Interventional gastroenterology

Bariatric surgery not always the silver bullet

Questions have emerged over the effectiveness of weight loss surgery for patients with problem eating behaviours such as bingeing and emotional eating.

Existing research suggests that while there may be short to medium-term gains in weight loss, problem behaviours can recur over time in some patients – and in some cases may even occur for the first time.

Researchers, including leading Adelaide endocrinologist Professor Gary Wittert, have published the results of systematic review of studies on the subject in the journal Obesity Reviews.

They found 23 studies that looked at changes in problematic and disordered eating after gastric bypass, adjustable gastric banding and vertical sleeve gastrectomy.

And while they found significant gaps in the knowledge, lead author Melissa Opodza said that there was evidence that some patients experienced reoccurrences and even new occurrences of problem and disordered eating post-surgery.

She pointed out, however, that there were short to medium-term reductions in some problem and disordered eating behaviours, and even long-term improvements in a few of the studies.

“While surgery may help, it might be unrealistic to expect it to be the silver bullet,” she told the limbic.

The authors reported they were unable to make further conclusions or comparisons “because of limited or low-quality evidence.”

“Long-term comparison studies of changes to problematic and disordered eating in RYGB, AGB and VSG patients are needed,” they wrote.

“It is currently unclear whether any bariatric procedure leads to long-term improvement of any problematic or disordered eating behaviours.”

Ms Opodza, who is working with Professor Wittert and Professor Anna Chur-Hansen at the University of Adelaide’s faculty of health sciences, said many people with long-term problem eating patterns were turning to surgery in the hope that they would not only lose weight but address their problem behaviours.

She said she knew of patients who were so desperate for the surgery, and disillusioned by long public waiting lists, they were taking out loans or dipping into their superannuation to fund the procedure.

And while some may have great outcomes, others may have short to medium term weight loss, only to find their behaviours returning over time to the point when they regain weight.

“When it turns out that wasn’t the silver bullet then that’s very disheartening,” she said.

Ms Opodza said there was some evidence that suggested some types of bariatric surgery may be more effective than others in helping to address problem behaviours, but the dearth of literature made it too early to speculate.

“If bypass helps binge eating but sleeving doesn’t (as an example), then that would be really good information to have,” she said. “We really need more research.”

She is currently recruiting for a new study which she hopes will shed more light on Australian patients’ outcomes from bariatric surgery.

People aged 18 and over who have undertaken one of the major forms of bariatric surgery – gastric bypass, adjustable gastric banding and vertical sleeve gastrectomy – can take part in the Bariatric Eating Experiences Study. More details can be found here.

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