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Inequalities of access to bariatric surgery in Australia

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Bariatric surgery for obesity complicated by severe comorbid conditions should be accessible to all Australians

Severely obese people in Australia can undergo weight loss surgery in the private sector with little difficulty, but publicly insured patients are blocked from equivalent access. A recently published study in the Journal reports that weight loss, improvement in metabolic indices, and clinic attendance after bariatric surgery in public patients compared favourably with that in patients who were privately insured.1 With their findings, the authors’ call for increasing access to bariatric surgery in public patients is an important regional contribution to the national discussion of this vexed question. It is noteworthy that Australia’s world-class contribution to the vast literature on metabolic surgery, which includes randomised controlled trials and authoritative systematic reviews, comes predominantly from work carried out in the private sector.

Bariatric surgery has long been established as the only treatment for the morbidly obese that durably addresses the mechanical effects of obesity, such as sleep apnoea and joint disease, while producing profound metabolic changes including resolution of type 2 diabetes mellitus (T2DM), hypertension and dyslipidaemia. Yet, unlike for other chronic illnesses such as asthma, diabetes and joint disease, Australia still has no framework within which…