Using surgery to beat the bulge

If dieting doesn't work - try surgery. That's the message to New Zealand's obese population from Wellington obesity expert Dr Robyn Toomath, who claims the single most effective weapon against obesity is stomach-restricting surgery.

In the wake of new data showing the country's obesity rate has doubled in the past 25 years, Dr Toomath, a spokeswoman for Fight the Obesity epidemic, said diet and exercise were not realistic options for obese people who needed to lose weight permanently.

Stomach-reduction surgery, also known as bariatric surgery, leaves patients with a stomach about the size of a small plum - and an appetite to match. It is provided by a handful of district health boards and is given automatic cover by only one health insurance company in New Zealand.

According to Dr Toomath and Hamilton abdominal surgeon Dr David Schroeder, stomach-reduction surgery is the only realistic way for obese people to shed the necessary number of kilos - and keep them off.

Small amounts of weight can be lost using a combination of diet, exercise and weight-loss drugs, but anything more than 10 to 15kg requires surgery, they said.

Dr Toomath, who believes 80 per cent of obesity is genetically determined, said obese people should not be blamed for their size, nor made to diet and exercise to reduce it.

"I have had decades of trying to help highly motivated individuals, highly intelligent people, who couldn't have more reason in the world to lose the weight they need to - and they can't do it," she said.

But the head of the University of Auckland's School of Medicine, Professor Iain Martin, also an experienced bariatric surgeon, said obese people should not rest on their genetic laurels and give up on non-surgical weight-loss methods entirely.

"If you're not morbidly obese, then I would very very strongly encourage everybody to try the other things; diet, exercise and maybe a kickstart with drugs, although the drugs are not that effective," he said.

Carol Gibbs, executive officer of the Dietetic Association, said she would hesitate before saying an intensive regime of diet, exercise and behavioural modification - without surgery - would not work.

Also speaking on behalf of the Dietetic Association, Lyn Gillanders, a senior dietitian at Auckland City Hospital, said bariatric surgery might be the "crutch" some people needed to change their behaviour, but a determined overeater could stretch their stomach afterwards.

- THE HERALD ON SUNDAY