if their BMI is 40 or higher. In case their BMI is 35 or higher, they would be considered for bariatric surgery only if they have other life-threatening ailments such as high blood pressure, type 2 diabetes that is uncontrolled or cardiovascular ailments.
Brethauer said this needs to change, adding, “For example, if you have two patients who each have obesity with uncontrolled diabetes, the patient who has a BMI of 35 or higher would qualify for bariatric surgery, while the other patient with a BMI of 34 or lower would often be denied coverage by insurance companies.”
“National data says that two-thirds of the population is either overweight or obese, and up to 8% are severely obese and clearly would qualify for bariatric surgery. But right now in the United States, we do more than 250,000 bariatric surgeries a year, so that means we're operating on 1% of the patients who are eligible for surgery based on their BMI.”
“There’s now about 12 randomized controlled trials that demonstrate that surgery provides better benefits, more remission of diabetes, than ongoing medical therapy, even really intensive medical therapy.”
Experts on the panel have added that there have been multiple clinical trials and studies that have shown that people with lower BMIs could also benefit from bariatric surgery.
A new set of guidelines
The American Society for Metabolic and Bariatric Surgery has developed a new set of guidelines on who could opt for bariatric surgery. Brethauer was the president of the society when these revised guidelines came into place.
The patient who doesn't get the operation, we know very well that their disease will progress and their lifespan will be shortened. Continuing to increase their insulin requirements will not change the trajectory of the disease. Surgery does.”
Dr. Stacy Brethauer
Similar recommendations had been made in 2016 at the 2nd Diabetes Surgery Summit which were published in the journal Diabetes Care. It was aimed to outline the pros and cons of bariatric surgery. These guidelines received approval of over 45 scientific and medical societies around the world.
The team now urges physicians as well as insurance providers to accept and adopt these new guidelines so that more and more obese patients can opt for bariatric surgeries.