The idea of
lap banding and/or other surgical procedures that limit food intake or absorption have
been in the news recently. This technique involves placing a band around
the stomach to reduce intake and absorption of food.
Some feel that
obesity is best addressed with diet and exercise, whereas others advocate these
surgical procedures. As obesity in
Australia has doubled since 2005 1, and
has other associated problems, such as diabetes. The question arises whether
the cost of lap banding be born by the individual having the procedure or by
society through Medicare?
Obesity is due to two interconnected causes:
- Regularly consuming more food than the body
needs
- And a dysfunctioning hormonal system.
One basically leads to the other. The body produces energy
from food, mainly from fats and carbohydrates. What it doesn’t use - it stores
as fatty tissue. A sophisticated system of hormones regulates this process.
When the intake regularly exceeds personal needs, not only does the storage
increase, but the fatty tissue itself produces hormones. Another factor in derailing our hormonal
system is high glucose levels in the blood by eating too much carbohydrate such
as sugar, pasta, bread, cakes and processed foods.
The body produces insulin to help transport glucose into our
cells. The lower the blood glucose, the more sensitive the body’s cells are to
insulin and the more efficient is the transport of glucose into the cells. The
higher the blood glucose, the less sensitive the cells are to insulin and the
less glucose is transported into the cells occurs.
If blood glucose is maintained at a constant high level, the
cells eventually lose their sensitivity to insulin, becoming insulin resistant.
The glucose stays in the blood, and the cells starve, causing the brain to
think the body needs more food, particularly more high sugar foods. We then eat
when we actually don’t need any more energy.
The trend towards obesity and associated diseases, such as
diabetes and cardiovascular disease, is driven by poor hormone regulation. The
more we eat, the worse it gets. So obesity can be seen as a sliding scale of
hormone function, ranging between health and disease, and it is driven by how
much and what we put in our mouths. This is why the cure for type 2 diabetes,
cardiovascular disease and obesity is based on the same idea: reduce the intake
of refined carbohydrates and increase exercise.
Because obesity has reached a certain critical mass, it is now
classified as morbid obesity, and this entitles an individual to lap banding under
Medicare. Body Mass Index (BMI) is defined by the ratio of an individual’s height
to his or her weight. Normally ranging from 20-25, an individual is considered
morbidly obese if he or she is 40 klg over his/her ideal body weight, has a BMI
of 40 or more, or 35 or more and experiencing obesity-related health
conditions, such as high blood pressure or diabetes. 2
By projecting the cost to society of morbid obesity and
associated diseases, medical economists have reasoned that it is cheaper for
the society to pay for lap banding individuals in this category, than pay for
their diabetic and cardiovascular treatments.3 There are several reasons
why this is an impractical suggestion.
- An adult is responsible for their health
choices, not the community.
- It is the individual, not television or advertising
or social media who dictates what goes in their mouth.
- It is the individual who dictates whether they spend their time in the
pub or on the playing field.
- As a parent, there is a further responsibility
to teach your children how to be healthy.
The lap banding procedure itself is a very poor investment,
because it fails to achieve weight loss in over 50% of cases, and then may need
to be removed!4 This is because
the individual fails to increase their exercise and reduce their calorie intake,
which was the original problem. In
addition, to increase eligibility for lap banding, the BMI is being downgraded.
As a result more and more individuals will be eligible for the procedure under
Medicare.
Given that the levels of obesity in Australia have doubled
since 2005, lap banding is an expensive and ineffectual approach that doesn’t
address the causes of obesity; it is simply the wrong approach.
Written by: Luis Miguel
Trapaga B.HSc; M.App.Sc
References
1. Taft, P; Guinea, A; Guthrie, W: “The Australian Diabetes, Obesity and
Lifestyle” The Lancet 2:125–128, 1971.
