The push for increased access to publicly funded bariatric surgery for obese Australians has been supported by new research published in the Medical Journal of Australia.
A team led by Associate Professor Tania Markovic from Royal Prince Alfred Hospital in Sydney analysed data from obese patients who underwent publicly funded bariatric surgery between October 2009 and September 2013. They measured postoperative weight loss, and markers to assess improvement of type 2 diabetes, hypertension and obstructive sleep apnoea.
Sixty-five patients lost a mean of 17% of their preoperative weight by 3 months post-surgery, 26% by 12 months and 29% by 24 months. Their body mass index (BMI) decreased from a mean of 48.2 pre-surgery to 35.7 at 24 months. By 12 months, there was full resolution of diabetes in 50% of patients, hypertension in 55% and sleep apnoea in 63%, with further improvements at 24 months. "Bariatric surgery performed in the public is efficacious in the treatment of obese patients with comorbid conditions", the lead author, Dr Lukas, and her coauthors wrote.
"Since 1992, Medicare has reimbursed the cost of bariatric surgery in the private sector. "As most surgery is carried out in private hospitals with large out-of-pocket expenses for those without private health insurance, a significant inequity in obesity management exists", they wrote. "In Australia, an inverse relationship exists between high obesity prevalence and low socioeconomic status; incidence is almost double for areas indexed as the most disadvantaged compared with areas within the highest strata.
"Paradoxically, this surgery is least accessible to those who are likely to be in the greatest need." There has been doubt about the motivation of obese patients whose surgery is fully subsidised, but this study, the authors wrote, supported the hypothesis that "patients reliant on public health care maintain sufficient intrinsic motivation" to lose weight.
"Improved access to bariatric surgery publicly can justifiably reduce the health inequities for those most in need", they wrote.
"We hope that our study provides an evidence base for the surgical treatment of obesity in the public health system and, in turn, that consideration will be given to increasing the supply of publicly funded bariatric surgery in Australia."