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Perspective

Why Surgery Isn’t Always a Silver Bullet for Obesity

June 21, 2015| By Dr. Ian Cox | Life | English

Obesity is both preventable and reversible. But for those whose weight has spiralled out of control into severe obesity, controlling it and losing it through diet and exercise alone often proves ineffective.

A growing number of people are being judged as eligible for gastric bypass surgery. This next blog in our Outlook on Obesity series explores how successful this type of surgery is and what the implications are for underwriters assessing an application for life or health insurance.

With a gastric bypass, the upper part of the stomach below the oesophagus is isolated to create an egg-sized pouch. The pouch is then connected to the jejunum, so that food bypasses the stomach and instead goes directly into the small intestine.

The intended effect of this surgery is to limit calorie absorption. It’s thought that over half of people who have gastric bypass surgery achieve better control over their diabetes, a condition commonly associated with obesity.

But a gastric bypass is not a silver bullet. To be successful in the longer term, patients must still make the right food choices and practise self-control. Indeed, the causes of obesity are complex and there are many reasons why surgical treatment can ultimately prove unsuccessful. Some are related to the surgery itself and others have a behavioural cause.

Following a gastric bypass, patients must learn to eat differently - not least because the small stomach pouch has around 25% of the capacity of a normal stomach. Meals have to be smaller but more frequent, and take much longer to eat because they have to be chewed slowly and completely.

Unless the surgery is accompanied by a change in attitude to food, patients end up snacking, eating the wrong things or flushing food through the gastric pouch to let them consume more.

Sadly, some bypass patients will simply end up back where they started - and that has to be a consideration for underwriters assessing applicants with a history of bariatric surgery.

There are also unpleasant side effects to overcome in the months after surgery; the reality of life after the procedure often fails to match patients’ expectations. The low moods that trigger over-eating can be more keenly felt as a consequence.

Depending on the type of intervention, the potential for post-operative complications (e. g. leaks, infections, adhesions) must also be taken into account by underwriters as negative risk factors. An observation period of at least one year following the operation is recommended for all contract types before terms can be considered.

Even if significant weight loss has been achieved and no post-operative complications have been encountered, patients remain at heightened risk of vascular and metabolic disease, depending on the length of their previous exposure to related risk factors.

Such close attention to risk assessment must grow in importance as levels of obesity rise around the world. After all, it’s possible that public health policymakers could encourage bypass operations for more people as a way of heading off the longer-term costs of treating the many and varied health problems related to obesity.

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