What Is on the Horizon for Metabolic Surgery?

At IFSO 2023 in Naples, it was clear the people are keenly aware. Change is afoot in obesity care. New obesity medicines are starting to produce clinical outcomes that approach the outcomes people see with surgery So the recurrent question at the meeting was all about what might be on the horizon for metabolic surgery.

Will these new medicines drive surgical procedures down? Or will they drive greater utilization of medical obesity care and lead people to be more open to metabolic surgery.

Strong views about this abound. So in collaboration with Francesco Rubino and Ricardo Cohen, we had the opportunity to present new research at the meeting to inform our understanding of how people living with obesity might feel about this.

The crystal ball is hazy. In honesty, our research tells us that any outcome is possible. But these numbers can serve to inform our opinions.

Appreciation for a Medical View of Obesity

One thing that surfaced pretty clearly is that these new medicines are bringing an increased appreciation for a medical view of obesity. Nearly 70% of respondents told us they agree with the idea that “there is strong evidence that body weight is regulated by a biological mechanism, not just by willpower.”

But at the same time, many respondents point to behavioral factors – overeating and sedentary lifestyles – as primary drivers of obesity. More than 40% of respondents told us they believe diet and exercise is more effective for treating type 2 diabetes than either diabetes medicines or metabolic surgery. It’s not really true, but many people believe it anyway.

A Clear Need for More Work on Public Perceptions

Rubino explained that these data present a very mixed picture of the future prospects for metabolic surgery. When asked if they are more or less likely to consider it than they were five years ago, 30% said they were less likely. Slightly fewer – 22% – said they were more likely.

But for those who were less inclined to favor surgery, new medicines were not the biggest driver. By a large margin, it was all about a belief that diet and exercise is the “best way” to control the obesity.

Thus, we have to say that on the horizon for metabolic surgery it is not clear what we are seeing, simply because public perceptions are clouded by a poor understanding of the evidence favoring medicine and metabolic surgery.

The task that lies ahead is to bring better information, better messaging, to the public.

Click here for the slides that we presented at IFSO 2023 in Naples and here for an excellent perspective on this question from STAT News. For further perspective from ConscienHealth, click here.

Naples Sun on the Horizon, photograph by Ted Kyle / ConscienHealth

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September 1, 2023