More information on potential harms and availability would have made this news release on three medical interventions for weight loss stronger. And addressing the need to complement the procedures with other lifestyle changes would have made the release much stronger.
The news release addresses study findings related to the relative success of endoscopic sleeve gastroplasty (ESG) — in which the stomach is sutured via a tool introduced through the mouth — as a less invasive, non-surgical alternative to facilitate weight loss in obese patients. We disagree with the release’s use of the term “non-surgical” to describe the procedure since it involves internal cutting and suturing of internal organs. However, the release does a good job of addressing cost and comparing the outcomes of various procedures.
According to the NIH, 35.7 percent of U.S. adults are obese — and obesity increases an individual’s risk for heart disease, stroke, diabetes and other health problems. On top of those health risks, obesity also has an adverse effect on an individual’s quality of life. Patients with obesity may view medical procedures, such as ESG, as effective ways of helping them lose weight — and a study that compares costs and outcomes of several procedures is a useful means of helping patients consider their options. For the most part, the release does a good job here. However, additional insight on the lifestyle choices needed in conjunction with the procedures, and more information on potential harms, would have offered a fuller overview for readers.
The release does a good job here, comparing the average cost of three different procedures: “researchers reported endoscopic sleeve gastroplasty resulted in the lowest-cost, with an average institutional procedure cost of $12,000, compared to $22,000 for laparoscopic sleeve gastrectomy and $15,000 for laparoscopic banding.” However, the release also notes that banding and gastrectomy involve spending more time in the hospital, and it’s not clear if those costs are solely for the procedures, or if they are for both the procedures and the hospital stay. Some clarification there would have been valuable.
The release does a direct comparison between the three procedures: “At one-year follow-up, patients who chose laparoscopic sleeve gastrectomy surgery achieved the greatest percent total body weight loss at 29.28 percent, compared to 17.57 percent for [ESG] patients and 14.46 percent for laparoscopic banding patients.” That earns it a satisfactory rating. However, based on an abstract of the conference presentation, the researchers also collected data on weight loss 18 months after the procedure. This raises the question: why didn’t they include the 18-month follow-up numbers here? In addition, the release would have been stronger if it had told readers whether there was any significant variation between the patients who had the various procedures. For example, were the patients who had the gastrectomy procedure more obese to start with? Or were there differences in age across groups?
In addition, following surgery the patient volunteers all went to a weight-loss “center of excellence” for a full year. The release doesn’t mention whether that made a difference in the results within each group or among the entire group. In any case, this year-long stay at a weight loss center after a procedure is not likely to be replicated in other studies and in the real word.
This is a close one. The release does state that “researchers found that patients who received endoscopic treatment had lower complications (1 percent) than those who received surgical treatment (10 percent for laparoscopic sleeve gastrectomy and 11 percent for laparoscopic banding).” That’s good. However, the release doesn’t tell us what they mean by “complications.” Endoscopy, in general, is fairly low risk — but potential complications can include short-term pain and nausea, infection, organ tearing and bleeding.
The release does an adequate job of describing the study. However, there are two things that could have made the release significantly better. First, there could have been some information about the patients involved — including age, sex, and other characteristics that could potentially affect outcomes. (e.g., the conference abstract notes that a lower age was a predictor for weight loss at six months.) Were there any factors that informed physicians to choose one procedure over another? Since this was not a randomized trial, the release could have noted that factors other than the treatment itself likely played a role in how much weight was lost.
Second, while the release notes that “patients went to an academic bariatric center of excellence as part of their treatment,” it could have made it clear that changes to diet and exercise are an important factor in determining the outcome of medical interventions for weight loss.
The release doesn’t engage in disease mongering. It does refer to the “obesity epidemic” and there’s some difference of opinion as to whether obesity is a disease. The word “epidemic” applies (or should apply) solely to disease. But there’s no question that obesity contributes to a host of health problems and is a significant risk factor for serious diseases, which are discussed near the end of the release.
The release includes a reference stating that the researcher actually making the presentation does not have any conflicts of interest to report. However, there is no information on conflicts of interest regarding the other researchers, nor does the release tell readers who funded the research.
