I’m on holidays, but my colleague sent me a link to this article by WhatsApp: https://www.irishtimes.com/health/2023/08/17/call-for-creation-of-register-logging-patients-having-weight-loss-surgery-abroad/
She sent it to me because I had recently shared with her a desperate story about a patient. And that patient is not the first. In this linked article, there are 4 examples of catastrophic health complications from ill-advised bariatric surgery abroad.
Will creating a registry help? No. Not at all.
This will do nothing to fix the problem nor address what causes it. I also suspect it will also continue to under-report the real scale of this problem due to a combination of patients not wanting to self-report and the fact that there is often a delay in diagnosing complications from poorly-performed bariatric procedures if patient attends a healthcare professional without training in obesity medicine. Many patient experience weight-shame or weight-stigma from healthcare professionals and others. They may not willingly share their decision. Given that it is self-pay and their healthcare is entitle to privacy, how would one enforce that registry??
Facts First: patients only choose to go to bariatric surgery abroad in desperation. They have been failed by the healthcare system to have comprehensive, competent, and compassionate care for their chronic disease [note: obesity is a disease] provided in their community.
The fact that they choose to have out-dated procedures (gastric balloons and bands are no longer standard of care and do not work!!!) means that they have had poor or exploitative counselling/advice before making that decision. [note: there are aesthetic clinics in Ireland still offering these out-dated and inexpensive procedures. While it is safer to have this done in Ireland, it is still doesn’t work and no longer a standard of care as a treatment for obesity. Patients should avoid weight loss treatment at any centre who markets weight loss treatment as aesthetics.]
Let’s be clear: this is not any patient’s fault. Combination of weight-stigma, lack of access to healthcare professionals trained in obesity medicine, long waiting lists and woefully underresourced HSE services, barriers to reimbursement from private insurance, and targeted misleading marketing are creating this storm.
Lastly, and most importantly, what would be the point?? I have struggled to get patients help who have had complications from bariatric surgery abroad. In particular, in relation to that patient I was telling my colleague about, it was in the context of discussing that I had gone to great lengths but services just weren’t there and the patient was young and effectively disabled.
Make no mistake: The services that are in place are amazing but far from adequate already due to under-resourcing. The wait list is years. Follow-up from bariatric surgery to prevent many complications requires comprehensive and expert multi-discplinary team and the resources allocated for this in the HSE are woefully inadequate and under-resourced.
What is needed (and it’s not a registry):
More services and healthcare professionals allocated to obesity medicine clinics: doctors, dietitians, psychologist, nurse specialists, and physiotherapists to make the services actually accessible. Expand number of clinics. This is a no-brainer from a health economy point of view: treat obesity, you reduce pressure on all the other clinics that treat complications of obesity: cardiology, stroke, diabetes, orthopaedic/joint pain, back pain… That same economy applies to the private insurance sector as well, if they would just do some math
an accessible, dedicated clinic with all services for all patients who have returned from abroad to be seen before certain complications arise
Public health campaign educating patients on making informed decision and safety risks
More resources for primary care to be able to knowledgeably counsel patients on this decision
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