A multi-pronged attack


Between 22 and 23 per cent of Irish people are obese, with a body mass index (BMI) in excess of 30. Some individuals will have struggled to lose weight with diet and exercise, only to see their initial success reversed as they regain weight over time. A significant minority will become morbidly obese (BMI greater than 40) at which point their life expectancy becomes severely compromised. Many more obese patients will develop chronic illnesses such as diabetes and hypertension as a direct result of their weight gain.

As Michael Gibney, Professor of Food and Health at UCD pointed out in the pages of this newspaper recently, the problem of obesity is highly complex. Even with a body of evidence from several disciplines, the answers are neither straightforward nor are they necessarily known. There is a clear need to integrate what scientific evidence we have. Because of its complexity, helping people with obesity requires a multi-pronged approach. What works for those who are overweight may not be appropriate for people at the severe end of the obesity spectrum.

There was some welcome recent news for those with morbid obesity: new research suggests they could have their life expectancy significantly increased and chronic diseases reversed following obesity surgery. Galway researchers found that two years after laparoscopic sleeve gastrectomy (a form of bariatric surgery), some 80 per cent of patients with pre-existing high blood pressure required less medication. And two-thirds of those with pre-existing diabetes were able to completely discontinue their medication.

These outcomes, allied to the participants sustained weight loss, are life-altering. They suggest that bariatric surgery may be a cost-effective intervention for a minority of obese people in the medium to long-term. However any element of discrimination against obese patients, on the basis that the condition is the result of some self-inflicted moral failure and that might limit the availability of funding for surgical intervention, must be resisted. Bariatric surgery is a minor but essential element in the battle against obesity.