Surgery for obese young people?

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I just wondered if any of you might have some thoughts on this proposal from the Australian Medical Association (AMA).
I am by no means an expert on this subject, but my first response was: Huh? But what's wrong with education, diet & exercise?
And I would have thought surgery was an absolute last resort solution to any health problem. There's something about using surgery (at taxpayer expense) on what I'd understood to be often life-style induced health problems (not for everyone, I know) that doesn't sit comfortably with me. Or have I got my wires crossed on this?
I'd also be interested to know if this sort of approach to the problem common in other parts of the world?:

Free surgery plan to fight obesity and save lives
Jason Dowling
January 6, 2008/the AGE

OBESE people as young as 14 would get free weight-reduction surgery under a radical Australian Medical Association proposal to tackle the obesity crisis.

The Opposition and health groups have backed the scheme for publicly funded weight loss surgery, which was proposed by the association in a submission to the State Government.Douglas Travis, the president of AMA Victoria, said: "Obesity is now classified as one of the national health priorities by the new federal minister, and it's a big problem for Australia. Once you are morbidly obese, almost all of the talking, walking magic cures don't work." In its 2008-09 budget submission, the AMA has called on the State Government to fund five public hospitals to provide 3000 obesity-related operations over the next three years, at a cost of $40.5 million.

Obesity surgery is considered appropriate for patients with a body mass index above 35kg/m2 (with co-morbidity) or 40kg/m2 who have failed to lose weight other ways but who will try a strict eating and exercise plan and follow-up, and who are an acceptable operation risk.

Body mass index is determined by your weight in kilograms divided by your height in metres squared (m2). A healthy BMI is between 20 and 25. A result below 20 indicates that you may be underweight, and a figure above 25 indicates that you may be overweight.

According to the AMA, patients reportedly lose 50% to 70% of their excess weight after the surgery, and more than 80% of patients experience significant amelioration of diabetes, hypertension, hyperlipidaemia and obstructive sleep apnoea.

Dr Travis warned that weight-loss operations were rare, particularly in the public health system.

"It is something that carries a very low priority in the health system because it's not seen as life-saving surgery, when the reality is it is," he said. "It's just not saving their life next week."

Dr Travis said the surgery should be available to people of most ages. "It depends on the person or their problems," he said. "I am not for age being the major determinant. While the surgery should not be done on 10-year-olds, teenagers should not be excluded. If you are 16 and you weigh 170 kilograms, you've got a problem, and the literature will tell you it is very unlikely that problem is going to be solved."

Opposition health spokeswoman Helen Shardey said Victoria had to tackle the problems of morbid obesity because it was "an enormous threat" to the overall health of the people concerned.

"We do need to recognise that morbidly obese people need assistance in weight reduction," she said.

"Bariatric surgery, or the banding, is one good way of achieving that.

"I certainly support the idea of looking at providing this kind of surgery for people who are morbidly obese and whose health is therefore very much at risk."

Emma Diffen, a spokeswoman for Health Minister Daniel Andrews, said the Government had provided more than $150 million for Go For Your Life initiatives to tackle risk factors for such chronic diseases as diabetes and obesity.

She confirmed that the Government had received the AMA's submission, but said it had not yet formed an opinion.

http://www.theage.com.au/news/national/free-surgery-plan-to-fight-obesity/2008/01/05/1198950131112.html

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Looks to me like it is a cheap effort to cut the future costs that long-term obesity might cost the government in health care. There are very few long-term success stories of people who have had that surgery. The only ones counting their successes are the surgeons.

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I'm interested but am not informed enough re the pros and cons of bariatric surgery in general, much less at that age group. I'll sign in as wary.

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Butrflynet wrote:

Looks to me like it is a cheap effort to cut the future costs that long-term obesity might cost the government in health care. There are very few long-term success stories of people who have had that surgery. The only ones counting their successes are the surgeons.

Personally I know of only one person (an adult) whose had surgery for this reason. Twice. I can't exactly say it was a success, but then on the basis of just one person .....?

It is interesting that it's the AMA putting up this proposal. A bit out of left field, for me, anyway ....
We've had BIG (government funded) campaigns on the dangers of smoking & prevention of skin cancer in the past here, with impressive results. I guess I'm wondering why we have to consider the extreme of surgery before a really extensive public education campaign. I can understand, though, that there are some people whose obsesty is caused by factors entirely beyond their control. And for these people surgery might well be an appropriate option. But 14 year olds? I really don't know .... Confused

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ossobuco wrote:

I'm interested but am not informed enough re the pros and cons of bariatric surgery in general, much less at that age group. I'll sign in as wary.

