This 60 Minutes segment devotes a laudable amount of time to descriptions of the benefits of gastric bypass surgery for diabetes, independent of weight loss. It also reports on the link between the surgery and reduced cancer risk.
The segment’s main failing is the amount of time devoted to eight patients with positive outcomes and two physicians who have professional interest in a positive portrayal of the surgery. The broadcast gives no airtime to skeptics, independent researchers and patients with poor outcomes.
The result is an excessively positive, one-sided piece.
This is a shame. The fact that gastric bypass appears to reduce risk of diabetes independent of weight loss is credibly documented and a subject of continued independent research. It has produced new insights into the mechanism of the disease. The surgery may indeed become a more widespread treatment for severe and moderate obesity and its associated risks, such as diabetes and hypertension.
But by piling on exclusively positive anecdotes, and devoting so much airtime to supporters at the expense of independent sources and skeptics, the piece loses credibility. An important medical story is buried by a mound of hype. A more balanced story would have incorporated information about the limitation of studies to date and opinions from doctors who are doing research on the safety of the procedure.
This is one case where our ratings criteria may have allowed for a deceptively-high four-star score.
The segment reports that the surgery costs about $25,000 and is not always covered by insurance.
The segment uses figures repeatedly to back up assertions made by the sources. But with the exception of the American Cancer Society data on cancer, the information comes from sources that are either self-interested (surgeons who perform the surgery) or not specified.
The segment mentions some harms of the surgery, including death, depression and suicide.
The segment repeatedly refers to "studies." But in no case does it describe what kind of studies these are, whether and where they were published, whether they were conducted independent of self-interested sources, etc.
While most if not all of the evidence presented in this story is factually correct, there are many limitiations to the studies themselves that reduce the scientific confidence in these facts. For example, the report cites a reduction in diabetes of 80 percent, but the current long term evidence indicates that many of these patients do have recurrence of their diabetes in the long-term. This story they relies on the statement of one physician who said, in his experience, these patients don’t have recurrence.
Another example is the rate of death due to surgery. The story quotes the same physician who says the rate is now 1/1000. This is not entirely accurate for most centers in the U.S — it’s closer to 2/1000 in the best of surgical centers. And that’s 2/1000 who die IN THE HOSPITAL — there are many more deaths that occur in the first 30-days, 90-days, and 1-year that can be directly attributed to the surgery itself.
The segment does not exaggerate the risks or burdens of obesity or diabetes, which are considerable.
The segment draws on the experience of eight patients, all of whom have had positive results.
It also quotes at length a surgeon who is an enthusiastic advocate of the surgery, a surgeon participating in Brazilian clinical trials on the procedure’s effect on diabetes and a physician who had the surgery himself with positive results.
A doctor who expresses mild skepticism about the total weight that follows surgery is quoted.
The segment quotes an American Cancer Society epidemiologist, who describes the links between obesity and several cancers.
Absent are skeptics who could raise questions about such issues as the long-term effectiveness of the surgery’s ability to "cure" diabetes, the nutritional challenges of a post-surgical diet, and the wider range of outcomes observed for different forms of the surgery.
Absent also are patients who had outcomes different from those repeated so frequently here: Those who developed illness due to nutritional deficiences, those who regained the lost weight, and those whose diabetes was not "instantly cured."
The segment mentions medications to control weight, diabetes and hypertension, but only to describe them as ineffective and unnecessary for those who have the surgery.
There are no alternative treatment approaches that are as successful as surgery for reducing body weight and diabetes.
The segment makes clear that the gastric bypass operation is widely available and done as many as 200,000 times per year.
The segment makes clear that the operation is common, citing 200,000 surgeries per year. It also reports that the surgery was done as early as the 1950s.
There is no evidence the report is based on a press release.
Many previous news reports have been done on the link between the surgery and reduced incidence of diabetes independent of weight loss, however.