KEY POINTS:
The Ministry of Health is considering a radical and controversial expansion of obesity surgery financed by taxpayers.
District health boards have given provisional approval to the scheme to operate on more than 900 "morbidly obese" people annually. This would cost more than $17 million in the first year and around $15 million in each of the next two years.
But there will be debate over using taxpayers' money for what some regard as an individual problem caused by overeating and laziness - despite the argument that the obesity "pandemic" is caused by our electronic lifestyles and appetite for commercially prepared food.
A survey of 400 people, commissioned by health boards, found that 61 per cent believed obesity surgery should be state funded and 35 per cent said it should not be. Seventeen per cent of the sample agreed "strongly" that it should be state funded, and 20 per cent strongly opposed the idea.
The strong supporters said it would save money for the health system long term, and nothing else worked.
The strong opponents said individuals were responsible for what they ate and taxpayer money should not be spent on fixing something individuals had done to themselves.
The ministry says it and DHBs are still to make their final decisions about the proposal. A spokesman for Health Minister Tony Ryall said it would need his approval only if boards wanted new money, rather than funding it out of their existing budgets.
Obesity surgery is the fastest-growing surgical area in Australia. Several private clinics offer it in New Zealand and some health boards, including those in Auckland, pay for a limited amount.
Private and public sector surgeon Michael Booth said North Shore Hospital performed 20 to 30 of the operations a year.
The surgery was life-changing for the majority of those who had it, he said. But it failed in 40 to 50 per cent of gastric-band cases because the patient did not eat or exercise properly or the band slipped or eroded. In up to 30 per cent of gastric bypass cases the patients regained weight because they snacked constantly - instead of eating three small meals a day - and stopped exercising.
There was also a risk of death of 1 per cent or less.
Whether funded privately or by the Government, he said, the operations should be done only on those who were already motivated to lose weight by dieting and exercise.
The aim is to treat 0.5 per cent of the "morbidly obese" - those above body mass index 40, or above 35 with significant illnesses like diabetes. It is estimated that 5.8 per cent of the population, more than 200,000 people, are morbidly obese. The percentages are much higher among Maori and Pacific people, who are expected to particularly benefit if the scheme proceeds.
An assessment for the ministry found that providing the surgery would be cost-effective. It offered "a potential cost saving for the health sector, with a payback time of around eight years post surgery". The operations cost between $15,000 and $25,000.
Obesity increases many risks, including type 2 diabetes, heart disease and cancer. The mortality risk for the morbidly obese is double that of lean people.
