Bariatric Surgery And Ethics

I listened to a programme on BBC radio 4 today on whether it is ethical to offer bariatric revisions to patients who have jumped the queue by “going private.” There were two people with gastric bands whose ops had gone horribly wrong, the money had run out and they needed extra help. In one person the band had become too tight – almost killing her. The second young woman found that her band has “stopped working” and she had no money to ask for it to be tightened.

Having contributed to the NICE bariatric technology appraisal, I have some thoughts about these issues. The first is that of desperate need. The two girls had done everything they could to lose weight.  They almost certainly had some kind of eating disorder which, by the way, is not a contra-indication for surgery. The quality of their lives was severely impaired despite the fact that they did not quite fit the criteria for inclusion for surgery.

The second issue is all about preparation, which was almost absent for these ladies. There is a  fallacy out there that you have to prove your ability to eat normally and sensibly before having the surgery. If the girls could have done that, they would not have spent money they could barely afford - but they almost certainly had no help to figure out how to manage their lifestyles after the operation.

In both ladies, the gastric band has failed and they are both looking at the gastric bypass now. Even bypass operations can stop working in time and pose their own physical and emotional risks. They are regaining all their weight. Sadly, neither  of these girls know that weight regain is the default position for dieters and not a sign that they are weak or greedy which is the belief system that has arisen from their repeated failures to lose weight.

 For one of the ladies it was clear that overeating junk food is the glue of most of her most intimate and loving relationships. Health psychology teaches us that people only change and want to change if the immediate social environment provides the support and the opportunity to change. It is insane to blame the overweight for being irresponsible when they are faced with a  choice between intimacy and “taking care of yourself properly” . To help a person like this, we have to work with the person holistically  and help her to feel effective in managing the system in which she lives rather than just being a part of it.

I am not against bariatric interventions. I know all the pros and the cons. Einstein told us however, that the solutions we create to solve problems must be far more elegant than we suppose.

I am providing a course on bariatric counselling in September 2010. Visit http://www.eating-disorders.org.uk/ for the details.