The release does compare the most common types of medical weight loss interventions that involve making changes to the stomach. However, there is no real discussion of alternatives, such as pharmaceutical interventions, attending counseling or support groups, and lifestyle changes involving diet and exercise. This is an important oversight given that, even with a surgical or endoscopic procedure, these other interventions are likely to play an important role in helping patients keep off any weight that they lose. What would the outcome be for patients who only went to a “center of excellence” weight loss facility for a full year?
For someone reading the news release who is unfamiliar with weight loss treatment procedures, ESG may sound like an entirely novel treatment that is not yet clinically available. However, while it is relatively new, it is already in use. The release doesn’t give us any idea of how many facilities perform any of these procedures.
The release notes that this is the first study to compare the outcomes associated with these three procedures.
The release uses fairly measured language.
Although it doesn’t rise to the occasion of sensationalism, we do have concerns over the use of the term “non-surgical” to describe a procedure that certainly sounds like surgery. If it walks and quacks like a duck….
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Psychological barriers and stigma are cited to explain "abysmal" screening rates for lung cancer at #ASCO2018. Shouldn't 50%+ false positive rate, related follow-up biopsies, and modest mortality benefit also be part of the discussion? https://t.co/JXGZiir3X5
Comments (2)
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Linda Bacon
May 15, 2017 at 7:19 amI’m a big fan of the work that you do, except for any article you post about weight concerns. I wish that you would challenge the weight industrial complex with this same critical lens you apply elsewhere. In this article, for example, the first thing that struck me was the offensive image you chose. In the critical fat studies community we call this the “headless fatty” image – it promotes the idea that a fat body is so shameful you are not even going to show the person’s head. Consider how dehumanizing that is and the value judgment you set up in the reader. Next, your reviews always start with the usual unsubstantiated fearmongering, like this, “obesity increases an individual’s risk for heart disease, stroke, diabetes and other health problems. On top of those health risks, obesity also has an adverse effect on an individual’s quality of life.” Use the same lens you use elsewhere: just because there’s association doesn’t mean there’s causation. And just because “everyone says it” doesn’t mean it’s true. Challenge these ideas. When you let go of your assumptions, it is well established that there is much that can explain increased disease incidence that had little to do with weight itself. Weight stigma plays a much larger role in the diseases associated with weight than high weight itself, and this article just contributes to that. Please educate yourselves. This article may get you started on that critical lens: https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-10-9, and you can read more of my work to go further. I so appreciate the critical lens you apply elsewhere, and its quite disturbing to see your buy-in to conventional thought anytime you report on weight.
Lily OHara
May 16, 2017 at 12:10 amI continue to be amazed that the high level of critical analysis your otherwise excellent site applies to news stories is not applied to stories about body weight. Every time I read one your reviews about a weight-related story, I find myself rolling my eyes, heavy sighing, or shouting at the screen because you have dropped your critical analysis lens yet again. The work you do on other stories is generally excellent, and I use your site as a teaching resource to help students learn how to critically analyse media stories about health. But you have a major blind spot when it comes to weight, and I really wish you would address it. Your reviewers are firmly placed within the weight-centred health paradigm, and fail to acknowledge any of the mounting critique against the tenets of this paradigm. For example the author of this review states that “there’s no question that obesity contributes to a host of health problems and is a significant risk factor for serious diseases” when in fact there are big questions about the complex role that body weight plays in health and wellbeing, in conjunction with or completely confounded by weight related issues such as weight stigma, weight discrimination, weight dissatisfaction, dieting and weight cycling, all of which have been demonstrated to be independent risk factors for the very same ‘host of health problems … and serious diseases’ associated with higher body weight. And of course being a higher weight impacts on quality of life; not because of the physiological consequences, but because people with higher weight are treated so poorly by society (including the stigmatising image you use for this very review). If you are treated poorly, of course your quality of life is going to be diminished. In addition, your reviews on weight-related stories don’t acknowledge the complete absence of data on long term ‘success’ of weight reduction strategies, and the extremely high risk of weight regain and overshoot. Unfortunately your reviews related to health stories have never addressed any of these ethical or empirical critiques. I really do love your reviews, and believe that you provide an essential service to the scientific and general community. But there is massive scope for you to do much much better on weight-related stories.
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