Malpractice and incompetence risk bariatric surgery growth

 

According to a new report from insurance group SCOR called,'Obesity-The Health Challenge of the 21st Century', obesity is a serious problem in both developed and emerging countries.

The growing global problem

For the first time in history, more people worldwide are suffering from obesity than from starvation. According to the World Health Organization, 2.3 billion adults were overweight, and 700 million people were obese in 2015, a substantial and rapid increase compared to the prior decade. 

Obesity affects the entire world irrespective of age, income and country. While the USA, Australia and the UK are still at the top of the list of nations affected, the countries that have seen the biggest increase in the number of obese and overweight people are in the Middle East and North Africa.

Projections for the future show that obesity rates are expected to continue to rise, particularly in the USA, Mexico and UK where 35-50% of the populations are expected to be obese by 2030. These rates are also predicted to increase more dramatically in countries with historically low obesity rates, such as Switzerland and Korea.

Over 50% of men over 50 years old worldwide are overweight. There could be as many as 70 million obese children around the globe in 2025.

Obesity is the result of a prolonged mismatch in the balance of energy, with energy intake exceeding energy expenditure.  Three main factors combine to arrive at this imbalance:

  • Genetic - 50 genes connected to obesity have been identified. Certain genetic mutations mean that some people do not secrete leptin, which is the hormone of satiety. Genetic factors increase the possibility of people becoming obese.
  • Environmental - certain situations can favour obesity: low education, high availability of food, sedentary lifestyle, pollutants, gut microbiota, drugs and poor sleep patterns.
  • Hormonal - thyroid insufficiency and menopause frequently coincide with a weight gain.

Obesity is the direct or indirect cause of many illnesses, the most serious of which are type 2 diabetes, coronary heart disease, cerebrovascular incidents (strokes and transient ischemic attacks) and cancer. Obesity can also be associated with many other conditions such as respiratory impairment, sleep apnoea, bone and joint illnesses (the main one being osteoarthritis) and psycho-social problems such as depression, which are both a cause and a complication.

Complications also result from obesity such as skin diseases, digestive disorders, pancreatitis, biliary diseases, and hypertension. 

Solutions and treatment opportunities

The obvious solution to obesity is better diet and more exercise, while bariatric surgery (involving one of sleeve gastrectomy, gastric band or gastric bypass surgery) is the only effective treatment for morbid obesity. It leads to a reduction in long-term morbidity, thanks to beneficial effects on hypertension, diabetes, dyslipidaemia, sleep apnoea and bone and joint disorders.

Every year there are 200,000 bariatric operations in the USA and 95,000 in Brazil, with 50,000 in France, and while more health insurance schemes and health systems will offer surgery in their own country, there may be limitations or longish waiting lists.

Currently most bariatric operations are paid for by the patient, and this is where medical tourism can meet this growing problem area.

There are however many restrictions and requirements before surgeons will operate in Asia, Europe and the USA.  Complication rates range from 10% to 22%, and the global mortality rate is less than 1%, but this does vary by country. While we are quite familiar with reports of complications from cosmetic surgery, horror stories are emerging about medical tourists in difficulty or even dying from obesity surgery.

Who will control treatment quality at global and national levels?

Unfortunately, this is another sector where a handful of "make a fast buck and ignore the consequences" medical travel agents, unqualified or unskilled surgeons, and poor quality clinics are a problem for the image of medical tourism.

Will those businesses and nations promoting the message "come to Country X and get prices 60% below what you pay at home" do anything when customers suffer complications or die when they should not?

When researching surgery stories of 'where did it all go wrong?’, I am no longer amazed at the number of medical tourism organisations, regulators and politicians who are not leading or taking ownership of the surgery quality issue.

I’d be interested to know just how many medical travel agents properly inform their customers of the relatively high risk of complications or even death from bariatric surgery.  Even with the headlines, clinics rarely seen to get closed or prosecuted.

As the SCOR report and OECD figures show, obesity is a huge (pun intended) global problem and a significant chance for medical tourism to offer high value treatment in this area.  It will be a challenge for the whole sector however to face up to the associated risks and counter the bad publicity arising from malpractice and incompetence.

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