Yeah, I feel rather the same, osso. I was hoping to get a bit more information here about how other countries approach the problem. There's no doubt about it, obesity is becoming a huge health problem in this country.

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Well, this is what the Mayo Clinic says

Quote:

Weight-loss surgery can be a safe and effective option for some severely obese adolescents who have been unable to lose weight using conventional weight-loss methods. However, as with any type of surgery, there are potential risks and long-term complications. Also, the long-term effects of weight-loss surgery on a child's future growth and development are largely unknown.

http://www.mayoclinic.com/health/weight-loss-surgery/AN01331

---

If adolescents are that gravely overweight, I think the parents are partially
to blame and a mandatory class on nutrition and health should have
to be attended by both parents and adolescents, before bariatric surgery
is even discussed. The surgery should be the very last resort, not
an alternative to weight loss. I am definitely against this.

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Hospitals don't seem to be able to cope with the demand for beds at present. Why add to the problem.

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Another aspect of this proposal that concerns me is the funding of it. Public hospitals (the whole public health sector, actually) have been starved of funds for years in this country. If there are extra $$$$ available, my preference would be to spend the funds shortening the existing queus for essential surgery. You hear of people (poorer, of course, who can't afford private health insurance) in extreme pain while waiting for ages for surgery. (eg hip replacements). I think any new request for public funds should be weighed against all the other health needs within the community.

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dadpad wrote:

Hospitals don't seem to be able to cope with the demand for beds at present. Why add to the problem.

Snap!

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msolga wrote:

Butrflynet wrote:
Looks to me like it is a cheap effort to cut the future costs that long-term obesity might cost the government in health care. There are very few long-term success stories of people who have had that surgery. The only ones counting their successes are the surgeons.

Personally I know of only one person (an adult) whose had surgery for this reason. Twice. I can't exactly say it was a success, but then on the basis of just one person .....?

It is interesting that it's the AMA putting up this proposal. A bit out of left field, for me, anyway ....
We've had BIG (government funded) campaigns on the dangers of smoking & prevention of skin cancer in the past here, with impressive results. I guess I'm wondering why we have to consider the extreme of surgery before a really extensive public education campaign. I can understand, though, that there are some people whose obsesty is caused by factors entirely beyond their control. And for these people surgery might well be an appropriate option. But 14 year olds? I really don't know ....

Hmmmm......I recently read in some damn place (can't recall where) research data suggesting that this sort of surgery was efficacious enough for the current restrictions on it (re weight and the number of currently existing related health problems) to be relaxed. Maybe it was medscape weekly????

I don't know re doing it to adolescents.....but I do not think the research is as clear cut as Butterflynet suggests. And, certainly, the stats re keeping weight off are very discouraging for this population with normal weight loss methods.

I know when it first began to be done here, there was a massive psycho-social input to the early patients, as there was real concern about the surgery. Some fascinating stuff came out of that, re the dynamics in families and marriages when the weight loss occurred.

That is no longer put in place, to my knowledge.

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dlowan wrote:

msolga wrote:
Butrflynet wrote:
Looks to me like it is a cheap effort to cut the future costs that long-term obesity might cost the government in health care. There are very few long-term success stories of people who have had that surgery. The only ones counting their successes are the surgeons.

Personally I know of only one person (an adult) whose had surgery for this reason. Twice. I can't exactly say it was a success, but then on the basis of just one person .....?

It is interesting that it's the AMA putting up this proposal. A bit out of left field, for me, anyway ....
We've had BIG (government funded) campaigns on the dangers of smoking & prevention of skin cancer in the past here, with impressive results. I guess I'm wondering why we have to consider the extreme of surgery before a really extensive public education campaign. I can understand, though, that there are some people whose obsesty is caused by factors entirely beyond their control. And for these people surgery might well be an appropriate option. But 14 year olds? I really don't know ....

Hmmmm......I recently read in some damn place (can't recall where) research data suggesting that this sort of surgery was efficacious enough for the current restrictions on it (re weight and the number of currently existing related health problems) to be relaxed. Maybe it was medscape weekly????

