ACCESS
TO OBESITY SURGERY IN NEW ZEALAND HAMPERED BY LACK OF GPS’ UNDERSTANDING
Media Release for OSSANZ
One of the most
effective long-term forms of treatment for obesity is being denied to thousands
of New Zealanders because of a lack of understanding among family doctors about
the procedures available, as well as public and private reluctance to fund
bariatric surgery, according to the Obesity Surgery Society of Australia and
New Zealand (OSSANZ), which will be holding its annual scientific meeting in
Wellington this week (November 20th -21st).
The uptake of
bariatric surgery in New Zealand is one of the lowest in the world, with less
than 900 procedures performed across the entire country last year, which means
that around 0.03% of persons who are potentially eligible is having this
treatment.
OSSANZ spokesman Dr Jon Morrow, a bariatric surgeon
at Auckland’s Middlemore Hospital, says GPs’ lack of understanding about
obesity surgery is as much to blame as poor funding for the poor access to bariatric surgery in New Zealand, in spite of the country
ranking third in the world for obesity rates.
Dr Morrow explains:
`GPs in New Zealand are generally against bariatric surgery even though the
evidence is unequivocally in favour of its use. GPs generally tend to be quite
traditional in their approach to weight loss, I reckon less than a quarter of
GPs here will refer patients for surgery. Diet and exercise are important
factors, but there is now a huge amount of data, which demonstrates that for up
to 15 years after bariatric surgery people do lose weight and keep it off.
Unfortunately in the face of this evidence GPs just continue to do what they
have been doing. They see obese patients everyday and just don’t mention it to
them because they find it impossible to broach the subject with them.’
Wendy Brown,
OSSANZ President and Associate Professor in the Faculty of Medicine, Nursing
and Health Sciences at Monash University, Melbourne, adds: `The theme of our annual meeting in
Wellington is “working together for the
good of our patients”. We know that when diet
and exercise intervention has failed for obese patients, bariatric surgery is
an effective treatment with a good evidence base. It is important that we educate GPs and the
community on the role bariatric surgery may play in the treatment of obesity.
‘Surgery is
currently one of the only options available that predictably provides
substantial weight loss which is sustained when provided in an environment that
supports lifestyle change. We hope that we can raise the awareness of this
option for obese persons in New Zealand, and that the community can explore
ways to improve access to this surgery.
‘However,
bariatric surgery is not a magic bullet.
It requires a commitment from the patient to change their lifestyle and
to actively participate in long-term follow-up.
Therefore, we need to involve GPs and other health professionals to
support patients on this journey. It is
important we have a team approach in the management of this disease so that we
can get the best outcomes for our patients.’
Dr Morrow adds: `Most of the surgery performed in New Zealand is gastric
sleeve. This procedure involves removing around 80% of the stomach, leaving
behind a small tube of stomach. The part
of the stomach that is removed is the area that produces hormones that increase
hunger, and on top of this patients are physically not able to eat as much. It is safe surgery, causes less severe
nutritional deficiencies in the longer term, has few longer term complications
and requires 2-4 follow up visits per year, making it well suited to our
population who are often reluctant, or find it difficult to, attend follow-up
appointments. Typically, by four years people lose around 60% of the extra
weight that they are carrying. With this we see diseases related to obesity
such as diabetes, high blood pressure and sleep apnoea improve or completely
resolve.
`Yet even though the New Zealand ministry of health knows that there are
huge health and economic benefits from bariatric surgery, public and private
funding is limited. Procedures cost between $18,000 and $20,000 privately, but the
insurance companies will only pay a third of the cost up to a maximum of $8,000
even though it is in their economic interest to reduce the long-term economic
effects of untreated obesity.’
According to the World Health Organization someone with a body mass
index (BMI) of 30 or more is generally considered as obese. Obesity rates in New Zealand as a whole are just under 30% of the
population, but among Maori the rates are over 48% and rise to 68% in Pacific
islanders.
Now characterised as an epidemic, obesity in
children and adults is associated with serious health risks that include
hypertension, dyslipidemia, diabetes, fatty liver disease, obstructive sleep
apnea, and psychosocial complications.
Professor Brown
points out: `Obesity is a disease with far reaching consequences for health and
well-being. Weight loss has the
potential to be one of the most powerful health interventions in our
community. Whilst prevention would be
the ideal, preventative programmes just have not worked so far. Diet and exercise programmes are only
successful in the long term for 3% of patients. It is not that obese people are just lazy and
can’t be bothered; it is incredibly difficult to lose weight as your body
defends your weight vigorously. We
believe it is time for New Zealand to look at ways to improve access to
bariatric surgery.‘
