Bariatric surgery rates plummet: Why fewer Aussies are choosing weight loss procedures?

MedTech & Diagnostics News: Fewer Australians are having bariatric surgery and a new report shows the results for those who do are mostly positive, including significant weight loss and big improvements for those with diabetes.

The Australia and New Zealand Bariatric Surgery Registry’s 2023 Annual Report found participants lost an average 29% of their total body weight in the first year post-surgery, and more than half of those who had diabetes required no treatment a year after surgery.

Monash University’s Professor Wendy Brown, Clinical Director Bariatric Surgery Registry, said the drop in surgery numbers could be partly due to the significant uptake of very effective pharmaceuticals that provided weight loss similar to bariatric surgery at one year.

“It may be that practitioners and patients are opting for non-surgical pharmaceutical options rather than surgery,” Professor Brown said.

“We are also facing significant cost of living challenges, meaning that the cost of surgery now might be prohibitive for some, or people may fear being away from work when their job is under threat.”

In calendar year 2023, the Registry, led by Monash University with partner organisations, captured 19,599 Australian procedures. This included 15,985 primary and 3,614 revision procedures. The total number recorded by the Medibank Benefits Schedule (MBS) was 21,044, the lowest since 18,980 in 2016. The registry captures around 80 per cent of these.

Registry figures found most 2023 Australian bariatric surgery procedures were privately funded (95 per cent primary and 93 per cent revision) and 79.1 per cent of participants were female. The 30-34-year age group was most common for women and the 40-44 for men. The average age for having a primary procedure was 42. Nine per cent (9%) of women and 15% of men had diabetes before surgery.

The most common procedure, primary sleeve gastrectomy, had an adverse event rate under 2%. The rate was less than 5% for the primary gastric bypass procedures.

Long-term outcome data for Australia showed:

• 29 per cent average total weight loss at one-year following a primary bariatric procedure
• 73 per cent average excess weight loss at one-year following a primary bariatric procedure
• 56 per cent of people with diabetes at time of primary procedure were reported as requiring no medication for diabetes at one-year follow-up
• 70 per cent of participants on insulin for diabetes at the time of surgery no longer required insulin after 12 months
• 4.1 per cent of people who had a bariatric procedure went on to have at least one more bariatric procedure or subsequent intervention

Professor Brown said while it was clear there had been a decline in primary and revision procedures, the drop was more pronounced in the revisional setting.

“This possibly suggests that patients and practitioners are choosing the safer pharmaceutical option for weight loss rather than more aggressive surgery when metabolic bariatric procedures are no longer providing the required weight loss,” Professor Brown said. “This is a pattern we will continue to monitor in years to come.”

Most of the 15,985 primary bariatric procedures recorded in 2023 were sleeve gastrectomy (79.8 per cent), followed by one anastomosis gastric bypass (10.9 per cent), Roux-en-Y gastric bypass (8.6 per cent) and other types of primary procedures (0.7 per cent) including laparoscopic gastric band, single anastomosis duodeno-ileostomy (SADI)/stomach intestinal pylorus-sparing surgery (SIPS) and other.

The Registry began as a pilot project in Melbourne in 2012, and expanded significantly with federal government funding in 2014. Aotearoa New Zealand joined the program in 2018. In total, the Registry has recorded more than 180,000 procedures for more than 170,000 participants.

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