The benefits of weight loss surgery

Legendary soul singer Aretha Franklin has denied her new slimmer figure is due to weight loss surgery. But plenty of other famous and not-so-famous people have had gastric operations to shed stones. This feature looks at the procedures and how they work.

Legendary soul singer Aretha Franklin has denied her new slimmer figure is due to weight loss surgery. But plenty of other famous and not-so-famous people have had gastric operations to shed stones. This feature looks at the procedures and how they work.

By Lisa Salmon

You don’t need to be a celebrity to have weight-loss surgery, but certain slimline famous faces are high-profile proof of the benefits of going under the knife to improve health and appearance.

Fern Britton has shed more than five stone, Shameless actress Tina Malone lost 10 stone and former TV presenter Anne Diamond is six stone lighter, all after having gastric bands fitted.

Legendary soul singer Aretha Franklin also hit the headlines earlier this year after losing six stone post-op, although she denies having weight-loss surgery.

The number of weight-loss operations, also known as bariatric surgery, performed in England have increased massively from 238 in 2000 to 4,619 in 2009 and, according to a recent report published by the National Bariatric Surgery Registry (NBSR), the results of such surgery are impressive.

Within a year, patients lose more than half of their excess weight and four in five no longer suffer from associated conditions such as diabetes, high blood pressure and high cholesterol.

Yet despite being highly effective and clinically safe, these operations are merely a drop in the ocean of need, says bariatric surgeon Alberic Fiennes, president of the British Obesity and Metabolic Surgery Society.

While around a million people in the UK meet the qualifying guidelines for weight-loss surgery, less than 1% of those were treated by the NHS during the last two years.

“The amount of bariatric surgery that’s done is the tiny tip of a huge iceberg of unmet need,” stresses Fiennes.

People are prejudiced against obesity, he says, and surgery is viewed as the luxury solution to a self-made health problem.

But severely obese people simply can’t get well, he says. “People consider it to be an issue of moral weakness. This goes against the available evidence.

“Appealing to people with obesity to exercise willpower to lose weight is like asking somebody to hold their breath for 10 minutes.”

People with severe obesity aren’t able to control their eating, he says. “Severe and complex obesity should be seen as an organic disease.”

Experts believe hormones that help normal people regulate their appetite and metabolism are deficient in severely obese people.

Certain physiological signals that might tell a person when they’re full no longer work, explains Fiennes.

“There’s good evidence that one particularly important signalling mechanism relating to appetite suppression and the control of diabetes and metabolism is permanently suppressed or lost in people with severe and complex obesity.” But certain types of surgery restore that signal, he points out.

Virtually everybody who comes forward for surgery has had a desperate time struggling for years with a weight problem, Fiennes stresses.

“If it sounds like a quick fix, that’s only in the eyes of the lean people,” he says.

“Severe obesity isn’t just physiologically a disease, it’s socially and psychologically a torture for these people.”

Around 80% of weight-loss surgery patients are female and the average age at which people have operations is the late forties. They are generally around twice the weight they should be for their height.

Bariatric operations are by no means a magic bullet. As well as the normal risks of surgery, there can be complications including gastric band slippage, gallstones, a blockage known as a stomal stenosis after gastric bypass, and the development of food intolerances. However, in most cases the benefits of surgery outweigh the risks.

As well as experiencing weight loss, patients’ eating habits should be changed forever as they learn to eat much smaller portions of food. If they eat too much, they will feel uncomfortable and may be sick.

Consultant bariatric surgeon Richard Welbourn, author of the NBSR report, says weight-loss surgery has “staggering” outcomes for patients, but stresses that it isn’t an easy option.

“The biggest challenge is to change the way society views the operations, and secure more NHS funding for them,” he says.

“There’s a lot of prejudice against this area of medical problems. People assume obesity is about gluttony and it’s self-induced, but then so are smoking and drinking-related health problems, and some driving accidents, and we pay for all those things.

“We have to get a sense of proportion. We’re already paying for this disease because we’re paying for treating its medical consequences.”

Research shows that the baseline cost of bariatric surgery - roughly £9,000 for gastric bypass and £5,000 for gastric band surgery - is recouped within three years of surgery as obesity-associated costs are eliminated.

Welbourn says provision of operations can be patchy as many Primary Care Trusts can’t cope with the costs, despite potential savings in the future.

“People say, ‘Why should we pay for gluttony?’ But the answer is we’re already paying for it.

“As surgeons, all we’re offering is a mechanism to get people off medication, restore health, get people off benefits and back to work, and to improve their quality of life. The risk of doing nothing is probably greater than the risk of the operation.”

Gastric band

:: Around a fifth (21%) of the UK’s NHS weight-loss operations are gastric band surgery.

:: During the surgery a band is fitted around the top of the stomach. The stomach above the band stretches a little after eating, sending a signal to the brain that the stomach is full much quicker than normal.

:: There should be steady weight loss of around 1lb-2lb a week.

:: Weight loss will take two or three years, generally stabilising at 50-55% of the excess weight.

Gastric bypass

:: Around two thirds (67%) of the UK’s NHS weight-loss operations are gastric bypass.

:: A more complicated operation than gastric banding, this involves a small pouch being created at the top of the stomach, which is connected directly to the middle portion of the small intestine, bypassing the rest of the stomach and the upper part of the small intestine.

:: Weight is lost in the first year, faster than with a band, and around 60-70% of excess weight is lost.

:: After the operation the hormones which control appetite and satiety begin to work differently and patients begin to feel full again.