Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Overeating is a behavioral problem, not a surgical one

Dr. Joe Kosterich
Conditions
March 27, 2011
208 Shares
Share
Tweet
Share

Overeating is not a surgical problem.

This may seem to be a statement of the obvious, but the solution to a behavioral problem is not surgery. Overeating is not a surgical problem — it is a behavioral one. The problem is not because the stomach is too big and needs to be made smaller. It is a function of how much food is put into the stomach. Surgical “solutions” should be the absolute last resort measure.

The company that makes lap band devices (used in bariatric lap band surgery) has applied to the FDA to lower the obesity threshold at which surgery can be performed. According to the New York Times, if successful, this application would double the number of people who would “qualify” for surgery. An FDA panel has supported the application and now it awaits a final decision.

Another FDA panel is about to consider the merits of a weight loss drug, which narrowly meets the criteria for effectiveness but has heart related side effects.

The thresholds are based on the body mass index (BMI). This is a useful but flawed indicator of obesity. It is not a predictor of future health problems in a given individual. Bariatric surgery has been an option for people who are classed as morbidly obese. Initially the main candidates were those with a BMI of over 40, or 35 if the person has other health problems. The new application would include people with a BMI of 35 (without other problems) and 30 (with other health problems).

The cut off for overweight versus obese is 30. Yes these people are carrying more weight than might be ideal but not by that much. Critically studies have shown that people with a BMI between 25 and 30 live longer than those with a “normal” reading of 20 to 25.

The makers of the device and the surgeons doing the operation have a legitimate commercial interest in doing more procedures. The Times report stated sales were down 4% this year. The real question is whether these are the right people to be driving the agenda?

In Australia lap band surgery continues to “grow.” Figures show Western Australia has the highest rate in Australia. This prompted the local Australian Medical Association president to opine that this was because the state had  “leaders in the field.” Another view may be that there is just a greater willingness to operate.

There is no long-term safety data on surgery as it has not been around long enough. One thing is certain. Nothing happens in isolation in the body. Interfere with the gut and other things will happen. Already it is emerging that there are higher rates of kidney stones and bone fractures eight to ten years post surgery. Who knows what may happen after 20, 30 or 50 years?

Furthermore we do not actually know the risk benefit equation or if indeed the procedure” works” long term. We know that some people lose weight in the first few years. Not all keep it off.

In all of this it remains the case that there is promotion of a surgical solution by those who perform the surgery or make the devices for a problem, which is not fundamentally a surgical problem. This is happening without any knowledge of whether there is long term benefit and certainly without knowledge of long-term complications.

There is no need to increase the market for bariatric surgery by including those who are moderately obese. Neither do we need more weight loss pills, which cause more problems than they solve.

Eating less and moving more is side effect free and inexpensive.  Why on earth is so much effort devoted to other so-called “solutions”?

Joe Kosterich is a physician in Australia who blogs at Dr. Joe Today.

Submit a guest post and be heard on social media’s leading physician voice.

Prev

KevinMD posts of the week, ending March 27, 2011

March 27, 2011 Kevin 0
…
Next

Life at a needle exchange

March 27, 2011 Kevin 3
…

Tagged as: Patients, Surgery

Post navigation

< Previous Post
KevinMD posts of the week, ending March 27, 2011
Next Post >
Life at a needle exchange

More by Dr. Joe Kosterich

  • a desk with keyboard and ipad with the kevinmd logo

    ADHD medications: Performance enhancing drugs of the mind

    Dr. Joe Kosterich
  • a desk with keyboard and ipad with the kevinmd logo

    We are overdosing on medical tests

    Dr. Joe Kosterich
  • a desk with keyboard and ipad with the kevinmd logo

    There is scope for harm when ordering tests

    Dr. Joe Kosterich

More in Conditions

  • Lazarus: the dead man brought back to life

    William Lynes, MD
  • The psychoanalytic hammer: lessons in listening and patient-centered care

    Greg Smith, MD
  • 5 essential tips to help men prevent prostate cancer

    Kevin Jones, MD
  • Changing the pediatric care landscape: Integrating behavioral and mental health care

    Hilary M. Bowers, MD
  • Unlocking the secret to successful weight loss: Curiosity is the key

    Franchell Hamilton, MD
  • The teacher who changed my life through reading

    Raymond Abbott
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • Why it’s time to question medical traditions [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden gems of health care: Unlocking the potential of narrative medicine

      Dr. Najat Fadlallah | Physician
    • The realities of immigrant health care served hot from America’s melting pot

      Stella Cho | Policy
    • The dark side of immortality: What if we could live forever?

      Ketan Desai, MD, PhD | Physician
    • Lazarus: the dead man brought back to life

      William Lynes, MD | Conditions
    • Revolutionizing COPD management with virtual care solutions [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 32 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Doc Moms, Mind the Gap -- $3M Earning Difference by Sex
  • Clinical Note Writing App Powered by GPT-4 Set to Debut This Year
  • Helping Patients Get Fit -- One Walk at a Time
  • TB Cases Rebound to Near Pre-Pandemic Levels, CDC Data Show
  • Marginalized Groups May Benefit More From Decreasing Air Pollution

Meeting Coverage

  • Switch to IL-23 Blocker Yields Deep Responses in Recalcitrant Plaque Psoriasis
  • Biomarkers of Response With Enfortumab Vedotin in Advanced Urothelial Cancer
  • At-Home Topical Therapy for Molluscum Contagiosum Gets High Marks
  • Outlook for Itchy Prurigo Nodularis Continues to Improve With IL-31 Antagonist
  • AAAAI President Shares Highlights From the 2023 Meeting
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • Why it’s time to question medical traditions [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden gems of health care: Unlocking the potential of narrative medicine

      Dr. Najat Fadlallah | Physician
    • The realities of immigrant health care served hot from America’s melting pot

      Stella Cho | Policy
    • The dark side of immortality: What if we could live forever?

      Ketan Desai, MD, PhD | Physician
    • Lazarus: the dead man brought back to life

      William Lynes, MD | Conditions
    • Revolutionizing COPD management with virtual care solutions [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Overeating is a behavioral problem, not a surgical one
32 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...