x Abu Dhabi, UAESunday 21 January 2018

Gastric surgery numbers balloon

With one doctor saying demand for operations is up 500 per cent, another expert calls for guidelines to regulate such treatments.

Doctors are reporting increases of up to 500 per cent in the number of people turning to gastric surgery in an attempt to lose weight and are operating on patients as young as 12. Demand for surgery has soared as obesity rates in the UAE have reached "epidemic" proportions, with more than 25 per cent of men and almost 40 per cent of women classed as being dangerously overweight, according to World Heath Organisation estimates.

But health experts fear that some people may be opting for the surgery, which can cost more than Dh50,000 (US$14,000), as a quick fix and want national guidelines to regulate who can perform the surgery and who is treated. A gastric operation is usually seen as a last resort. Most surgeons draw the line at treating patients under 16 but, in one case, a girl of 12 with severe obesity was given a gastric band.

Dr Gabi Wazz, the doctor who performed the procedure on the girl, said he agreed to operate because it was an extreme case of obesity in which surgery was the only option. Potentially risky surgery on a child as young as 12 was "a controversial issue and we are very cautious", said Dr Wazz, the director of the obesity surgery unit at Dr Sulaiman al Habib Medical Centre in Dubai. The operation was only performed after seeking the opinions of several international experts and the girl was given a full psychiatric evaluation before the operation, which could be reversed later, he added. Dr Wazz said he was performing 30 to 40 bariatric - weight loss - operations every month, a year-on-year increase of 500 per cent, and is fully booked for the coming months.

"It's increasing exponentially because people are becoming more aware about the dangers of obesity," he said. Obesity is said to be a factor in the UAE's high rate of diabetes. A gastric band reduces a patient's stomach, restricting the amount of food it can hold, thereby preventing overeating and inducing weight loss. On average, people lose up to 50 per cent of their weight within two years. Most dieticians agree that a healthy weight loss is around 0.5kg to 1kg a week.

Surgery is one of few viable options left to save the lives of morbidly obese people with a body mass index (BMI) over 40. BMI is a representation of a person's weight to height ratio. For a person to stay healthy, it should not exceed 25. Dr Hala Abu Taha, a Dubai-based nutritionist and dietician, estimates that the number of her patients having bariatric surgery rose by 50 per cent in the first half of this year, compared with the same period last year.

"It's the perfect way for people who have tried everything else," she said. "They have no choice at all. It's not that they can't lose the weight, but maintaining it is very hard." Diets usually fail for the morbidly obese, said Dr Abu Taha. "Their willpower is weak, especially binge eaters." For many, "food controls the mood. There is a tendency for people who work on losing 10 per cent of their weight, then binge eat and regain a lot of that weight quickly."

However, Dr Abu Taha said the growth in bariatric surgery was a cause for concern. "Some doctors are overdoing it." Dr Tarek Saleh, a gastroenterology and obesity expert, said more stringent rules were needed to limit the number of patients having the operations as well as the medical professionals performing them. "Overweight people can suffer from problems such as a larger liver, which makes operating on them harder for doctors," said Dr Saleh. "This type of surgery should only be performed by experienced doctors who deal with at least 10 cases a month."

There are three main forms of bariatric surgery. In gastric banding, an inflatable band is placed near the top of the stomach, squeezing it and restricting the passage of food. A gastric sleeve operation involves the removal of up to 80 per cent of the stomach. The remaining portion is pinned together, creating a substantially smaller digestive tract. With gastric bypass, a stomach pouch is created to bypass part of the small intestine. Afterwards, the patient can only eat small meals and the body absorbs less of the food.

A gastric band operation done privately costs around Dh30,000 with the gastric sleeve and bypass upwards of Dh50,000. Doctors stress that surgery should not be chosen reflexively. "Bariatric surgery is not the first line of defence," said Dr Wazz. He said he required patients to go through a supervised diet before the operation was approved. Dr Alkassem Algameel, a paediatrician based in Sharjah, said if surgery was necessary, he had no problem recommending it.

"Twelve for a girl is considered mature. It can be done. We're not told of any limits," he said. But such operations do carry risks. Serious complications can include infection, damage to other organs, and problems with the band slipping, leaking or slipping through the stomach wall. "The mortality rate of the surgery is not above 0.5 per cent," said Dr Wazz. Around one in 10 people may require another gastric band operation.

In the UK, gastric band surgery is not recommended for all obese people. National guidelines say a gastric band should only be considered after all other solutions have been exhausted. Patients should also be counselled beforehand. In the US, guidelines say gastric surgery should only be performed on patients 18 or over, who have gone through puberty and are physically mature, unless there are exceptional circumstances.

The UAE's health authorities have already taken strides to try to reduce obesity, particularly in children. The Ministry of Health recently launched a campaign with Unicef to encourage children to exercise more and adopt healthier diets. The increased prevalence of surgery has led some health workers to question whether obesity is a lifestyle choice. "Seven out of eight patients eat junk food at night," said Dr Abu Taha. "Eight out of eight don't do any physical activity. Some blame it on the weather or long working hours. They just don't want to."

While some insurance plans with high premiums in the UAE cover bariatric surgery, along with the comprehensive coverage offered by Thiqa, the national health insurance programme for Emiratis, many providers exclude it from their policies, with most labelling it as cosmetic. "Some insurers do not cover obesity as it is not considered to be a medical condition," said the UAE-based manager of an international health insurance company.

But one Dubai-based doctor said exclusion made business sense for UAE insurance companies since the high mobility of the country's large expatriate workforce meant the providers did not have to deal with obesity-related diseases later in life. "In the long run they save money," he said. * The National