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Jenni Murray joins growing number of Britons to have gastric surgery Jenni Murray joins growing number of Britons to have gastric surgery
(about 5 hours later)
In opting to have a gastric band fitted, prompted by despair at her inability to shed weight via dieting and keep it off, Jenni Murray is set to join the growing number of obese people – obese is the word Murray uses in Thursday's confessional in the Daily Mail explaining her decision – who undergo drastic weight loss surgery. Jenni Murray, the host of Woman's Hour on Radio 4, has joined the growing number of people opting to have a gastric band fitted, prompted, she says, by despair at her inability to shed weight by conventional dieting and to keep the pounds off.
NHS figures reveal the number of people having a "stomach bypass procedure for obesity" in England has soared by almost 2,000% over a decade from 242 in the year ending 2004 to 4,074 in 2013 and by a similar amount for "restrictive stomach procedures for obesity", which have shot up from 267 to 4,857. Writing in Thursday's Daily Mail, the broadcaster said the realisation that something radical needed to be done came as she shopped for a new swimming costume, part of a fresh attempt to lose some weight. "At 64, I'm far too old to pass myself off as chubby or plump. Even fat doesn't cover it these days. Obese is the only word for it."
Add in the 405 patients who had an "endoscopic insertion of gastric balloon for obesity" in 2012-13 – a procedure only available from 2011 – and that means 9,336 patients in one year underwent major invasive surgery to tackle their extreme weight. These operations cost the NHS an estimated £85m a year. Over the years she had tried diets including the cabbage soup, Atkins, Dukan and 5:2, sometimes losing stones but always putting it back on again. She felt she had run out of options. "'Eat less and get some exercise, you lazy lump,' the more cruel detractors will cry, to which I reply: 'Oh, I have done, believe me.'"
However, recent draft guidance from the National Institute for Health and Clinical Excellence (Nice) proposes reducing the eligibility for such surgery from a body mass index of 35 to 30, the point at which excess weight starts to be classed as "obesity". The sheer scale of the obesity epidemic means that an extra 800,000 people could qualify, with huge consequences for the NHS's already squeezed budget. Nice, however, believes such an expansion would ultimately save the NHS money, by reducing people's risk of other conditions. According to the NHS, the number of people in England having a stomach bypass – by stapling and inserting a tube to divert food directly from the upper stomach to the small intestine – to combat obesity has soared by almost 2,000% over a decade, from 242 in 2003-04 to 4,074 in 2012-13.
The NHS classifies the types of gastric surgery available as "partitioning of the stomach using band" – the Woman's Hour presenter's reluctant choice – "partitioning of stomach using staples", and "gastroplasty" – the partial removal of the stomach to help manage morbid obesity. There has been a similar growth for "restrictive stomach procedures for obesity", including gastric bands, which have shot up from 267 to 4,857.
As Murray says: "A gastric band is an operation in which a band is stretched around the upper part of your stomach, creating a small pouch to hold food. Because your new 'mini' stomach is so much smaller, it limits the amount of food you can eat by making you feel fuller more quickly." Add in the 405 patients who had a gastric balloon fitted in 2012-13 – a procedure only available from 2011 – and that means 9,336 patients in one year underwent major invasive surgery to tackle their extreme weight. These operations cost the NHS an estimated £85m a year.
Patients cannot simply have any of these operations on request. They must be so dangerously overweight that doctors deem it necessary to improve their health and those prepared to undergo it are first assessed and then counselled by psychologists about what the surgery involves and, crucially, how it will affect their life, notably permanent restrictions on the sorts of foods they can eat and quantities they can consume. Those figures seem likely to grow substantially. Recent draft guidance from the National Institute for Health and Care Excellence (Nice) proposes reducing the eligibility for surgery from a body mass index of 35 to 30, the point at which excess weight starts to be classed as obesity. The sheer scale of the obesity epidemic means that an extra 800,000 people could qualify, with huge consequences for the NHS's already squeezed budget.
Murray's motivation is medical, not aesthetic. "Most worrying was what my bulging stomach told me about the risk to my health. My shape screamed 'heart attack', 'type 2 diabetes' and possibly even 'cancer'", she wrote on Thursday. The NHS classifies the types of gastric surgery available as "partitioning of the stomach using band" – the Woman's Hour presenter's reluctant choice; "partitioning of stomach using staples"; and "gastroplasty" – the partial removal of the stomach to help manage morbid obesity.
