Why Metabolic Surgery Cannot Be A Population Solution To the Obesity Problem

Ludicrous as the thought that any form of surgery could be even remotely considered a possible solution to a problem that affects billions of people around the world may seem, the metabolic surgery literature continues to suggest that it may.

There is no doubt that bariatric (or metabolic) surgery is highly effective in reducing body weight and putting diabetes into remission, at least compared to any existing behavioural or medical treatment.

Be this as it may, a commentary by Robin Blackstone, published in JAMA Surgery in response to a paper by Chih-Cheng Hsu and colleagues showing favourable 5-year outcomes in surgical treated patients with type 2 diabetes with BMI lower than 35, makes some salient points.

“Should metabolic surgery be more widely adopted? The barriers are significant. Cost of the procedure, complications, lack of surgical manpower, poor access to financially supported care, the problems of weight regain, and clinician and payer bias against surgery limit application as a population solution. These barriers are unlikely to change and may be magnified in very large populations.”

No one can argue with this assessment.

Nor can anyone argue with the statement that what we really need is

“…disruptive innovation that can be widely applied to the population at risk, is inexpensive to administer, and can be repeated as necessary. The pace of this work needs to be accelerated with increased funding and collaboration.”

Although

“Our collective response has neither the scope nor the scale to stem or reverse the tide of this disease. Access to all modalities of treatment should be expanded, keeping our collective fingers in the dike to salvage people in this generation.”

This would of course  require an astronomical hike in funding for the search of innovative and disruptive treatments for obesity – funding that may need to approach the cost dimensions of a manned mission to Mars.

Whether or not there is any political will to do this, given the stigma and discrimination that people living with obesity experience on all fronts, remains rather unlikely at best.

@DrSharma
Edmonton, AB