I don't know re doing it to adolescents.....but I do not think the research is as clear cut as Butterflynet suggests. And, certainly, the stats re keeping weight off are very discouraging for this population with normal weight loss methods.

I really have no problem to someone undergoing this procedure to improve their self esteem, state of health, whatever, Deb. But unless their condition is immediately life-threatening I don't think it's reasonable to expect the tax paying public to pay for it.

The person I mentioned above paid heaps (twice! Shocked

) for it. The sort of costs that would be beyond our wildest dreams!

As for adolescents, unless there's (once again) some really pressing life-preserving reason for it, then why do it at all? Far better (for a healthy life) to learn about healthier ways of eating & living. Best investment possible for the long haul, I reckon! I'd be fully supportive of peoples' taxes supporting the necessary programs to assist in this process.

Am I quaint in this belief?: I would never, ever have surgery for any reason (apart from a life-saving emergency) before giving more "natural" remedies a good chance. Surgery should be the very last resort, only when all else has failed. I reckon if you haven't the will to change your diet & lifestyle (if this has caused the obese condition) then you haven't developed the necessary skills & approach to succeed after the surgery. Is that harsh?

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bookmark....

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msolga wrote:

dlowan wrote:
msolga wrote:
Butrflynet wrote:
Looks to me like it is a cheap effort to cut the future costs that long-term obesity might cost the government in health care. There are very few long-term success stories of people who have had that surgery. The only ones counting their successes are the surgeons.

Personally I know of only one person (an adult) whose had surgery for this reason. Twice. I can't exactly say it was a success, but then on the basis of just one person .....?

It is interesting that it's the AMA putting up this proposal. A bit out of left field, for me, anyway ....
We've had BIG (government funded) campaigns on the dangers of smoking & prevention of skin cancer in the past here, with impressive results. I guess I'm wondering why we have to consider the extreme of surgery before a really extensive public education campaign. I can understand, though, that there are some people whose obsesty is caused by factors entirely beyond their control. And for these people surgery might well be an appropriate option. But 14 year olds? I really don't know ....

Hmmmm......I recently read in some damn place (can't recall where) research data suggesting that this sort of surgery was efficacious enough for the current restrictions on it (re weight and the number of currently existing related health problems) to be relaxed. Maybe it was medscape weekly????

I don't know re doing it to adolescents.....but I do not think the research is as clear cut as Butterflynet suggests. And, certainly, the stats re keeping weight off are very discouraging for this population with normal weight loss methods.

I really have no problem to someone undergoing this procedure to improve their self esteem, state of health, whatever, Deb. But unless their condition is immediately life-threatening I don't think it's reasonable to expect the tax paying public to pay for it.

The person I mentioned above paid heaps (twice! ) for it. The sort of costs that would be beyond our wildest dreams!

As for adolescents, unless there's (once again) some really pressing life-preserving reason for it, then why do it at all? Far better (for a healthy life) to learn about healthier ways of eating & living. Best investment possible for the long haul, I reckon! I'd be fully supportive of peoples' taxes supporting the necessary programs to assist in this process.

Am I quaint in this belief?: I would never, ever have surgery for any reason (apart from a life-saving emergency) before giving more "natural" remedies a good chance. Surgery should be the very last resort, only when all else has failed. I reckon if you haven't the will to change your diet & lifestyle (if this has caused the obese condition) then you haven't developed the necessary skills & approach to succeed after the surgery. Is that harsh?

The questions are:

1. Risks vs benefits to the individual

2. Whether there is good data to suggest that a big outlay in adolescence will be balanced by savings to the public purse throughout the life-cycle.

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dlowan wrote:

msolga wrote:
dlowan wrote:
msolga wrote:
Butrflynet wrote:
Looks to me like it is a cheap effort to cut the future costs that long-term obesity might cost the government in health care. There are very few long-term success stories of people who have had that surgery. The only ones counting their successes are the surgeons.

Personally I know of only one person (an adult) whose had surgery for this reason. Twice. I can't exactly say it was a success, but then on the basis of just one person .....?

It is interesting that it's the AMA putting up this proposal. A bit out of left field, for me, anyway ....
We've had BIG (government funded) campaigns on the dangers of smoking & prevention of skin cancer in the past here, with impressive results. I guess I'm wondering why we have to consider the extreme of surgery before a really extensive public education campaign. I can understand, though, that there are some people whose obsesty is caused by factors entirely beyond their control. And for these people surgery might well be an appropriate option. But 14 year olds? I really don't know ....

