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Rare surgery brings more weight loss, more risks

Rating

5 Star

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Rare surgery brings more weight loss, more risks

Our Review Summary

While the story begins with a small research study about two different methods of weight-loss surgery, it expands and includes context about wider debate over whether shedding pounds improves health and life expectancy. We do wish it had included cost and insurance coverage information.

 

Why This Matters

Size matters. Today’s obese Americans face higher risks of heart disease, diabetes and stroke because of their weight. But in this story, important questions are raised about the risks posed by one type of weight-loss surgery – known as duodenal switch surgery. An estimated 220,000 Americans had some sort of weight-loss surgery in 2009. Besides the suggestion that this specific surgical procedure may pose inordinate risk, the story also raises overall questions about whether weight-loss surgery has been overhyped. “We really don’t know if there is a survival benefit” from weight-loss surgery, said one expert. The size of weight loss may not predict the improvement of health to follow, in a simple relationship. As with many clinical controversies, it may take doctors a long time to establish guidelines for the risks vs. the benefits of this sort of surgery.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

No mention in this lengthy story of the costs of the two procedures or insurance coverage. Readers need this information, and the fact that the duodenal switch may not be covered by most insurance. The total cost of gastric bypass is about $20,000.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

The story makes clear that the duodenal switch surgery, in comparison with the bariatric surgery, may give patients greater weight loss in pounds but the value of that reduction is not clear. The additional information from the paper published by Livingston demonstrating no advantage to surgery over medical management was very useful.

Does the story adequately explain/quantify the harms of the intervention?

Satisfactory

The story shines in its details about the delicate weighing of risk vs. benefits for weight-loss surgery in general, and then for the duodenal vs. gastric bypass method in particular. Some readers might find it confusing that the story includes two separate publications about weight-loss surgery. The story leads with the small study comparing duodenal with gastric bypass, published in the Annals of Internal Medicine, but then delves into a larger Veterans Administration study from the Journal of the American Medical Association that looked at the longer-term results of all surgeries for obesity. We salute Reuters for providing the context and the controversy within medical practice, and quoting a principal investigator on the VA study, Edward Livingstone, who wrote an editorial that appeared in the Annals beside the duodenal paper.

Does the story seem to grasp the quality of the evidence?

Satisfactory

The story reports on a very small study – just 58 patients in total and 29 received the duodenal surgery. Only one comment addressed the quality of the evidence: “Larger, longer-term studies are still needed to show whether the extra weight loss with duodenal switch” improves the health and lengthens the lives of obese patients, explained lead researcher Torgeir Sovik. We would have liked a reminder of the preliminary nature of the conclusions higher up in the story.

Does the story commit disease-mongering?

Satisfactory

This story does a good job of probing territory that is under-explored in most media accounts about obesity treatment. It poses the questions of long-term quality of life and life expectancy post treatment. Could obesity itself be less life-threatening than some of the radical treatments aimed at treating it?

Does the story use independent sources and identify conflicts of interest?

Satisfactory

In addition to quoting the lead author of the Annals article, we liked the balance provided by Edward Livingston in his comments about both the duodenal switch procedure and his comments about the value of surgery in general over medical management.

Does the story compare the new approach with existing alternatives?

Satisfactory

The story concentrates on patients receiving weight-loss surgery, and does not discuss non-surgical alternatives at much length. It does mention the study by Livingston questioning the value of surgery over medical management. Behavior coaching, diet and exercise are all potential treatments for obesity.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The story explains that duodenal switch is “less common” and that “Duodenal switch is not a popular procedure.” In a 2008 study, it accounted for just 1 percent of weight-loss, or bariatric, surgeries done in the U.S., and 5 percent in Europe.”

Does the story establish the true novelty of the approach?

Satisfactory

The story makes it clear that the duodenal switch procedure has been around for a number of years but is rarely used.

Does the story appear to rely solely or largely on a news release?

Satisfactory

No, it does not rely on a news release.

Total Score: 9 of 10 Satisfactory

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