DO WE HAVE ENOUGH EVIDENCE TO SUPPORT BARIATRIC SURGERY (PART III)
We shall now address the discrepancies within the results, as well as the arguments against obesity treatments such as surgery. We have picked up two examples.
- The first one shows the gap that exists between the results of the surgical literature and the real data that have been obtained from a comprehensive survey on the ground*. In the North-American population benefiting from the Medicare system, 16155 patients have been consecutively operated between 1997 and 2002 and reviewed. Two-months mortality has been 2% and 1 year mortality 4,6%, which is much more than what has been commonly reported in the surgical literature (average post-op mortality: 0,5%). The spontaneous course of the 'obesity-disease' should indeed compete with the post-operative course! Let us remind you that gastric bypass is the most common operation in the US, and has a higher mortality than other simpler procedures, such as lap-banding.
Some degree of arrogance is also present when surgeons claim that surgery is the unique method to obtain a long-term weight-loss. In the mean time, they just forget that surgery is only a part in a large project, including other people (dietitians, psychologists and support groups, etc.).
- The second example comes from a minority proactive group, who claims there is no real 'obesity epidemic', unless to serve the vested interests of some corporations (e.g. drug industry). Moreover, this group states that there is no additional morbidity and mortality related to obesity and a lack of scientific evidence in this respect **! This group is close to the « Fat Activists » or to the NAAFA (National Association to Advance Fat Acceptance). They may have a point, for instance in arguing against treatment in merely overweight patients. Yet one can question the motives of these groups, knowing that few obese people wish to remain so!

*FLUM D, SALEM L, BROECKEL ELROD JA, et al. Early mortality among medicare beneficiaries undergoing bariatric surgical procedures. JAMA, 2005: 294: 1903-1908.
*CAMPOS P, SAGUY A, ENSBERGER P, OLIVER E, GLASER G. The epidemiology of overweight and obesity: public health crisis or moral panic? Int J of Epidemiology, 2006; 35: 55-60