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London 2012: Future of Obesity Treatment

Which patients gain from obesity treatment?

Several medical therapies for treating co-morbidities, but not for obesity
Simon Aylwin

In his presentation, ‘Which patients stand to gain most from obesity treatment?’ Dr Simon Aylwin, King’s College London, UK, said that this was an almost impossible question to answer but said he would explain some of the questions that should be considered in trying to answer the question.

“Historically, prevention consisted of diet, exercise and risk factor management, however for today’s patients who are aged >55 with co-morbidities intervention is required. But what intervention?” asked Aylwin. “There are a whole host of medical therapies available to treat co-morbidities such blood pressure, diabetes, cholesterol, but there are no medical therapies available to treat their obesity.”

Even though the Swedish Obese Subjects (SOS) study recently reported that patients who undergo gastric bypass surgery are less likely to have cardiovascular events than people who receive more conventional treatment for their weight condition, he suggested that it is not the number of heart attacks, but whether the patient survives it.

He argued that the evidence is not there yet to categorically state that obesity surgery is useful in preventing death, however it is useful in preventing disease, dysfunction and dissatisfaction. Another aspect of surgical intervention is economic, and Aylwin presented economic models that showed that if 25% of patients had surgery they would incur less overall costs than patients who continue with medical therapy only, saving approximately £1billion. 

He concluded by asking who is appropriate for bariatric surgery: “I know who is eligible but who requires it the most, what about those with psycho-socio dysfunctionality? Such conditions are the harbingers of medical disease and should be considered as reasons for intervention.”

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