Treating Obesity

Happy Halloween! The clocks go back this weekend so it's also the start of winter - officially. Had no idea what to write about this week, a medical student was accused of being behind the plot to blow up a plane bound for the US, I heard on the radio that they're hoping to invent an alternative to the contraceptive pill which involves rubbing cream into your thighs, and David Nutt has announced that alcohol is more dangerous than heroin (albeit on a population scale).

An article in the Sunday Times this weekend highloghted the ongoing debate over availability of drugs and the catch phrase 'post-code lottery'. The headline read 'Call for Banned Obesity Drugs Re-Think'. There have been calls in Scotland for the NHS to re-instate treatments for obesity despite evidence of the risks involved which include 'heart problems and depression'. In January the NHS chose to withdraw Sibutramine from the market, a drug which causes early satiety and can reduce food consumption by up to 20%. There is a growing feeling that relatively safe drugs are being withdrawn from the market because obesity is viewed differently to other disabling diseases without consideration for the physical, mental and social consequences of the condition. A whopping 10,500 people in Scotland are estimated to be on a daily treatment for obesity. Ribonamant was another anti-obesity drug withdrawn from the market in 2008 due to increased risks of suicide, and Orlistat which prevents fat absorption has unpleasant gastric side effects.

In the BMJ this week, the headline article was about surgery for obesity. NICE and SIGN have now published guidelines recommending bariatric surgery for specific groups of patients however many are still unable to gain access to treatment. NICE guidelines recomment bariatric surgery for patients with a BMI of greater than 40. A Cochrane review found that surgery was more effective than conventional management. the question that remains is should we be offering more bariatric surgery than is available at present? The surgery comes with its risks but the bottom line is that what was once considered an un-necessary and rare form of surgery is more and more becoming a leading treatment for obesity, at a time when obesity is reaching 'pandemic' levels in the UK.