Tuesday, May 5, 2009

Bariatric Surgery in Australia and India

I've read a great deal about efforts to curb obesity in the US and in the UK, but two recent stories about efforts in other countries recently caught my eye.

Today, the AFP reports that Australia, purportedly one of the fattest countries in the world (and according to a report by Australia's Baker Heart Institute, even fatter than the US), is considering government-funded lap-band surgery. According to Australian newspaper the Herald Sun, Parliament is expected to approve this measure next week. I'm sure some people, even bariatric surgery patients, will be shocked by the fact that government would pay for lap-bands in Australia. But it's important to note that Australia's healthcare system is largely funded by the government, so other procedures are subsidized or completely paid for by the government as well.

Also, on May 2, a piece in on the Hindu News Update Service reported on a conference focused on curbing obesity in India. (Apparently, now "obesity is as much a problem in India as is malnutrition.") Referring to lap-band as "one of the newest techniques," the conference attendees discussed ways to make the surgery more affordable. One expert, a leading bariatric surgeon in India, promoted the surgery by sharing statistics on the success of the surgery in the US: After three years, the average weight loss of lap-band patients was 36.2% of their excess weight.

A couple of comments about these stories.

First: It's interesting that both countries are focusing on the lap-band. Obviously the lap-band works great for some people, but it would be interesting to think about why the government and Indian experts are ignoring other procedures. A lot of people have misconceptions about the safety of procedures like RNY and DS. Then there's the sleeve, which involves less "messing around" than the RNY or DS. Are these procedures off the table? Will Indian leaders focus only on making the lap-band affordable, but not other procedures? Will Australia pay for only the lap-band?

Second, I wonder what kinds of supports these countries will have in place for bariatric surgery patients, particularly Australia, since it will be picking up the tab. The AFP story described lap-band as a surgery that works because it helps obese people fill full faster - but all of us who have dealt with weight issues know that people don't eat just because they are hungry. So, aftercare is really important. I hope that the government is planning to fund a full-blown program, not just the procedure itself.

Third, it's fascinating that the Indian surgeon cited the American statistic about average lap-band weight loss over three years to support making the surgery more available. Weight loss surgeons, at least in the US, consider surgery "successful" when a patient has lost 50% of her excess weight and maintained the loss for at least five years. By that measure, the statistic given in the India story is not even of "successful" patients. Also, I'd love to see that statistic broken down. Were the bulk of cases people who were still in the process of losing weight, people who were on a plateau, or people who had lost more than 36% of their excess weight but had started to regain?

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