Hmmmm......I recently read in some damn place (can't recall where) research data suggesting that this sort of surgery was efficacious enough for the current restrictions on it (re weight and the number of currently existing related health problems) to be relaxed. Maybe it was medscape weekly????

I don't know re doing it to adolescents.....but I do not think the research is as clear cut as Butterflynet suggests. And, certainly, the stats re keeping weight off are very discouraging for this population with normal weight loss methods.

I really have no problem to someone undergoing this procedure to improve their self esteem, state of health, whatever, Deb. But unless their condition is immediately life-threatening I don't think it's reasonable to expect the tax paying public to pay for it.

The person I mentioned above paid heaps (twice! ) for it. The sort of costs that would be beyond our wildest dreams!

As for adolescents, unless there's (once again) some really pressing life-preserving reason for it, then why do it at all? Far better (for a healthy life) to learn about healthier ways of eating & living. Best investment possible for the long haul, I reckon! I'd be fully supportive of peoples' taxes supporting the necessary programs to assist in this process.

Am I quaint in this belief?: I would never, ever have surgery for any reason (apart from a life-saving emergency) before giving more "natural" remedies a good chance. Surgery should be the very last resort, only when all else has failed. I reckon if you haven't the will to change your diet & lifestyle (if this has caused the obese condition) then you haven't developed the necessary skills & approach to succeed after the surgery. Is that harsh?

The questions are:

1. Risks vs benefits to the individual

2. Whether there is good data to suggest that a big outlay in adolescence will be balanced by savings to the public purse throughout the life-cycle.

....when compared to other pressing demands on the public purse.

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... & after thorough consideration of the pros & cons of alternative treatments to surgery.

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Surgical intervention may well reduce the long term cost on the public purse. and could be cheaper and more effective than education campaigns.
Obese people need a lot of assistance to change lifestyles.

October 18th, 2006
A report published (snip) in Australia puts a cost to the obesity epidemic facing Australia.

The cost, a staggering $17.2 billion a year.

The report shows the drain on human resources as a result of the sharply rising incidence of costly chronic diseases associated with obesity, including type 2 diabetes, heart disease, stroke, osteoarthritis and cancer.

It finds the heaviest losses result from the burden of disease, accounting for $17.2 billion a year and representing the non-financial costs of disability, loss of wellbeing and premature death caused by obesity.

he burden of disease figure is based on numerous studies calculating the worth Australians put on their lives in areas such as high-risk occupations. This averages $162,561 a year, and for a whole of life $3.7 million, Access Economics says.

The next biggest loss triggered by obesity was in productivity, estimated at $1.7 billion a year, flowing from the fall in output caused by reduced employment and premature death.

Obesity generates $873 million in health spending and another $804 million in carer costs.

Lost tax revenue, welfare and other government payments incurred by people with obesity was put at $358 million.

http://www.smh.com.au/news/national/obesitys-huge-cost-dwarfs-medicare/2006/10/17/1160850935071.html

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Did that report give examples of other countries where this sort of approach has been tried, or any future plans for such an approach, dadpad?

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The report I quoted did not relate to surgical intervention in any way. It was a 2006 report about costs only.

I posted it as, on purely economic grounds it may be economically viable to have surgical intervention. Whether surgical intervention is socially desirable is another matter entirely.

Dont forget that there are lies damn lies and statistics. I'm not saying the report's figures are correct.

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No, I wasn't suggesting you were, dadpad. I'm just wondering whether the AMA is basing this proposal on existing programs elsewhere. It just seemed a helluva big jump from next to nothing from the health profession (in the way of educating the public about obesity) to surgery to me.

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I worked with a woman at the shop who had this done and she almost died in the hospital. It was touch and go for a while there, but she pulled through. I left the shop before she came back, so I don't know what ever happened with her.

The last time I went to see my doc, we somehow got on the subject of this surgery and after I told about this woman almost dying, he told me that not only is the surgery itself a risk, but he told me something else I didn't know.

He said that this procedure may shrink the stomache so you can't eat as much, but many have turned to foods in liquid form, which are high in calories, such as ice cream, milkshakes, etc, and they end up gaining whatever weight they lost, many times even more.

I don't like this for adults, never mind teenagers!

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Surgery for obese young people?

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