HOSPITAL CONSULTANT PROFESSOR Helen Heneghan is seeing more and more people needing urgent treatment after going abroad for weight-loss surgery.
The long waiting list for bariatric operations has driven many patients to overseas clinics, but Heneghan warns that nightmare stories are becoming more common.
The bariatric surgeon and her team at St Vincent’s University Hospital in Dublin now deal with a worrying number of complications from procedures carried out by poorly regulated providers in other countries.
“We get admissions through the emergency department two or three times a week,” she said.
There’s been a significant increase in patients travelling abroad for surgery since the pandemic began, and the result is a lot more people presenting to our hospitals in serious trouble when they get home.
Heneghan appreciates that some feel medical tourism is their only option.
Waiting times for operations in Ireland can be as long as seven years, leaving patients at higher risk of health problems. Many develop new complications while waiting for surgery, and a small number even die.
“We’ve had 13 deaths on our waiting list over the last few years,” she told The Journal.
“We don’t get much traction when we talk about these sorts of figures, whereas there’d be uproar among clinicians if people died on, say, a transplant waiting list. I think there’s still a perception with obesity that it’s that person’s fault, which is absolutely not the case.”
Heneghan isn’t alone in her frustration at the lack of resources for obesity treatment.
The HSE’s new model of care for obesity management includes plans for better-resourced services in general practice, community and hospital settings, but clinicians fear that many of its proposals are far from being realised.
“We know what we need to do but the funding hasn’t been put in place to deliver it,” said Heneghan.
Obesity is costing our health service every single day, and yet we invest very little in treating the underlying condition.
“With obesity treatment, or anything to do with obesity, it’s usually the first thing to be shelved when there’s any other pressure on the health system.”
Francis Finucane, a consultant endocrinologist who runs the MSc in obesity at NUI Galway, points out that there are also barriers to safe and effective weight-loss drugs.
“We have well-established drug therapy regimes that work very well in terms of reducing cardiovascular risk and the risk of diabetes, and reducing excess dietary intake. I could see a patient with obesity in my clinic and advise that they start a particular drug therapy, but that patient would then have to pay for the drug out of pocket,” he said.
That wouldn’t be the case if they had diabetes, for example, or if they have hypertension, or cardiovascular disease. We don’t stigmatise those conditions in the way we stigmatise the problem of excess body weight.
However, he added that medication and surgery only go so far in addressing the problem.
Bariatric procedures might be the only way forward for people with severe obesity, but he said public policy must also tackle the environmental drivers of people being overweight.
“What we need are population-wide initiatives like compulsory labelling of calories, like sugar taxes, like restricting the advertising of junk food.”
He suggested that Irish policymakers look at public health measures being mooted in Britain, including the proposed banning of pre-watershed TV adverts and multi-buy deals for unhealthy foods.
“I think that’s an approach we need to replicate in Ireland and even take on more aggressively. We have completely inadequate policies when it comes to advertising targeted at children.”
The need for action seems clear in light of the recent warning by the World Health Organization that “epidemic” levels of overweight and obesity are linked to more than 1.2 million deaths a year across Europe. In Ireland, around 60% of adults are currently overweight or obese.
But stigma still deters many from accessing support and treatment.
Consultant endocrinologist Jean O’Connell, who chairs the Association for the Study of Obesity (ASOI), points out that obesity is a complex, chronic disease driven by multiple genetic, biological and environmental factors – and not, as many think, a lifestyle choice.
“The big misunderstanding is that it’s caused by eating too much. Healthy eating and exercise are important in managing any chronic disease, but we have to move away from this idea that obesity can be addressed solely through willpower.”
O’Connell said that some doctors wrongly assume any patient can lose weight if they try hard enough.
The notion that individuals are to blame for obesity, she said, ignores the science behind why people have bigger bodies – and the fact that many will never manage to reach and maintain a so-called “normal” weight.
Such assumptions can also affect how health professionals engage with patients.
For example, recent research found that more than half of entry-level physiotherapy students in Ireland feel that treating people with above-average BMIs isn’t worth the time, with most agreeing with the statement that “overweight individuals tend to be lazy about exercise”.
Susie Birney of the Irish Coalition for People Living with Obesity said that even long-serving medical professionals jump to conclusions.
“We hear people in our support groups saying that doctors will point to their weight whatever the problem. It stops people from getting support because you end up going into yourself,” she said.
A patient advocate, Birney had bariatric surgery in 2015 after trying numerous diets and therapies.
She began putting on weight as a teenager, and in later years was diagnosed with type two diabetes and polycystic ovaries.
The surgery reversed her diabetes straight away, but she said it wasn’t a quick-fix solution: she regained some of that weight in subsequent years and again sought support.
Birney always thought her size was a result of food and activity, but she began to think differently after being referred to the weight management service in Dublin.
“The multi-disciplinary team there is what completely changed my understanding of my weight and all its fluctuations,” she said.
“I started to see that it wasn’t just my own fault that I needed help.”
Infographics by Fionn Thompson
This work is co-funded by Journal Media and a grant programme from the European Parliament. Any opinions or conclusions expressed in this work are the author’s own. The European Parliament has no involvement in nor responsibility for the editorial content published by the project. For more information, see here.
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