Gastric bands are as useful as a plaster on a severed artery

The Department of Health favours a huge increase in bariatric surgery. Clearly it hasn't done its sums

Share

I sat next to a nice chap called Ken at an obesity conference dinner in 2009. Ken had been one of the speakers that day, sharing the fact that he'd had bariatric surgery and telling the audience all good things about the procedure, glossing over the complications and weight regain in his enthusiasm. What I didn't know was that Ken worked for Gravitas, "the nationwide partnership of bariatric surgeons and clinicians". This wasn't a human interest story on the agenda; bariatric surgery is big business – morbidly big business.

On Friday, Nice issued some revised guidelines. Nice stands for the National Institute for Health and Care Excellence. It describes itself as follows: "We provide independent, authoritative and evidence-based guidance on the most effective ways to prevent, diagnose and treat disease and ill health."

There were two parts to the Nice announcement. The largely ignored recommendation was "don't use VLCDs [very low-calorie diets] to manage obesity". The headline grabber was "Give weight-loss surgery to obese patients on NHS to curb diabetes, says Nice".

Until this announcement, the guidelines for eligibility for bariatric surgery were either a BMI (body mass index) of 40-plus or a BMI of 35-plus with what is called a co-morbidity. The latter is typically type 2 diabetes. Nice is now recommending that people who are merely obese (a BMI of 30-plus), with recent-onset type 2 diabetes, should be considered for surgical intervention.

There appears to be some dispute over the impact of this recommendation. Approximately 8,000 bariatric surgery operations were performed in 2010-11. Diabetes UK estimates that 460,000 people meet the current criteria and 850,000 will meet the new threshold; and there may be even more because type 2 diabetics of Asian origin will be eligible at a lower BMI.

When asked about the numbers, Professor Mark Baker from Nice told the BBC: "It would be between 5,000 and 20,000 operations a year, but we haven't done the modelling." I suggest that Nice starts modelling.

With 2.9 million diabetics in the UK, 95 per cent type 2 and the majority of these likely to have a BMI of 30-plus, the Diabetes UK estimate of candidates for surgery seems conservative. Even if there are "only" 850,000 people to surgically alter, and even if operations are almost doubled to 15,000 a year, it will take 57 years to clear the backlog. Add to this the projected forecast of five million diabetics by 2025 and Nice may regret not modelling.

My first thought when I saw the headline was that you may as well put a plaster on a severed artery. This is not going to stop the problem. It shows no understanding about the problem. It does not address the cause of the epidemics that we – yes, we – have created among our fellow humans.

To understand the obesity epidemic we need to know when it started. In 1972, 2.7 per cent of UK men and women were obese. By 2000, 22.6 per cent of men and 25.8 per cent of women in the UK were obese. What happened?

The short answer is that we changed our dietary advice. We demonised fat and eulogised carbohydrate. "Base your meals on starchy foods," we were told. Obesity has increased up to 10 fold since – coincidence or cause?

To show just how much carbohydrate should be consumed, the Department of Health launched something called "The Balance of Good Health" plate in 1994. This was tweaked by the Food Standards Agency and re-launched in 2007 as the Eat Well Plate. I call it the eat badly plate. In among the chocolate, sweets, biscuits, Battenberg cake, Victoria sponge, cornflakes, baked beans, flavoured yoghurts and even a can of cola, I spotted just two or three items that wouldn't have an impact on blood glucose levels. Then we wonder why we have an epidemic of type 2 diabetes.

Diabetes can be defined as an impairment of the body's glucose-handling mechanism. When someone has an inability to manage glucose, why, why, why would you advise them to base their meals on glucose (starchy foods)? It's not just bad practice, it's medical malpractice in my view.

Our current dietary advice has produced epidemics of both obesity and diabetes. In terms of direction of causation, I think that obesity can cause diabetes and diabetes can cause obesity. However, but for the unprecedented level of carbohydrate recommended in the so-called "developed" world, we would have neither.

Dr Natasha Campbell-McBride calls the gut the second brain in the body. We mess with digestion of nutrients and hormone feedback loops at our peril. We don't need bariatric surgery at all, let alone inflicting it on another million or so human beings. We just need to dump our current dietary advice and stay true to evolution.

We have eaten real food – that provided by nature – since Australopithecus Lucy first walked upright, an estimated 3.5 million years ago. We should be eating meat, eggs and dairy from pasture-living animals, fish, vegetables, nuts and seeds and fruits in season. We did just fine until man started messing with his own food chain.

If you are left wondering why Nice would recommend removing half of someone's stomach before advising them to eat real food, I have a theory. Just as the Government will stick to its "Responsibility Deal" – better called Irresponsibility Deal – to keep the fake-food companies happy, so a conflicted guideline development group will act according to conflicts.

In February, Nice recommended a substantial increase in the number of people who should be given statins. I discovered that eight out of 12 of its panel members had conflicting relationships with the drug companies.

