There was some interdisciplinary verbal sparring about obesity management on the final day of AGW 2018 but, entertainment value aside, all parties agreed on the seriousness of the problem.
Endocrinologist Professor Ian Caterson set the scene with the sobering statistics that 63% of Australian adults are overweight or obese and the cost to the community in direct and indirect health costs is about $8.6 billion.
He said patients with a BMI over 30 could expect a reduction in life expectancy of about three years while those with a BMI over 40 would lose about eight years.
Professor Caterson, foundation director of the Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders at the University of Sydney, said obesity had to be considered a disease in its own right in order to elevate the importance of the issue.
“Everyone says that obesity is a personal choice – you can eat less and exercise more – but in our society and with our genetic background, it’s not that simple. Obesity causes major problems and we need to prevent and manage it properly.”
“If it is a lifestyle choice, it can’t be prevented and managed properly because there is not the engagement. As it is a disease, everyone should be managing it.”
He said there had to be a range of treatment options for patients based on their phenotype but importantly, clinicians had to be prepared to raise the issue with patients.
Lifestyle modification was a first step but also underpinned other weight loss strategies.
Dr Adrian Sartoretto, medical director of The BMI Clinic in Sydney, said there was a clear place for endoscopic bariatric procedures as either primary, bridging or revisional treatments.
In conjunction with diet, exercise and behavioural interventions, patients might expect to lose up to 20% of their body weight depending on the procedure.
Intragastric balloons, despite a range of contraindications, could help patients lose up to 18% of their total body weight.
In a recent series of 112 patients receiving endoscopic sleeve gastroplasty, 81% lost more than 10% of their body weight at six months.
He made the audience squirm describing the venting gastrostomy tube for weight loss, which allows for removal of about 30% of ingested calories following a meal.
And there were emerging treatments such as the transpyloric shuttle that slows gastric emptying, fractyl duodenal mucosal resurfacing and incision-less anastomosis systems.
He said patients had to understand they had a chronic relapsing condition and should be conditioned to come back when they start putting on weight again.
Upper GI surgeon Dr David Martin, from the Concord and Royal Prince Alfred Hospitals, said his average patient had a BMI of 45 and were looking for remission of diabetes, hypertension and dyslipidaemia as well as weight loss.
All procedures were well established with evidence now helping to match the choice of procedure to the patient and their comorbidities.
Dr Patrick Walsh, from the Holy Spirit and Royal Brisbane and Women’s Hospital, said about 20% of post-bariatric patients will get weight recidivism.
However any serious attempt at weight loss, even if not maintained, had long-term benefits.