February 14, 2017 Read Original Story

‘The most effective intervention we have:’ NY Times glosses over risks of bariatric surgery

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Rating

Why Weight Loss Surgery Works When Diets Don’t

Our Review Summary

The story offers an overview of benefits associated with permanent bariatric surgery. It cites several studies, and includes links to all of them, and includes important information about the cost of surgery.

However, the benefits — and health risks — of such surgeries are discussed in only general terms, and the story borders on advertorial copy when it opens with this unsubstantiated quote: “Bariatric surgery is probably the most effective intervention we have in health care.”

Why This Matters

According to the NIH, more than two out of three adults are considered to be overweight or obese, which increases the risk of health problems such as type 2 diabetes and heart disease. Given those numbers, it is perhaps unsurprising that bariatric surgeries appear to be on the rise. According to the American Society for Metabolic and Bariatric Surgery, the number of bariatric surgeries in the U.S. went from 158,000 in 2011 to 179,000 in 2013.

When a medical problem is widespread (as is the case with obesity), and a growing number of people are likely to know someone who has had a relevant treatment (as is likely the case with bariatric surgery), more and more people may begin asking themselves: “Should I do this?” News stories that discuss costs, benefits and side effects can be a valuable resource for people asking that question. And for that reason, it is particularly important for those stories to discuss the costs, benefits and side effects in a meaningful way.

Criteria

Does the story adequately discuss the costs of the intervention?

Satisfactory

The story tells readers that the bariatric surgery has a “typical” price tag of $30,000 — and that some medical insurers, including Medicaid programs in many states, are reluctant to cover the cost of bariatric surgery. That’s good.

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

Not Satisfactory

Benefits are discussed at length, but only in vague terms. For example: “Matched with comparable patients who did not have surgery, those who did fared much better physically, emotionally and socially.” What does “much better” mean?

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

Not Satisfactory

The story tells readers that bariatric surgery “is also much safer nowadays than it was even a decade ago.” It also refers to the “well-documented safety and effectiveness of bariatric surgery.” But there are still potential harms, such as bleeding, infection and — in rare cases — surgical problems that can be fatal. After surgery, there also is the long-term risk of nutritional deficiencies.

If a story aims to offer a complete picture of bariatric surgery it needs to address all aspects, including risks. And if the risks are low, articulate how low those risks are. This allows readers to make more informed decisions about their personal health.

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

Not Satisfactory

The story refers to four studies, and offers broad overviews of each. Some important context was missing in these overviews. For example, the story refers to one study of 31 patients. It would have been worth noting that it is difficult to draw broad conclusions from a study with such a small number of participants. By the same token, the story also refers to two retrospective observational studies of 2,500 and 1,787 patients, respectively. A brief discussion of the limitations of retrospective observational studies, and the importance of evaluating such a large number of patients, would have made the story stronger.

Does the story commit disease-mongering?

Satisfactory

No disease mongering here. That said, the story is weighted very heavily to endorsing weight loss surgery, making it guilty of “treatment-mongering.”

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

Not Satisfactory

All of the sources in the piece are the authors of published papers discussed in the story, though one of the sources is the author of an “invited commentary,” rather than a study.

Also, at least one of the sources in this story also had potential conflicts of interest that weren’t disclosed: Dr. Stacy Brethauer has worked as a speaker or consultant for several companies that provide products for bariatric surgery.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The story refers to non-surgical weight loss options only obliquely, noting that “the overwhelming majority of patients who undergo bariatric surgery have spent many years trying — and failing — to lose weight and keep it off.” A basic summary of other weight loss options, including lifestyle changes, medical management and pharmaceutical treatments, was needed.

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

Satisfactory

It is clear from the story that bariatric surgeries are common and widely available–if not necessarily covered by one’s insurance plan.

Does the story establish the true novelty of the approach?

Not Applicable

The story offers an overview of bariatric surgery outcomes, discussing multiple studies that have been published over the past two years. It is clearly intended to address common questions and concerns regarding bariatric surgeries, rather than serving as a “new-study-of-the-day” story.

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

Satisfactory

The story does not appear to be based on a news release.

Total Score: 4 of 9 Satisfactory

Comments (2)

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Carey Goldberg

February 14, 2017 at 3:42 pm

Well done….I would also add that the story does not live up to the headline — it does not even attempt to explain “why weight loss surgery works when diets don’t” — and that’s a question interesting enough to have made me click on the story — and then feel disappointed….

Paul Ernsberger

February 20, 2017 at 3:05 pm

The article is based entirely on a press release issued by a professional association of bariatric physicians. A press release promoting a controversial procedure that provides significant profits for surgeons and hospitals is not science but public relations and marketing.
The real alternative to bariatric surgery is intensive medical management of obesity related risk factors. Blood pressure and cholesterol are easily managed with proven medications. Treatment of diabetes is improving every year as new medications are approved in a steady stream.
This promotional piece is based on the STAMPEDE trial. Many experts, including some involved with the study, consider it a failure because bariatric surgery was effective in reversing diabetes in only 29% of the patients, in contrast the the nearly 100% effectiveness claimed by several surgeons.

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