So this angle was an obvious one to check for the latest guidelines. Sure enough, six out of 14 members of this latest panel have conflicts of interest. Four are bariatric surgeons and two are happy customers of bariatric surgery. One of them is Ken, the nice chap I met at the obesity conference, or should that be the Nice chap representing the bariatric surgery industry.

Zoë Harcombe is the author of 'The Obesity Epidemic'

React Now

Latest stories from i100
Have you tried new the Independent Digital Edition apps?
iJobs Job Widget
iJobs General

Year 5 Teacher

£80 - £140 per day: Randstad Education Leeds: Year 5 Teacher KS2 teaching job...

Software Developer

£35000 - £45000 Per Annum Pensions Scheme After 6 Months: Clearwater People So...

Systems Analyst / Business Analyst - Central London

£35000 - £37000 per annum + Benefits: Ashdown Group: Systems Analyst / Busines...

Senior Change Engineer (Network, Cisco, Juniper) £30k

£30000 - £35000 per annum + Benefits: Ampersand Consulting LLP: Senior Change ...

Day In a Page

Read Next
 

i Editor's Letter: A huge step forward in medical science, but we're not all the way there yet

Oliver Duff Oliver Duff
David Cameron has painted a scary picture of what life would be like under a Labour government  

You want constitutional change? Fixed-term parliaments have already done the job

Steve Richards
Oscar Pistorius sentencing: The athlete's wealth and notoriety have provoked a long overdue debate on South African prisons

'They poured water on, then electrified me...'

If Oscar Pistorius is sent to jail, his experience will not be that of other inmates
James Wharton: The former Guard now fighting discrimination against gay soldiers

The former Guard now fighting discrimination against gay soldiers

Life after the Army has brought new battles for the LGBT activist James Wharton
Ebola in the US: Panic over the virus threatens to infect President Obama's midterms

Panic over Ebola threatens to infect the midterms

Just one person has died, yet November's elections may be affected by what Republicans call 'Obama's Katrina', says Rupert Cornwell
Premier League coaches join the RSC to swap the tricks of their trades

Darling, you were fabulous! But offside...

Premier League coaches are joining the RSC to learn acting skills, and in turn they will teach its actors to play football. Nick Clark finds out why
How to dress with authority: Kirsty Wark and Camila Batmanghelidjh discuss the changing role of fashion in women's workwear

How to dress with authority

Kirsty Wark and Camila Batmanghelidjh discuss the changing role of fashion in women's workwear
New book on Joy Division's Ian Curtis sheds new light on the life of the late singer

New book on Ian Curtis sheds fresh light on the life of the late singer

'Joy Division were making art... Ian was for real' says author Jon Savage
Sean Harris: A rare interview with British acting's secret weapon

Sean Harris: A rare interview with British acting's secret weapon

The Bafta-winner talks Hollywood, being branded a psycho, and how Barbra Streisand is his true inspiration
Tim Minchin, interview: The musician, comedian and world's favourite ginger is on scorching form

Tim Minchin interview

For a no-holds-barred comedian who is scathing about woolly thinking and oppressive religiosity, he is surprisingly gentle in person
Boris Johnson's boozing won't win the puritan vote

Boris's boozing won't win the puritan vote

Many of us Brits still disapprove of conspicuous consumption – it's the way we were raised, says DJ Taylor
Ash frontman Tim Wheeler reveals how he came to terms with his father's dementia

Tim Wheeler: Alzheimer's, memories and my dad

Wheeler's dad suffered from Alzheimer's for three years. When he died, there was only one way the Ash frontman knew how to respond: with a heartfelt solo album
Hugh Bonneville & Peter James: 'Peter loves his classic cars; I've always pootled along fine with a Mini Metro. I think I lack his panache'

How We Met: Hugh Bonneville & Peter James

'Peter loves his classic cars; I've always pootled along fine with a Mini Metro. I think I lack his panache'
Bill Granger recipes: Our chef's heavenly crab dishes don't need hours of preparation

Bill Granger's heavenly crab recipes

Scared off by the strain of shelling a crab? Let a fishmonger do the hard work so you can focus on getting the flavours right
Radamel Falcao: How faith and love drive the Colombian to glory

Radamel Falcao: How faith and love drive the Colombian to glory

After a remarkable conversion from reckless defender to prolific striker, Monaco's ace says he wants to make his loan deal at Old Trafford permanent
Terry Venables: Premier League managers must not be allowed to dictate who plays and who does not play for England

Terry Venables column

Premier League managers must not be allowed to dictate who plays and who does not play for England
The Inside Word: Brendan Rodgers looks to the future while Roy Hodgson is ghost of seasons past

Michael Calvin's Inside Word

Brendan Rodgers looks to the future while Roy Hodgson is ghost of seasons past