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NPR’s story on weight loss surgery in teens: Cost info would have improved a well-reported story

Rating

4 Star

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Bariatric Surgery Helps Teens With Severe Obesity Reduce Heart Disease Risk

Our Review Summary

This story covers an observational study showing cardiovascular risk factors improved after three years for teens who underwent weight-loss surgery. The story does a good job describing the study, the potential harms of the intervention, and limitations to the findings.

One area with room for improvement: it doesn’t mention how much these procedures cost or whether they are covered by insurance. Also, it’s always a good idea to point out when surrogate markers are being used as stand-ins for heart health. Lastly, some readers of the story might have found the photo stigmatizing–here’s our tips for communicating about obesity without promoting stigma.

 

Why This Matters

This isn’t the first research to suggest that bariatric surgery might help teens with severe obesity, who are at risk of developing health problems in their 30s and 40s. Yet one recent review asserted that while weight-loss surgeries are increasingly being offered to teens, there’s no data to show what impact these involved procedures will have in the long term. News coverage should remain cautious, stressing the risks and extreme lifestyle changes they entail and the fact that the jury is still out on their ultimate impact.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

There’s no mention of the cost of these procedures or whether they are covered by insurance. The average cost of gastric bypass surgery is $23,000, the average cost of lap band is $14,500, and the average cost of sleeve gastrectomy surgery $14,900, according to the web site ObesityCoverage.

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

Not Satisfactory

The story states: “Before surgery, only 3 percent of the teens had no cardiac risk factors at all, but three years later, just over half of them (52 percent) had no risk factors. Just 5 percent had all four cardiac risk factors before their surgeries, but none had all of them three years later. In fact, the majority of the participants — 83 percent — had only one or no risk factors three years after their surgeries. The proportion of participants with two or three risk factors also dropped substantially.”

This is a useful start, but the story needed to remind readers: Changes in risk factors predicated on lab values are surrogate markers, so they may not actually lead to improved “heart health” as the story states.

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

Satisfactory

The story states that the weight-reduction procedures “carry the same risks as any surgical procedure, such as infections, blood clots and bleeding” as well as nutritional and vitamin deficiencies. It also states that gastric banding “has low effectiveness and a risk of the band slipping down the stomach.” Note: The most risky complications (problems arising from general anesthesia) were not mentioned.

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

Satisfactory

The story describes how the study was conducted and provides important caveats, stating: “The study’s biggest limitation is its very selective population. Most of the participants were female, most were white, and most received the gastric bypass. Children of color have the greatest risk of obesity, heart disease and type 2 diabetes, but it’s not clear if they would see the same improvement with these procedures.” It also mentions that the study included “only teens with the greatest obesity who were also unsuccessful trying other weight loss methods. Further, it points out the need for longer-term data of 10 or 15 years.

The story does not mention one inherent weakness of this study: The lack of a comparison group that did not receive surgery.

[Editor’s note: We updated the final sentence in this criterion to strike the phrase “observational studies” and replace it with “this study.”]

Does the story commit disease-mongering?

Satisfactory

The story does not engage in disease-mongering. It states that an estimated 4 to 7 percent of teens have severe obesity.

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

Satisfactory

The story includes two sources who were not part of the study.

Does the story compare the new approach with existing alternatives?

Satisfactory

The story does a good job here, quoting Geetha Raghuveer, a pediatric cardiologist at Children’s Mercy Kansas City in Missouri who, it reports, was not involved in the study. Raghuveer is quoted saying surgery “would be considered for the highly obese and those not responding to any behavioral modifications, physical activity or calorie restriction.” Further, the story says, Raghuveer endorses public health efforts that “aim for better obesity prevention, including parent education and interventions when children are toddlers and preschoolers.”

“The big question is, how do we prevent obese kids from getting to this point where they would need an invasive surgical procedure?” Raghuveer says in the story.

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

Satisfactory

The story mentions that 1,600 teens undergo stomach reduction surgeries each year, which suggests that they are widely available. It also mentions the need to seek counseling and “detailed information from well-established bariatric surgery centers that are specifically dedicated to treating adolescents.”

