Life Is Better 15 years After Metabolic Surgery
The excitement of the moment we are in for obesity care can make it hard to step back and take a long view. But a new study in the International Journal of Obesity offers a good reminder about the importance of doing just that. Hanna Konttinen and colleagues offer us a good, objective view of quality of life 15 years after metabolic surgery. The outcomes are quite straightforward. Life is better 15 years after surgery than it is for people with obesity who did not get the procedure.
Their health is more improved and multiple measure of their quality of life are better. Depression, obesity-related problems, and limitations in social interactions are all less for people who had surgery, compared to the matched control group of people who did not.
Yes, life got better and it remained better after metabolic surgery.
Confusion in the Midst of More Options
This reminder is important right now because we are in a confusing time for obesity care. The confusion is not entirely a bad thing. It is simply the product of having more and better options for coping with the chronic disease of obesity.
Fifteen years ago, the options were more limited. For people with a long history of significant obesity had only one option that could usually offer significant and lasting relief – metabolic surgery. Back then, the label was more often “bariatric” or “weight loss.” But now, the understanding of the disease and the surgery tells us more clearly that this is a procedure to correct a metabolic problem. Not something to simply force a person to lose weight.
The confusion comes from uncertainty about the future role of surgery in a time when more medicines are coming available to help control the disease, even without surgery.
Abruptly Closing a Program
For a glimpse of mistakes that can come from this confusion, we have the example of the Journey Clinic at the Norman Regional Health System in Oklahoma. CEO Richie Splitt decided to abruptly close this clinic after decades of meeting patient needs and then to blame the closure on Ozempic.
Lana Nelson was director of metabolic surgery for the health system. She describes the decision as a mistake:
“They think that there’s no future in bariatric surgery because medications will replace what we do. But the very difficult and frustrating thing is that they are not clinicians. They are administrators. They made these decisions based upon no conversations with the clinical staff who are actually there taking care of patients and seeing trends.”
Patients were left in the lurch, said Nelson:
“Some of them were called the day before their surgical procedure and told, ‘I’m sorry, we’re closing the clinic and we’re canceling your surgery.’”
Hasty Mistakes
In a time of change, adaptation is important. But rash decisions based on false assumptions can hurt many people. Assuming that metabolic surgery will disappear because of obesity medicines is a mistake. Advances in medical oncology did not nothing to eliminate the need for surgical oncology. Rather, those advances brought growth in comprehensive care.
Likewise, integrated care for obesity is the future. Surgery and medicine are complementary, not competitive. The patient comes first.
Click here for the study of Konttinen et al and here for more on the Journey Clinic.
Childhood Memories, painting by Carlo Carra / WikiArt
Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.
July 18, 2024