Surgeon calls for radical shift in attitude towards obesity

Risk factors

14 Sep 2016

Radical change in community attitudes towards obesity is needed if there are to be any major gains in addressing what has become a national crisis, says a leading Victorian bariatric surgeon.

And Associate Professor Wendy Brown says health professionals also need to lift their game.

“There is a lot of stigmatisation attached to obesity and that’s not just perpetuated by society, there is also a lot of stigmatism within the health profession for people who can’t lose weight,” she said.

“We tend to blame the patient, it’s almost like taking the moral high ground.”

Professor Brown said there was often an over-simplistic approach to weight loss and management that it is all about making sure the energy in (i.e. food) is less than the energy out.

“There is a lack of understanding that equation isn’t always as simple as that,” she told the limbic.

“One of the keys is educating health professionals that obesity is a disease – people do suffer with their obesity, physically, socially and psychologically.”

Professor Brown is a senior Upper GI surgeon and an Associate Professor of Surgery at Monash University, as well as director of the Monash University Centre for Obesity Research and Education (CORE), and president elect of the Obesity Surgeons Society of Australia and New Zealand (OSSANZ).

She said there did appear to be some change in attitudes towards obesity, with many more patients opting to undergo bariatric surgery in a bid to both lose the weight and keep it off.

“I think people are surprised to hear that only 3% of people can keep the weight off (through diet and exercise alone),” she said.

A need for less red tape 

She recently co-authored a Perspective in the Medical Journal of Australia, which revealed the magnitude of bariatric surgery in Australia and raised concerns about the existing ethics review process.

In 2016 the authors estimated that there would be more than 15,000 bariatric surgery procedures across the country, at a direct cost of more than $225 million.

“Yet there are no evidence-based guidelines directing who should be offered this surgery, nor are there any long-term community data documenting its safety and efficacy in Australia,” the authors wrote.

The Obesity Surgery Society of Australia and New Zealand (OSSANZ) has teamed up with Monash University’s Department of Epidemiology and Preventive Medicine (DEPM) to establish a national registry of all bariatric procedures with the aim of filling these knowledge gaps.

The pilot commenced in 2012 and national rollout commenced in May 2014, with Federal Government funding.

The Bariatric Surgery Registry (BSR) collects information on each procedure performed, the devices used, changes in patients’ weight and diabetes status, and adverse events. Protocols require human research ethics committee (HREC) approval to ensure that they comply with privacy legislation.

Here is where the red tape has become problematic.

“Because the BSR is tracking and storing identifiable sensitive health information longitudinally as well as cross referencing data points to external data sources, HREC review is required at every site contributing to the BSR,” the authors wrote.

The median time from the first application to final approval was 86 days, while the maximum numbers of queries from or changes requested by an HREC was 67.

The process of obtaining ethical approval at these initial hospital sites cost the BSR $180 698.58 in salaries and $3474.97 per application. In addition, the BSR has had to pay five sites a total of $3927.00 for ethics approval application fees.

“The number of CQRs in Australia is growing rapidly in response to community demands for better monitoring of health care outcomes,” the authors wrote.

“HREC review of registry processes is one way of ensuring that the rights of individuals participating in registries are protected and complying with the Privacy Act. However, as highlighted by our experience in rolling out the BSR, the lack of a consistent process for obtaining HREC approval across multiple sites for these quality and safety initiatives creates cost and slows implementation.”

Based on this, they want to see a bespoke national process for HREC review of CQRs, which would “would streamline implementation and reduce costs while still protecting patient’s privacy.”

Professor Brown said it was important to balance the need for less red tape while not limiting access to people’s need for interventions such as bariatric surgery.

“It needs to be raised sensitively and with a bit of purpose, and with realistic goals in mind,” she said. “But it needs to be raised because obesity is a problem. If I took someone’s blood pressure and it was high I wouldn’t ignore it. Obesity should be treated no differently.”

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