Access to Obesity Surgery Hampered by Lack of Understanding
Date 17th November 2014
Access to Obesity Surgery in New Zealand Hampered by Lack of GPs’ Understanding
One of the most effective long-term forms of treatment for obesity is being denied to thousands of New Zealanders because of a lack of understanding among family doctors about the procedures available, as well as public and private reluctance to fund bariatric surgery, according to the Obesity Surgery Society of Australia and New Zealand (OSSANZ), which will be holding its annual scientific meeting in Wellington this week (November 20th -21st).
The uptake of bariatric surgery in New Zealand is one of the lowest in the world, with less than 900 procedures performed across the entire country last year, which means that around 0.03% of persons who are potentially eligible is having this treatment.
OSSANZ spokesman Dr Jon Morrow, a bariatric surgeon at Auckland’s Middlemore Hospital, says GPs’ lack of understanding about obesity surgery is as much to blame as poor funding for the poor access to bariatric surgery in New Zealand, in spite of the country ranking third in the world for obesity rates.
Dr Morrow explains: `GPs in New Zealand are generally against bariatric surgery even though the evidence is unequivocally in favour of its use. GPs generally tend to be quite traditional in their approach to weight loss, I reckon less than a quarter of GPs here will refer patients for surgery. Diet and exercise are important factors, but there is now a huge amount of data, which demonstrates that for up to 15 years after bariatric surgery people do lose weight and keep it off. Unfortunately in the face of this evidence GPs just continue to do what they have been doing. They see obese patients everyday and just don’t mention it to them because they find it impossible to broach the subject with them.’
Wendy Brown, OSSANZ President and Associate Professor in the Faculty of Medicine, Nursing and Health Sciences at Monash University, Melbourne, adds: `The theme of our annual meeting in Wellington is “working together for the good of our patients”. We know that when diet and exercise intervention has failed for obese patients, bariatric surgery is an effective treatment with a good evidence base. It is important that we educate GPs and the community on the role bariatric surgery may play in the treatment of obesity.
‘Surgery is currently one of the only options available that predictably provides substantial weight loss which is sustained when provided in an environment that supports lifestyle change. We hope that we can raise the awareness of this option for obese persons in New Zealand, and that the community can explore ways to improve access to this surgery.
‘However, bariatric surgery is not a magic bullet. It requires a commitment from the patient to change their lifestyle and to actively participate in long-term follow-up. Therefore, we need to involve GPs and other health professionals to support patients on this journey. It is important we have a team approach in the management of this disease so that we can get the best outcomes for our patients.’
Dr Morrow adds: `Most of the surgery performed in New Zealand is gastric sleeve. This procedure involves removing around 80% of the stomach, leaving behind a small tube of stomach. The part of the stomach that is removed is the area that produces hormones that increase hunger, and on top of this patients are physically not able to eat as much. It is safe surgery, causes less severe nutritional deficiencies in the longer term, has few longer term complications and requires 2-4 follow up visits per year, making it well suited to our population who are often reluctant, or find it difficult to, attend follow-up appointments. Typically, by four years people lose around 60% of the extra weight that they are carrying. With this we see diseases related to obesity such as diabetes, high blood pressure and sleep apnoea improve or completely resolve.
`Yet even though the New Zealand ministry of health knows that there are huge health and economic benefits from bariatric surgery, public and private funding is limited. Procedures cost between $18,000 and $20,000 privately, but the insurance companies will only pay a third of the cost up to a maximum of $8,000 even though it is in their economic interest to reduce the long-term economic effects of untreated obesity.’
According to the World Health Organization someone with a body mass index (BMI) of 30 or more is generally considered as obese. Obesity rates in New Zealand as a whole are just under 30% of the population, but among Maori the rates are over 48% and rise to 68% in Pacific islanders.
Now characterised as an epidemic, obesity in children and adults is associated with serious health risks that include hypertension, dyslipidemia, diabetes, fatty liver disease, obstructive sleep apnea, and psychosocial complications.
Professor Brown points out: `Obesity is a disease with far reaching consequences for health and well-being. Weight loss has the potential to be one of the most powerful health interventions in our community. Whilst prevention would be the ideal, preventative programmes just have not worked so far. Diet and exercise programmes are only successful in the long term for 3% of patients. It is not that obese people are just lazy and can’t be bothered; it is incredibly difficult to lose weight as your body defends your weight vigorously. We believe it is time for New Zealand to look at ways to improve access to bariatric surgery.‘