Weight loss surgery will become as common as hip replacements and cataract procedures in Australia and state governments should fully fund it for the hundreds of thousands of people who could benefit, experts say.
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The call for more public funding came on Tuesday as Swedish researchers presented new data at the World Diabetes Congress in Melbourne showing that bariatric surgery caused about one-third of type 2 diabetes patients to remain in remission for 15 years.
The Swedish Obese Subjects study is one of the largest in the world to track the long-term outcomes of bariatric surgery for about 2000 people, including some with type 2 diabetes.
It found that of 345 patients with type 2 diabetes who had surgery, 72 per cent were in remission at two years, 38 per cent at 10 years and 31 per cent at 15 years.
Of 262 control patients with type 2 diabetes who did not have surgery but were tracked over the same period, 16 per cent were in remission at two years, 10 per cent at 10 years and 15 per cent at 15 years.
Men were most likely to relapse after surgery and those who had had more severe diabetes for a longer period before surgery.
The head of clinical obesity research at Baker IDI Heart and Diabetes Institute, John Dixon, said the results from the Swedish government-funded study were impressive and exceeded expectations of the long-term outcomes. He said given that the health of most diabetics became worse over time – because the condition was progressive and harder to manage the longer it went on – surgery was in effect putting the disease "to sleep" and adding years to people's lives.
While the surgery carried risks, including a one in 300 to one in 2000 risk of death depending on the procedure and patient, Professor Dixon said it was only a matter of time before bariatric surgery was done routinely at Australian public hospitals to treat type 2 diabetes.
"As we get older, more of us will need pacemakers, joint replacements, cataracts done, and I think bariatric surgery will be one of those things that we provide as a standard of care for very big Australians. We just have to come to grips with that," he said.
"People will often say they have never had surgery that is so wonderful . . . The impact could be quite enormous but we still have to get over the stigmatisation to deliver it at higher levels."
At least 12,000 Australians pay thousands of dollars each year to have bariatric surgery in private hospitals because only about 1000 operations a year are fully funded by state governments in public hospitals. Medicare pays about $800 towards the procedure.
While federal Health Minister Peter Dutton has expressed a desire to see more publicly funded bariatric surgery done, Professor Dixon said state governments were not buying into the surgery which is highly effective when accompanied by lifestyle change to maintain weight loss.
"It's a tragedy when we see people who are very, very big and we have to rely on public hospitals who really don't want to know about them . . . You can wait years and years to get an appointment to see the group at the hospital who then pretend they will do something in 12 to 18 months."
Professor Dixon said about 400,000 people or one-third of the 1.2 million Australians with type 2 diabetes would have a body mass index of more than 35, making them good candidates for surgery.
Paul O'Brien, emeritus director of the Centre for Obesity Research and Education at Monash University, said the Swedish results were good news and supported the case for early diagnosis and treatment of type 2 diabetes. He said a recent study estimated obese people with type 2 diabetes cost the health system about $10,000 a year, whereas remission through surgery cost about $16,000.
"It pays for itself within two years," said Professor O'Brien, who has previously received research funding from gastric band manufacturers.
But Professor Dixon said surgery was not an easy path. He said 15 to 30 per cent of patients required continuing surgical procedures to fix complications from the operation. Others had concerns that the surgery could cause bone loss, potentially due to hormonal changes or lower intake of vital nutrients such as calcium and vitamin D.
While Professor Dixon has long been an advocate of bariatric surgery and has received funding from surgical, food and drug companies, he said his views were independent of commercial interests.
Some doctors and researchers have criticised advocates such as Professor Dixon and Professor O'Brien, saying bariatric surgery should not be oversold when lifestyle changes can work as well for weight loss and disease management.
There are also concerns that more money should be channelled into prevention efforts, rather than treatment.
More than 10,000 people from more than 100 nations are gathering this week for the International Diabetes Federation 2013 World Diabetes Congress, Australia's largest health conference.
