Obesity surgery not cutting it

DESPITE shedding the extra kilos after bariatric surgery, nutritional deficiencies that lead to health problems like diabetes and heart disease are still common in people who used to be morbidly obese. A leading nutrition organisation is calling for a Medicare rebate, which covers dietary management advice for these individuals.

“Obesity surgery is the starting point not the end point,” Dietitians Association Australia spokesperson Melanie Grice said. The surgery reduces the amount of food an obese person’s stomach can hold, creating a feeling of fullness, and results in the person losing weight because they are eating less. Grice said post-bariatric surgery patients might be eating smaller portions of food, but they avoided certain foods and often had a poor quality diet.

Grice said deficiencies in nutrients, such as protein, fat, folate and calcium, were more common in people who have had weight loss surgery compared to those who have not. The DAA says individuals who have these procedures need dietary checks and advice on meeting their nutritional requirements.

DAA chief executive officer Claire Hewat said it was a crying shame Medicare money was not being put towards rebates for patients to see an accredited practicing dietician for expert dietary advice.

“People who are morbidly obese often have other health problems like heart disease and diabetes, or are ticking time bombs for developing these conditions,” Hewat said. “So it is critical even after weight loss surgery that they have annual blood tests and dietary intake checks.”

“Unfortunately obesity is at an all time high in Australia,” Australian Medical Association chief executive Steve Hambleton said. “60% of the population is either overweight or obese.”

Latest figures from the Australian Institute of Health and Welfare highlighted that rates of obesity surgery has increased from about 500 surgeries between 1998-99 to 17,000 in 2007-08. In 2007-08, about $15 million in benefits was paid through Medicare for bariatric surgery related procedures.

“Bariatric surgery is to assist these people to eat less and therefore lose weight. It is not a replacement for a proper diet,” Hambleton said.

Individuals who have had the surgery need specific dietary advice to maintain balanced nutrition, he said. “Most bariatric surgeons work in conjunction with nutritionists because it is difficult to maintain a balanced nutritional intake when you can’t eat very much,” he said. “And if you can’t eat a large meal, you still need all the nutritional intake from all the food groups.”

Hambleton said some patients who have had the procedure drink shakes instead of eating a proper meal. “A glass of milk or those [diet] milkshakes do not give you a balanced diet,” he said.

Hambleton said a bariatric surgeon’s advice to a patient who has undergone surgery would be to eat normally, just less.