Healthy Skepticism Library item: 16544

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Brown R
Dangers of battling the bulge
ABC News: The 7:30 Report 2009 Sep 30
http://www.abc.net.au/news/stories/2009/09/30/2701186.htm

Full text:

As the fight against Australia’s obesity epidemic continues, more and more people are turning to gastric banding – a procedure commonly known as lap band surgery – to help beat the bulge.

Last year, about 14,000 Australians had lap band surgery and this year’s figure is expected to be higher.

But many health professionals and patients are starting to worry the gastric band may be more dangerous than the morbid obesity and diabetes it is supposed to help prevent.

There is concern it is being marketed as aggressively as cosmetic surgery.

Health sociologist Dr Samantha Thomas has spent the past three years talking with obese people about their experiences.

“This has been sold as the quick fix magic bullet for obesity,” she said.

“In actual fact what we’re doing is putting the ambulance at the bottom of the cliff rather than the fence at the top.”

It is a big leap from cardio twisters and diet shakes, yet gastric banding has become the new heavyweight in the weight loss industry.

Gastric banding involves a silicone band being tied around the upper stomach, creating a small pouch, with a narrow outlet.

It has become the most widely-used weight control treatment in the country.

Its recipients – usually with associated problems like diabetes and sleep apnoea – spend between $6,000 and $14,000 on private surgery or three years on the public waiting list.

The successes are heavily publicised, like comedian and broadcaster Mikey Robbins, who lost more than 60 kilograms after lap band surgery three years ago.

Tasmanian Labor MP Dick Adams has also had the procedure and has been lobbying for greater subsidies for lap band surgery.

Mr Adams says that the surgery has greatly improved the quality of his life.

“I lost about 32 kilos and from that it improved my blood sugar levels, therefore my diabetes and gave me control over that,” he said.

“It improved my way of life because I was able to exercise more.”

Surgery complications
But not everyone’s ending is as positive.

Melbourne youth worker Les Twentyman spent three weeks in an induced coma after his operation.

Doctors had found and repaired a double hernia during the procedure, but he suffered complications the next day.

“They rushed me straight back in and took it out and had to fight to keep me alive,” he said.

Mr Twentyman says he went into the surgery unaware of the associated risk.

“I didn’t think there was, I was a bit of a sulk in a lot of ways and if there had have been any risks I probably would have been a bit reluctant,” he said.

About one in every 1,500 to 2,000 lap band patients die from post-operation complications.

Psychologist Lauren Eden says the procedure does not address what triggered a person’s obesity, and often compounds eating disorders.

“There’s a fellow I know, it would appear to me that he’s managed to override his gag instinct because his partner told me that he eats to the point where if he opens his mouth she can actually see food at the top of the oesophagus,” she said.

But proponents argue eligible recipients with obesity-related diseases are more likely to die without the procedure, and say psychological issues do not affect the results.

Associate Professor John Dixon is a senior clinical scientist from the Baker IDI heart and diabetes institute.

“Risks associated with obesity surgery are very low, [there is] much more dangerous surgery in our communities; heart, bowel, hip,” he said.

“We believe the band is working through a physiological effect – it allows a person to be satisfied after a small meal, it’s magic what it does.”

Financial sacrifices
But many health professionals are worried by what they see as a hard sell that is pitched at a desperate population.

Some surgeons, and the company that dominates the gastric band market in Australia, Allergan, have come under scrutiny.

This company also makes the wrinkle erasing drug Botox, and breast implants.

Dr Thomas is concerned people are encouraged to make big financial sacrifices in order to have the surgery.

“If you look at gastric banding sites in Australia you’ll see very commonly that they encourage people to cash in their super or to take out financial support or loans to pay for this surgery,” he said.

The 7.30 Report can reveal some clinics are now setting monthly lap band targets and one GP likens it to the fine quotas for parking attendants.

Similarly academics, general practitioners and patient groups are concerned the majority of the research being relied on to promote the lap band is being bankrolled by its manufacturer Allergan.

Associate Professor John Dixon, for example, receives research grants and speakers fees from Allergan, and sits on its advisory board, as well as the board of Bariatric Advantage, which makes nutritional products for lap band recipients.

Monash University’s Centre for Obesity Research and Education is also funded by Allergan.

Allergan declined an interview with the 7.30 Report and did not respond to questions of perceived conflict of interest.

Dr Thomas is calling for greater regulation and transparency in the industry, before any wider programs or subsidies are rolled out.

“The majority of studies that come out, particularly on gastric banding surgery, are done by people who have very close links to the industry and so then we have to also look at how rigorous and credible are these findings in terms of what the positive things they’re showing us about bariatric surgery,” she said.