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….