Cutting edge: bariatric surgery may do more harm than good

We live in a time in which science plays an increasingly important role in public decision-making. Anyone who aspires to be an informed citizen needs to learn to read science news stories with a critical eye. Here's a suggestion: Whenever you read a science news story, ask: What's missing?

Consider this statement from a recent article: "The last resort, for those whose obesity is extreme, is bariatric surgery, which elicits a permanent and substantial weight loss in almost everyone."

What's missing? Simple: just how "substantial" is this permanent weight loss?

We have an answer to that question. The Swedish Obese Subjects Study followed patients for as long as 20 years or more and found the average amount they lost and kept off was equal to 18 percent of starting body weight. In other words, someone who starts out severely obese will end up — somewhat less obese.

Does this make a difference? A 2014 systematic review by the Cochrane Collaboration found no good quality evidence that bariatric surgery reduces the likelihood of either of the two outcomes that matter most: all-cause mortality and all serious adverse events.

In fairness, it should be mentioned that a more recent matched case-control study did find that bariatric surgery was correlated with a one in 10 drop in the death rate of Veterans Administration patients over the course of the next 14 years. The problem with this study is that it not a randomized controlled trial, which makes it difficult to separate the effects of surgery from potential confounders. Patients who are too sick or unmotivated to lose weight are unlikely to get the surgery, while those who do get the surgery may receive a level of support that previously was unavailable. Anyone who watches TLC's "My 600 Pound Life," that serial infomercial for Jonathan Nowzaradan's bariatric surgery practice, has seen those patients coming in for follow-up, weighing in and being harangued by a crabby old man to exercise, to stop overeating, to stop lying to themselves. That may not sound like much, but for these unfortunates, who often are woefully bereft of knowledge, skills, resources, self-respect and self-love, it's something — it's a modicum of concern for their well-being.

Anyone who watches "My 600-Pound Life" also knows that these folks, whose eating has been out of control for years, often manage to lose enormous amounts of weight — before the surgery. How do they do it? By exercising and eating less. And if you watch the closing credits, you'll see the executive producer of the series is Jonathan Nowzaradan. So much for journalistic objectivity.

For some reason, "My 600-Pound Life" never seems to mention the matter of cost, but a 2013 study by researchers at Johns Hopkins University found the average cost of bariatric surgery and 30 days of after-care was $29,517 — with no reduction in subsequent health care expenditures.

So why do some people think bariatric surgery is the solution to the obesity epidemic and associated skyrocketing health care costs? It can't be. According to the American Society for Metabolic and Bariatric Surgery, 18 million Americans are eligible for this procedure. At $29,517 a pop, that's over $500 billion. We don't have it. We're not paying for the medical interventions we're getting now. We're not going to cut our way out of this problem with a surgeon's knife.

As the number of bariatric surgeries has soared, the rates of morbid and malignant obesity have soared as well. Presumably this is not the outcome we were looking for.

So what is the solution? Perhaps we should start by exercising more skepticism toward those whose solution to skyrocketing health care costs always seems to involve making the rest of us throw even more money at the health care industry. And let's stop telling obese people they are helpless victims of their genes — there is no such thing as a gene that makes it impossible not to be obese.

None of this is intended to minimize the pain of the severely obese. A study conducted jointly by Kaiser-Permanente and the CDC found an extremely strong correlation between self-reported abuse in childhood and severe obesity. And anyone who watches "My 600-Pound Life" knows that one after another, the subjects report having been sexually abused as children. These are often broken, damaged, hurting human beings.

So maybe another part of the solution is to think about ways to show concern for broken, damaged, hurting human beings without submitting them to fantastically expensive surgical mutilations that do less good than people may realize.

Patrick D. Hahn is an affiliate professor of biology at Loyola University Maryland and a free-lance writer. He can be reached at patrickhahn@hotmail.com.

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