Determines the efficacy of bariatric surgery in the public sector for the treatment of complicated obesity.
• Obesity is shaping up to be the major health care problem and one of the most frequent causes of preventable death in Western countries in the 21st century.
• Bariatric surgery is the only current treatment that has been shown to achieve major and durable weight loss.
• Major weight loss in the severely obese leads to total or partial control of a wide range of common and serious diseases, such as diabetes, heart disease and hypertension.
• Laparoscopic adjustable gastric banding is the most common type of obesity surgery performed in Australia. It is effective, relatively safe and minimally invasive.
• The blocks to broader application of bariatric surgery should be identified and resolved.
Objective: To determine the efficacy of bariatric surgery in the public sector for the treatment of complicated obesity.
Design, setting and participants: A longitudinal observational study of obese participants with comorbid conditions, aged 21–73 years, who underwent publicly funded bariatric surgery. Data were extracted from clinical databases (1 October 2009 to 1 September 2013) and recorded at seven time points. Participants are from an ongoing public obesity program.
Main outcome measures: Postoperative weight loss and partial or full resolution of: type 2 diabetes mellitus (T2DM), hypertension (HTN), dyslipidaemia and obstructive sleep apnoea (OSA).
Results: The 65 participants in the cohort lost a mean weight of 22.6 kg (SD, 9.5 kg) by 3 months, 34.2.kg (SD, 20.1 kg) by 12 months and 39.9 kg (SD, 31.4 kg) by 24 months (P < 0.001). Body mass index (BMI) decreased from a preoperative mean of 48.2 kg/m2 (SD, 9.5 kg/m2) to 35.7 kg/m2 (SD, 7.7 kg/m2) by 24 months (P < 0.001). Full resolution of comorbid conditions by 18 months (P < 0.001) was achieved by almost half of those with baseline T2DM, nearly two-thirds with HTN and three-quarters of those with OSA, with continued improvements beyond 24 months.
Conclusions: Bariatric surgery performed in the public sector is efficacious in the treatment of obese patients with comorbid conditions. Our findings parallel similar studies suggesting that there is equal benefit in publicly funded and privately performed procedures. This study highlights that obese patients reliant on public health care maintain sufficient intrinsic motivation in the absence of payment and supposed value-driven incentive. Improved access to bariatric surgery in the public sector can justifiably reduce the health inequities for those most in need.