The Trouble With Bariatric Surgery

I find this kind of troubling:

A federal advisory panel Friday endorsed an expansion of the use of Allergan’s Lap-Band stomach-restricting device to patients who are less than severely obese.

The vote could pave the way to double the number of Americans who qualify for weight-loss surgery. And it could eventually lead to making other types of weight-loss surgery available to those who are not quite as heavy.

Bariatric surgeries are often touted as a great option for severely obese people who have failed to lose weight from diet and exercise, but I think this is problematic for a couple reasons.  One is simply that, if a severely obese person with health problems has good diet and exercise habits, why does s/he necessarily need to lose weight in the first place?  I understand that it can be beneficial to many, but the relationship between weight and health is much more complex than lots of people assume, and exercise and nutrition are often more important than weight when it comes to health.  For obese people who improve their health through exercise and healthy eating, the only other reasons to lose weight would be cosmetic.

But besides that, it’s also not clear that weight loss from bariatric surgery reduces health risks for those who undergo the surgery.  Here’s Sandy Szwarc on the subject:

Doctors discussed these ethical dilemmas in the April 2003 issue of the Journal of the American Medical Association (JAMA) and noted that the long-term consequences of these surgeries remain uncertain, both in health outcomes and if any significant weight loss is even maintained. And of particular concern were the long-term effects of changing nutrient absorption.

[…]

A landmark report evaluating the evidence (more than 70 studies) on the efficacy of bariatric surgeries was released by ECRI in September, 2004. […] The ECRI report, “Bariatric Surgery for Obesity,” noted that the surgeries can produce significant initial weight loss but “three years after surgery, the typical patient is still obese.

So if we’re unsure of both whether or not these surgeries work and whether or not they pose any health risks, why would we be expanding their client base?  If this surgery was originally intended for severely obese who couldn’t lose weight any other way, why would we make the threshold lower?  I suspect this doesn’t have much to do with actual health but is just a stab at getting more customers for bariatric surgery. Not that I’m accusing bariatric surgeons of willful deception or anything; it just seems like the primary motivator is economic, and actual health considerations are continuing to fall by the wayside.

(Image by Spirit-Fire used under a Creative Commons license.)