Obesity is becoming the norm - but it doesn't have to be so
Surgeon Richard Wellbourn believes surgery is sometimes the best solution to losing weight.
Its official, Britain is obese. A quarter of women in this country, and over a fifth of men, are now obese. Our women are now the fattest in Europe, with the men not far behind.
What is worse, 17% of our young people are obese – far higher than the European average.
But why are we doing so much worse than say, the Romanians, where obesity levels are at a skinny 8%?
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A series of articles in medical journal The Lancet recently described British society as ‘obesogenic’. This means that a normal person reacting normally to their environment will now become obese. This is because healthy, low fat food is expensive and harder to find than high salt and fatty foods that are cheap and well-advertised.
What’s more, we are genetically programmed to add calories, to store energy for when we might need it. In the past our lifestyle ensured that we burnt the excess calories off. Now we don’t. We used to walk and run everywhere, and work in the harvest. Now we drive everywhere and we work in offices.
But does this matter? Surely there is nothing wrong with carrying a few extra pounds?
All the evidence tells us that obesity is dangerous. The chances of developing type 2 diabetes are massively increased if you are obese; as is the risk of heart disease and certain cancers. The everyday reality for obese people is also a concern. Just getting about can be hard, which not only creates problems in itself but makes it even more difficult to shift the weight. It can be a vicious cycle.
The really scary bit is that obese people will, on average, die nine years before their non-obese friends. Nine years of lost life, and a significantly reduced quality of the life they do have.
If this was an article about people who have arthritis or another more mainstream chronic condition, you would be up in arms by now. Somehow, over the years we have accepted it. But now we need to do something about it.
Given this situation – a ticking time bomb of human suffering and financial disaster for our health services awaiting us all, what are we doing? Some countries are implementing a fat tax, making bad foods more expensive. Others are investing in sports schemes and education for children. Michelle Obama is leading a national initiative to reduce childhood obesity in the USA.
The UK government issued a “call to action” on obesity recently. Their plan? No fat tax, no fiscal measures, no new investment. They called on the food industry to provide more choice and more healthy options and they called on us to eat less and eat better. The strategy was ridiculed by many, including Jamie Oliver, and the government’s very own advisory group complained and were subsequently disbanded!
In a sense, we all know the answer to obesity: eat less and move more. But we also all know people who do exactly this and yet still cannot lose the weight; or more likely lose it then put it back on again after a few months.
As a bariatric surgeon who worked on the first ever comprehensive summary of obesity surgery in the UK, I am frustrated that more people are not talking about surgery as a solution.
A gastric bypass or a gastric band can make a huge difference. We are all on a path of weight gain based on our genetic make-up. And we can all alter the path slightly, increasing or decreasing our weight over time. But the frustrating scientific truth is that you cannot change your trajectory overall. Only surgery can do that. My patients who have had a bypass report an average weight loss of over six stones in two years.
Surgery changes not only the physiological make-up of the body but the way the brain itself works. A recent study showed that patients actually like different, healthier food after surgery, unwittingly choosing better options. We operate on the gut but we change the brain.
And surgery can effectively cure long-term conditions. In a study that my team carried out in Taunton, we found that 72% of our patients with diabetes who had surgery no longer had symptoms or needed medication 12 months later. This is in addition to the improved cardiac fitness and other benefits.
So bariatric surgery works. But it also pays. The Office for Health Economics published a report this year showing that surgery pays for itself within about two years. Surgery costs about £7,000. Supporting a patient with diabetes costs £3,000 a year.
So the fact that we need to tackle obesity is clear. We have failed to prevent the epidemic, and the Government’s approach is to blame the individual. For me, one part of the jigsaw must be surgery. Not the only answer, not the answer for everyone, but an option that can benefit the individual and save money for the NHS and the taxpayer.
Richard Welbourn, MD FRCS, is an NHS consultant bariatric surgeon and the clinical director of The Bariatric Group.