KEY POINTS:
Stomach stapling operations could become a common weapon in the fight against New Zealand's obesity epidemic.
The Counties Manukau District Health Board has approved the procedure for 60 diabetic patients at Middlemore hospital to assess its long-term benefits. If the trial is successful, the service could be extended around the country.
The board said a $20,000 stomach stapling operation was more cost-effective than treatment for obesity-related problems, including diabetes, arthritis and hip and knee replacements.
"The DHBs think if people are treated early it won't cost taxpayers extra," spokeswoman Dr Anne-Thea McGill said.
"The obesity problem is not going away. Last century, only 3 per cent of our population were deemed obese. We are knocking up to 30 per cent now."
The Health Ministry estimated the cost of obesity-related healthcare was about $460 million in 2004.
Type 2 diabetes is attributed to about 2000 deaths a year, costing the public health system more than $170m.
Stomach stapling is among a range of procedures known as bariatric surgery.
Obesity Action Coalition director Leigh Sturgiss said the procedures worked but didn't change the habits or environments that caused patients to overeat.
"We think DHBs should fund some of these operations but it's not the only answer," Sturgiss said.
"This problem is significant and is costing the country a lot of money.
"If we don't do something soon this will be the first generation likely to die before their parents."
Maree Burns of the Auckland-based Eating Difficulties Education Network said the "incredibly invasive" procedures were not the answer.
"The message should be that fitness not fatness predicts mortality and morbidity," Burns said.
"These surgeries tend to go wrong and aren't necessary successful long-term. We should focus on messages about eating nutritious foods and exercising."
Nationally, 70 non-preventive bariatric operations were publicly-funded in the financial year ending June 30, compared to 63 in the previous 12 months.
Some were for obese patients who needed to lose weight to minimise risks associated with required operations such as knee replacements.
A conservative estimate of 400 obesity operations are performed each year by private surgeons but firm figures are not available.
A phone survey of 1000 people by social telemarketing company Phoenix Research for district health boards is gauging public attitudes towards spending taxpayer cash on preventive procedures.
The results will be presented to the Government early next year.
Medical ethics professor Grant Gillett said obesity should be viewed as a life-threatening condition like appendicitis.
"People believe morbidly obese people should control themselves, and the public shouldn't give them surgery for their own lack of self control," Gillett said.
"But many of us have grown up in a generation where we have not been taught self-discipline.
"We have to look at our social practices and teach people to take more responsibility for their own lives."
Royal New Zealand College of GPs president Jonathan Fox said the organisation had no formal position on the subject.
But speaking as an Auckland doctor he said the jury was still out on the effectiveness of such surgeries.
"We need these pilot studies to weigh up the benefits, costs and effectiveness of weight-loss surgery," Fox said.
"But we can't give up trying to prevent people getting to that stage by promoting healthy lifestyles and food choices."
Green Party health spokeswoman Sue Kedgley said more research was needed before a national strategy was put in place.
"Surgery should be a last resort," Kedgley said.
"There is an argument we have generated a whole environment where unhealthy foods are more heavily promoted and readily accessible than healthy foods.
"Are we going to allow this environment and accept this is the consequence and price we have to pay?
"It's a very vexed issue but an important one."
FIGHTING THE FLAB
* The most recent Government snapshot of the nation's health, the 2002-03 New Zealand Health Survey, said 21 per cent of adults and 10 per cent of children aged 5-14 were obese.
* About 10,400 people in the Counties Manukau District Health Board area are morbidly obese.
* In the Auckland District Health Board area about 80,000 are deemed obese and 8000 morbidly obese. A study of the long-term effectiveness of gastric bypass surgery carried out by Wellington's Wakefield Gastroenterology Centre on 342 morbidly obese patients between June 1990 and April 2003 found 85 per cent of those with type two diabetes were cured. A further 10 per cent with type two diabetes had improved.
