Obesity Management

Conventional and Non-Surgical Treatment

Dieting, exercise, and medication have long been regarded as conventional methods in achieving weight loss. There is considerable research evidence that some people who are severely obese and do not benefit from these conventional and non-surgical therapies.

Surgical Treatment: Bariatric Surgery

"Surgery is the most effective treatment for morbid obesity: for most procedures and most patients, good weight maintenance has been observed three to eight years after surgery."

Over many years, bariatric surgery has proven to be a successful method in treating individuals who are morbidly obese. There are several surgical treatment options available and performed (Table 4). So far, all surgical treatment options have allowed patients to achieve and maintain significant weight loss, improve their health, and enhance their quality of life.

Table 4. Main types of bariatric surgery procedures for morbid obesity management in Australia

Restrictive Procedure
Laparoscopic gastric banding (LAGB)LAGB works mainly by decreasing food intake. Food intake is decreased by placing an adjustable band around the top of the stomach. The outlet size is controlled by inflating or deflating the band with saline solution to meet the needs of the patient. Adjustment of the band is performed through an access port, which is an essential part of LAGB therapy.
Gastric sleeve or sleeve gastrectomyGastric sleeve or sleeve gastrectomy is usually recommended to patients who may be at high risk for complications from more extensive types of surgery. The high risk levels are mainly due to patient’s body weight or medical conditions. The sleeve gastrectomy divides the stomach vertically to reduce its size. It leaves the pyloric valve at the bottom of the stomach intact, which means that the stomach function remains unaltered and digestion is therefore unaltered. This procedure is not reversible.
Malabsorptive Procedure
Open biliopancreatic diversion (BPD)BPD is a complex bariatric operation that includes removing the lower portion of the stomach and creating a gastric sleeve with the remaining portion. The remaining portion or small pouch is connected to the small intestine, bypassing the duodenum and upper small intestine from contact with food. 
Combination Procedure
Roux-en-Y gastric bypass (RYGB)RYGB works by excluding most of the stomach, duodenum, and upper intestine from contact with food by routing food directly from the pouch into the small intestine. Therefore, food intake is restricted and absorption of food is decreased. 

Bariatric Surgery in Australia

In Australia, gastric banding and other gastric reduction surgeries account for the vast majority of bariatric surgeries. The rate of gastric reductions has grown by 800% over the last decade (Figure 3). The rapid growth in gastric reductions is associated with the uptake of adjustable gastric banding which is perceived as a relatively safe, effective and reversible procedure.

Figure 3. Gastric reduction procedures 2000-01 – 2009-10

Source: Medicare Australia Statistics.

Note: Data based on Medicare Benefits Schedule (MBS) item numbers: 30511 - laparoscopic gastric banding (LAGB) and other gastric reduction, and 30512 - gastric bypass. This data is based on health insurance data and therefore does not include bariatric surgery performed on public patients in public hospitals.