Weight loss surgeon Dr Richard Babor, star of the TV2 show The Big Ward, says tens of thousands of morbidly obese New Zealanders would benefit from bariatric surgery but that's not a solution to the obesity epidemic.
1 This is the second season of The Big Ward. What was the response like to the first?
The first season was unexpectedly successful, I think because it told interesting human stories. It's also had real educational value. My job has got easier because pretty much everybody who comes in wanting bariatric surgery has seen the show. In the second season we have a broader cross-section of society to show that obesity affects all socio-economic groups. MP Paula Bennett is the perfect example of someone who is educated, affluent, health literate and highly motivated but can't regain control of her weight. I see many successful people like her in my private practice one day a week.
2 You were one of only two surgeons doing bariatric surgery when the first season was shot. How many are there now?
There are five surgeons doing bariatric surgery at Middlemore Hospital now. I do between 80 and 100 weight loss operations a year. I could do twice as many if I didn't do cancer surgery but that takes priority because it's time critical and there's only two of us doing upper gastro-intestinal cancer surgery. I also do on-call acute surgery every second week.
3 Only a small percentage of the tens of thousands of people who would benefit from bariatric surgery will qualify under the public health system. How do you prioritise?
We use a Ministry of Health scoring system which is mandatory for public hospitals in New Zealand. Patients have to have a major obesity-related health problem that has already brought them into contact with the hospital system like diabetes, osteoarthritis, bad sleep apnoea or fatty liver disease. Weight loss surgery is going to save the health system money in these cases because they're going to have fewer heart attacks and strokes and less need for things like kidney dialysis or laser treatment for retinopathy. Diabetes is the top qualifier because it has the most costly long-term health effects.
4 What's life like for those who don't qualify?
Surgery could bring a whole range of improvements to their quality of life. A 32-year-old woman who weighs 130kg might feel confident enough to get a job, a partner, start a family, have a fuller happier life and come off anti-depressants. But those things aren't taken into account by the rationing system.
5 Should the Government be funding more bariatric surgery?
Surgery is a powerful tool to help individuals but you can't use surgery to fix the obesity epidemic. Over 20,000 people are morbidly obese in south Auckland alone. We'd have to have 20 surgeons working 24/7 and the hospitals wouldn't have space to do any other surgery. So that's not the answer. Reducing obesity in the population is a political problem. There's all sort of initiatives around the world to reduce obesity because it's such a hideously expensive health problem that can sink the whole healthcare system. Other countries have already banned junk food advertising to children, limited the size of soft drinks or imposed sugar taxes.
6 Do you think those measures help?
They have a cumulative effect but it needs a multi-pronged approach. It's a massive job and our government doesn't seem to have the appetite to take it on. Partly it's because the food lobby has such a strangle-hold on how food is marketed and sold. Our food supply is controlled by massive multi-national corporations that make their biggest profits by selling carbohydrates because they're cheapest to produce and humans are unable to stop eating them. We're biologically wired to love carbs, particularly sugar. We've become Iike those feedlot cattle, standing in a bleak square up to our ankles in mud being pump-fed corn feed to fatten us up. That's how we're treating the human population now and nobody's prepared to say stop. Industry lobby groups spend billions influencing governments not to interfere. The public health advocates on the other side like Boyd Swinburn and Robyn Toomath are working on grants of tens of thousands of dollars. Robyn quit in exasperation and I don't blame her.
7 Does education help?
Part of it is educating people to eat vegetables and real food instead of crap out of packets. But telling people sugar's bad for them doesn't stop them eating it because it's extremely addictive. Experiments show it lights up the same circuits in your brain as drugs like cocaine. There's this neo-liberal idea that people should just choose to eat healthier but if your BMI's over 35 or 40 we know absolutely scientifically that you can only lose weight for a few months. Nine months is as long as anybody can maintain a really substantial diet change in the toxic food environment we live in. Within a few years 99 per cent of those people will be back up to their previous weight, plus more. If you're still less than 35 BMI there's a chance you can maintain your weight at a healthier level.
8 What about exercise?
Exercise has no effect on your weight. This is another fallacy. Exercise is good for your mental health, it makes your mood better, it makes you sleep better which is really important for weight maintenance and it helps the inhibitory centres in your brain. So people who exercise regularly are more likely to choose healthier food. But you can't compensate for the amount of bad stuff in our diet by exercising it away. You have to change your diet. I'm 48 and it's getting harder for me to maintain a healthy body weight. I eat less carbs, try to have a more plant-based diet, get some exercise, sleep well and stay off the booze.
9 Do you ban your children from eating junk food?
No. My sons are 18 and 20. I still buy them potato chips and ice cream, even though I shouldn't, because they like them. They have high metabolic rates because they're still growing but I worry about them in the longer term. They can't keep eating like that in their 30s.
10 What was your childhood in the Hutt Valley like?
I had a fun suburban childhood in Naenae hanging out with my mates, building forts in the bush, playing around with the slug guns, that sort of stuff. My parents are Czechs who escaped from Prague when the Russians invaded in 1969 and ended up in a refugee camp in Austria. Because they were both engineers there was demand for their skills. They chose to come here because it was the furthest away.
11 Did you always want to be a doctor?
No, I drifted into it because I was good at science and maths. I knew I'd get into medicine so I did and it turned out to be quite interesting. As a junior doctor you have to move around all the different specialties and what you find is different specialties attract different personality types. Surgeons are practical people who like to do stuff that has a direct and immediate effect.
12 Why did you decide to do bariatric surgery?
When I was training in upper gastro-intestinal surgery 10 years ago I noticed colleagues doing it. It was a rewarding part of their job because they were changing people's lives. Cancer surgery's much more difficult emotionally because people are staring death in the face. They're often desperate, anxious and frightened and sometimes in denial and angry. After surgery the cancer often comes back so I have to tell people there's nothing more I can do for them. That uses up emotional energy which bariatric surgery gives me back. There's a huge satisfaction in seeing people's progress afterwards.
• The Big Ward season 2 airs this Thursday, 8pm on TVNZ 2 or TVNZ.co.nz