“No” to the knife, “Yes” to Ritalin?
Obesity surgery has grown in the UK, as it has worldwide. But unless it can be shown that it saves money which could be transferred from elsewhere (diabetes care, for example), less than 5% of eligible patients might receive NHS operations in the next few years.
With couple of internet searches, today I found plenty of advertisements for self-funded surgery, including centres in India and Central America. The demand is clearly huge.
On Wednesday this week Joan Bakewell’s Radio 4 medical ethics programme addressed the previously little-publicised problems with obesity surgery (1). In particular, careful follow-up is needed as banding operations may need to be repeated or redone. For patients who go abroad, continuity of care may be less than optimal if they need to turn to the UK NHS later.
A study published last year (in a Nature group journal) suggested ADD / ADHD may be a significant, and treatable, cause of obesity (2). One third (78/242) of patients in an independent Toronto weight loss clinic were found to have ADD / ADHD, and with treatment they lost 10% of body weight. That is as good as obesity surgery.
More research is of course needed, but I find the idea that some people with ADD / ADHD overeat makes clinical sense. Many of my patients, successfully treated, get on with their lives more effectively, and find they “snack” less. Because the underlying dissatisfaction and discomfort is reduced, so is the need for “comfort eating”.
In my view this treatment effect is separate from the “appetite suppressant” effect, which is often transient anyway, of medications such as methylphenidate and amfetamine.
Interestingly, another large study on obesity, recently published in The Lancet (3), showed good results for a medication combination which included bupropion (available in the UK only as the smoking cessation drug Zyban, but more widely used in the US for years). Bupropion is thought by many developmental disorder specialists to be effective in ADD / ADHD.
I am sure we will see many overweight and obese people in the UK considering whether they might have ADD / ADHD. Surely having assessment and possibly treatment in London is a reasonable thing to try, before flying off for surgery in Cancun or Delhi (4) ?
(4) No disrespect to Mexican or Indian surgeons intended at all. The point is about continuity of care. It also seems possible to me that people with severe ADD / ADHD might have a poor outcome with apparently successful surgery: I understand this is not uncommon.