Issue 21 / 22 November 2010

IMAGINE a proven, demonstrably cost-effective treatment for a common debilitating condition but we don’t make it available to the majority of sufferers.

Sounds improbable?

Not if the condition is obesity.

Although governments around the country have expressed support for increasing the availability of bariatric surgery in the public hospital system, patients can still wait years to access the treatment.

And those who give up and go private face costs that can be upwards of $10 000.

Figures released by the Australian Institute of Health and Welfare last Friday (19 November) show a phenomenal increase in weight loss surgery in recent years — at least, for some.

Numbers of bariatric surgery procedures have ballooned in line with our waistlines, the AIHW report found, from just 500 in 1998–99 to 17 000 in 2007–08, a phenomenal 54% average annual increase.

But there could have been a lot more.

More than 90% of procedures in 2007–08 took place in private hospitals.

Surgery rates were lowest in the most disadvantaged areas of the country — precisely the areas where obesity rates are highest.

Surgery may not be the be-all and end-all when it comes to obesity — and obviously we’d all rather see effective prevention — but for the morbidly obese it may be just about the only approach that has an evidence base.

And we know it helps reduce future health costs through improved cardiovascular health and control of type-2 diabetes.

The intensive, multi-disciplinary case management that accompanies surgery is part of the reason for the success, and it’s possible many patients might benefit from that alone, if we were only prepared to invest the necessary time and money.

But it’s a big “if”.

Obesity is very much the poor cousin when it comes to dividing up the health pie, says Associate Professor Tim Gill, principal research fellow at the University of Sydney’s Boden Institute of Obesity, Nutrition and Exercise.

Our tendency to see the condition as self-inflicted and (wrongly) as non-life-threatening, is one of the reasons it gets a low priority when allocating health resources, he says.

The end result?

GPs valiantly discuss lifestyle changes with their patients, but the bulk of obesity goes more or less untreated.

And the cost of that is something we all wear.

Jane McCredie is a Sydney-based science and medicine writer. She has worked for Melbourne’s The Age and contributed to publications including the BMJ, The Australian and the Sydney Morning Herald. She is also a former news and features editor with Australian Doctor. Her book, Making girls and boys, on the science of sex and gender, will be published by UNSW Press early next year.


Posted 22 November 2010

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