Yup, I am on my banding soapbox yet again… but how could I go past this fantastic article that appeared today in Australia’s Newcastle Herald?

Surgery for weight loss is far from an easy fix

The glossy ads don’t tell of the real risks, writes Lily O’Hara

First there was one or two, then 10 or 20, but now the number of people with stories to tell about the horrors of lap-band surgery is reaching hundreds.

The glossy ads and celebrity endorsements show the “success” stories of lap-band surgery. The before-and-after pictures depict the transformation from fat to slim, from desperately unhappy to overjoyed, from sloppy to stylish. But move away from the paid advertisements and endorsements from surgeons profiting from these procedures, and you see a very different picture. All over the blogosphere people are telling their stories about bariatric (weight-loss) surgery gone wrong.

Lap-band surgery (or laparoscopic gastric-banding surgery as it’s officially called) is now the most widely used surgical procedure for weight loss. In 2008, according to Medicare, more than 12,000 people had lap-band surgery. With this many procedures being performed each year, it might be reasonable to expect it has undergone the sort of scientific testing we expect from new developments in medicine. Evidence-based medicine is the new mantra for medical procedures these days, and in this climate, any new procedures or pharmaceutical products are not just expected to perform better than no treatment or a placebo, but are expected to outperform the best current treatment practices.

Does lap-band or any other form of bariatric surgery, stand up to this rigorous scientific testing? The surprising answer is no. There have been no studies conducted in which lap-band surgery has been compared to conservative clinical management of health problems, and shown to be better for life expectancy or improving health outcomes. Lap-band surgery should therefore more appropriately be described as experimental gastric-banding surgery.  As with any experimental procedure, prospective patients should be made fully aware of the experimental status, as well as the range of potential unintended side effects. However this is not the case. Patients considering the procedure are only given the positives, and shown photos of success stories. They are not usually subjected to any psychological screening and often have no follow-up after the procedure. They are not told about the potential short-,medium- or long-term complications, and the prospect of dying as a result is almost certainly never mentioned. They are not told that at least one-third of all patients will have their band removed, that the honeymoon period of rapid weight loss, only 25 per cent will ever lose even half of their “excess weight”, that more than 75 per cent will have complications, or that patients can start regaining weight as early as one year after the surgery.

They are not told they may have band erosion or leakage, food intolerance, reflux, constant vomiting or digestive disease. They are not told the risk of dying after weight-loss surgery is considerable higher than with similar health conditions. One study suggests that the mortality risk is increased by 300 per cent in the first four years. They are not told that post-bariatric surgery patients die at five to 10 times the population average, with the higher rates being in the 25-34 age group. Experimental gastric-banding surgery continues to be performed on people on the basis that it is their “last hope” for a healthy life. In fact, many people have come to believe that their obesity will actually cause them to die, and this is reinforced by the clinics aggressively marketing lap-band surgery. It seems as though we are prepared to allow this surgery to become so mainstream that it is now proposed for children as young as 12.

Thankfully there is an alternative approach to improving the health of people of all shapes and sizes. This approach is called Health at Every Size, and it involves helping pursue better health outcomes without focusing on body weight. Scientific studies have demonstrated that this approach is superior to tradition weight-loss approaches in achieving physical and mental health outcomes. People are healthier and happier as a result of letting go of their obsession with body weight and focusing instead on the things that are within their control. Their body-image and self-esteem improve, their eating and physical activity behaviours improve, and their physical markers such as blood pressure, cholesterol and blood glucose all improve too. Aren’t they the healthy outcomes we all want?

In the cacophony of anti-fat public health messages the voices of those harmed by these messages and those proposing alternative approaches remain almost unheard. It is high time public health authorities started listening.

Lily O’Hara is a lecturer in Public Health at the School of Health and Sports Sciences at the University of the Sunshine Coast, in Australia.