Here’s an article in the New York Times which describes efforts to expand the pool of people eligible for bariatric surgery.
Current guidelines restrict the surgery to individuals with a Body Mass Index in excess of 40, or in excess of 35 for individuals with at least one complication judged to be related to their excess weight, such as Type II Diabetes, hypertension, or high serum cholesterol levels.
(Body Mass Index, or BMI, is equal to in individual’s weight in kilograms, divided by his height in meters squared. To convert English units into BMI, multiply an individual’s weight in pounds by 705 and divide the product by his height in inches squared.)
Allergan, a manufacturer of medical devices, has petitioned the FDA to approve gastric banding surgery for individuals with a BMI of 30, provided they have at least one serious complication, or a BMI of 35 for individuals with no complications. To use the hypothetical example given in the article, an individual who stands five feet six inches tall and has at least one major complication would be eligible for surgery provided she weighed at least 186 pounds. A study funded by Allergan showed that 80% of these less-obese people lost at least 30% of their excess body mass one year after lap-band surgery.
Under the proposed revised guidelines, millions of individuals would be newly eligible for the surgery, at an estimated cost of $12,000-20,000 a shot. That could easily run into hundreds of billions of dollars. And that’s not even counting after-care. Where are we going to get the money from? We’re not paying for the medical interventions we’re getting now.
It’s true that many patients experience reductions in blood pressure and blood sugar levels after bariatric surgery. It’s not a foregone conclusion that any of this results in a clinically meaningful long-term outcome for the patient. The medical literature is rife with examples of interventions which produce “favorable” results in terms of blood pressure, blood sugar, cholesterol, and bone density, but which had unfortunate side effects for the people who took them, like killing them.
Where are the studies that show that the long-term benefits of this kind of mutilation outweigh the harms? Remember that the effects of this procedure are intended to last a lifetime -- although, in fairness, I should note that unlike gastric bypass, the lap band is a reversible operation. In fact, the NYT article I linked to above claims that studies have shown that up to one-third of the patients who get the lap band later have it removed, either because of side effects and/or because they find the resulting weight loss underwhelming. That doesn’t bode very well for efforts to extend the procedure to those who are less obese.
There’s only been one study which has tracked outcomes for bariatric surgery patients for more than two years – the Swedish Obese Subjects Study. And what did they find? They found that gastric banding surgery resulted in a long-term weight loss of 15% of total body mass, and that weight loss surgery of all kinds was correlated with a one per cent reduction in all-cause mortality over ten years. That means one fewer death per thousand patients, per year.
Do you really think such a tiny reduction in risk can even be measured reliably? Given that there are so many ways for investigators to skew the results short of engaging in provable fraud, I submit that there is no convincing evidence that this type of mutilation produces any long-term health benefits, beyond a modest weight loss. And that’s in a country with a very different social organization from ours. There’s no reason to assume that even these underwhelming results would be forthcoming here.
The advocates of treating obesity as a medical problem requiring surgery like to imagine that their approach is more compassionate. You might try asking someone who has suffered complications from weight loss surgery how much compassion she got from her surgeon, after he’d extracted his pound of flesh (so to speak). But that’s a subject for another essay, another day.
They’ve been performing these surgeries for decades now. Why aren’t there more long-term studies? The fact is they don’t know what the long-term effects of these interventions are. And they don’t want to know. They just want to foist upon patients as many expensive and invasive procedures as they will stand for.
To return to the hypothetical example given in the article: according to the geniuses who make up these guidelines, a woman who stands five feet six inches tall and weighs 186 pounds is 32 pounds overweight. Thirty percent of 32 pounds is, uh, ten pounds.
Are they serious? They want to do major surgery on someone so she can lose ten pounds? If the FDA rolls over and plays dead for them on this one, we’re in trouble.
Photo via Wikimedia Commons
UPDATE 4 DECEMBER 2010: An advisory committee to the FDA voted yesterday to approve the new guidelines, which would expand the pool of those considered eligible for lap-band surgery by an estimated 27 million. After the vote as announced, shares of Allergan, Inc. rose in value by three percent.