However, one big key to availability is insurance coverage–and this was not mentioned.

Does the story establish the true novelty of the approach?

Satisfactory

The story mentions that this study includes more patients than some previous studies that looked at the impact of surgery on teens with severe obesity, and it quotes the study’s author saying it “serves to reinforce the benefits of bariatric surgery as a safe and effective treatment strategy that should be considered sooner rather than later.” Also, the the study of cardiac risk factors and how they are affected is novel, as well, and that’s clear in the story.

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

Satisfactory

The story does not appear to rely on a news release.

Total Score: 8 of 10 Satisfactory

Comments (2)

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Tara Haelle

January 11, 2018 at 2:19 pm

Thanks for this review! I knew I was leaving out cost — always the most difficult criteria to meet — because it’s so difficult to qualify the cost across the US. An editor originally wanted to remove the paragraph about the risks of the procedure, and I insisted it remain in. All three of my interviews actually asked directly about the fact that the risk factors were surrogate markers. I did not use the term surrogate markers because it’s an jargony term, but I did directly address that issue. The person I spoke with the most about it was the cardiologist. I asked whether these risk factors, since they are surrogate markers (I used that exact term), can adequately capture their disease risk. I included her response in the story: “”If you have very high blood pressure or lipids [cholesterol] or diabetes, you do see cardiovascular changes even at a very young age,” Raghuveer says. “They may not be having a heart attack or stroke in their teens and 20s, but they’re closer to having those in their 30s and 40s.”” She specifically stated that simply having those high values means they *have* had cardiac damage already, and the other two physicians said similar things. (I quoted the cardiologist because I felt her expertise was more on point.)

I also specifically described what each of the risk factors means as a way of explaining how they are surrogate markers: “The risk factors measured in the study included elevated blood pressure (above 120/80 mg/Hg), high cholesterol, high insulin levels in the blood and abnormally high levels of C-reactive protein, an indicator of inflammation in the body. The higher a person’s insulin levels are, the more likely they are to have or develop insulin resistance, which can increase blood sugar levels and diabetes risk. High insulin levels may also contribute to increased blood pressure and increase the risk of atherosclerosis, when fat clogs the arteries.”

I always appreciate the feedback I get when HNR reviews my stories — I use the criteria assiduously as much as I can, and I’m an evangelist for them :) I just wanted to clarify that I do feel I successfully fulfilled criteria #2, and I make an extra concerted effort to ensure that I did, including questions about surrogate markers for all my sources. I cannot put words in my sources’ mouths, and it would be journalistically inappropriate (and logistically not possible) to call many cardiologists to find one who will say precisely what I’d like them to say. This is a situation in which several of the surrogate markers are also diagnostic markers (high blood pressure is a surrogate marker AND a diagnostic marker for hypertension; insulin levels and blood sugar are surrogate markers AND diagnostic markers for diagnoses of prediabetes and type 2 diabetes. Therefore all the sources I spoke to (and likely any others I would have) were unwilling to speak about the risk factors described solely as surrogate markers. (Trust me — I TRIED — I asked multiple questions about this with each of them, and I pressed it with the cardiologist.)

Again, I appreciate the review and HNR’s dedication to rigorously evaluating news articles. It’s rare that I disagree with much in a review — though I definitely did not meet criterion #1 and knew I wouldn’t — but I think it’s important to note that I did all due diligence in fulfilling criterion #2 and ensuring that the benefits of the intervention were thoroughly covered.

Reply

    Joy Victory

    January 11, 2018 at 3:39 pm

    Hi Tara, thanks for leaving a comment, it’s great to hear your thoughts on the review, and to learn some background on the effort you put into the story.

    We agree that these are all risk factors for cardiovascular disease, and it’s good that they appeared to move in the right direction for these teens post-surgery. And yes, some of these were not just surrogate markers, but also diagnostic markers. Yet, even then, they may not accurately reflect the impact of this intervention on real patient-centered outcomes that people care about. Are these teens guaranteed to have fewer strokes and heart attacks? We just don’t know yet. We feel this caveat is something a reporter or editor can add to a story like this, without attributing it to a source.

    Reply