The use of gastric surgery to treat obesity and its medical complications should be greatly expanded, the BA Festival of Science in Liverpool heard on Monday.
Clinical researchers told the meeting, organised by the British Association for the Advancement of Science, that the gastric bypass operation, which makes the stomach smaller and removes part of the bowel, was the only effective treatment for obesity. It can also cure type-2 diabetes, the most serious complication of being seriously overweight.
“There is a real social stigma surrounding bariatric [obesity] surgery and those who choose to have the operation, which needs to be eliminated,” said Rachel Batterham of the Centre for Diabetes and Endocrinology at University College London. “The surgery really does work. Not only does it help people to lose weight by decreasing the amount they eat, but it also alters their hormone profiles, meaning it’s easier for them to maintain weight loss.”
Carel Le Roux, an obesity researcher at Imperial College London, said a 10-year Swedish clinical study showed that gastric bypass surgery typically led to 25 per cent long-term weight loss, while gastric banding – a less radical operation – produced a 13 per cent loss. Lifestyle changes and medication failed to produce any long-term benefits, he said.
Another Swedish study showed that patients lived longer after gastric surgery, Dr Le Roux added. Mortality after 15 years was 9 per cent in people who had the operation and 13 per cent in a comparable control group who did not.
Guidelines from the National Institute for Health and Clinical Excellence say people with a body-mass index above 35, who are suffering from obesity-related disease, should be eligible for gastric surgery. A typical operation costs £9,000.
According to Dr Le Roux, the National Health Service should be carrying out gastric bypass surgery on one in 1,000 of the UK population every year, if the Nice guidelines were implemented. In reality, only one in 10,000 people has surgery – equivalent to 6,000 operations per year. Numbers in other European countries and in the US are higher.
Research has shown gastric surgery works not only by reducing the stomach and bowel but also by affecting the balance of appetite-controlling hormones in the blood and brain. “One of the major areas that we are looking into is trying to find a drug equivalent to bariatric surgery,” Dr Batterham said. “An increased understanding of the hormone changes that occur with obesity surgery may enable us to develop non-surgical treatments.”