So does such surgery actually reduce these risks? Nice believes so. Murray said: "A gastric band is an operation in which a band is stretched around the upper part of your stomach, creating a small pouch to hold food. Because your new 'mini' stomach is so much smaller, it limits the amount of food you can eat by making you feel fuller more quickly."
"More than half of people who undergo surgery have more control over their diabetes following surgery and are less likely to have diabetes-related illness. In some cases, surgery can even reverse the diagnosis [of type 2 diabetes]", Professor Mark Baker, the director of Nice's centre for clinical practice, said last month. Patients cannot simply have any of these operations on request. They must be so dangerously overweight that doctors deem it necessary to improve their health. Those prepared to undergo it are first assessed and then counselled by psychologists about what the surgery involves and, crucially, how it will affect their lives – notably, permanent restrictions on the sorts of foods they can eat and quantities they can consume.
Research in March by the universities of East Anglia, Manchester and Aberdeen found that obese people who have bariatric surgery halve their risk of a heart attack and reduce their risk of death by 40%. Diabetes UK says such procedures can aid weight loss and reduce blood glucose levels, though it wants to see these operations remain "a last resort" for people whose previous attempts to reshape their body by other means have failed. Murray said her motivation was medical, not aesthetic. "Most worrying was what my bulging stomach told me about the risk to my health. My shape screamed 'heart attack', 'type 2 diabetes' and possibly even 'cancer'."
Dr Aseem Malhotra, a prominent cardiologist, understands Murray's decision, but warns that the idea of treating ever-larger numbers of obese people in this way is "ludicrous" and that prevention, not treatment, should be the priority. Does such surgery actually reduce these risks? The health watchdog Nice believes so.
"I have total sympathy with Jenni. But we need to concentrate on sustainable lifestyle changes through the correct advice that actually improves weight and health, which has cutting out refined carbohydrates at its core, such as sugar, white bread and chips", says Malhotra, who is also consultant clinical associate to the Academy of Medical Royal Colleges. "More than half of people who undergo surgery have more control over their diabetes following surgery and are less likely to have diabetes-related illness. In some cases, surgery can even reverse the diagnosis [of type 2 diabetes]", Prof Mark Baker, the director of Nice's centre for clinical practice, said last month.
"Nice's recent guidance to expand bariatric surgery is ludicrous and will benefit the weight loss surgery industry more than the population's health. When you add up the complications of infection that affect one in 20, food intolerance associated with nausea and vomiting that affect one in 35, and the cost of NHS appointments, this will increase costs to the NHS, not reduce them", he adds. Research in March by the universities of East Anglia, Manchester and Aberdeen found that obese people who have bariatric surgery halve their risk of a heart attack and reduce their risk of death by 40%. Diabetes UK says such procedures can aid weight loss and reduce blood glucose levels, though it wants these operations to remain a last resort for people who have tried but failed to reshape their bodies by other means.
These are not operations for the faint-hearted, risk-averse or those who mistakenly believe they are a one-off, quick fix. Solicitor Penningtons Manches is taking legal action on behalf of clients who experienced unexpected problems resulting from gastric band surgery, such as significant bleeding when an artery was damaged, to the insertion of a faulty band. Dr Aseem Malhotra, a prominent cardiologist, understands Murray's decision, but warns that the idea of treating ever-larger numbers of obese people in this way is ludicrous and that prevention, not treatment, should be the priority.
Yet, like Murray, more and more of us are undeterred and will continue to seek salvation from our excess weight via the scalpel rather than the tedious business of the 5:2 diet, exercise or Olympian willpower. "I have total sympathy with Jenni. But we need to concentrate on sustainable lifestyle changes through the correct advice that actually improves weight and health, which has cutting out refined carbohydrates at its core, such as sugar, white bread and chips," says Malhotra, who is also consultant clinical associate to the Academy of Medical Royal Colleges.
"Nice's recent guidance to expand bariatric surgery is ludicrous and will benefit the weight loss surgery industry more than the population's health," he adds. "When you add up the complications of infection that affect one in 20, food intolerance associated with nausea and vomiting that affect one in 35, and the cost of NHS appointments, this will increase costs to the NHS, not reduce them."
These are not operations for the faint-hearted, risk-averse or those who mistakenly believe they are a one-off, quick fix. The solicitors Penningtons Manches are taking legal action on behalf of clients who have experienced unexpected problems after gastric band surgery.