The science and studies behind weight-loss surgery include heroic efforts to change lifestyle and alter psychology as well. Some folks believe that is why the early data for weight-loss surgery shows it to be useful. It was the brain’s impact, not the ripping apart the stomach part, that produced some or much of the effect in the earlier work on weight loss surgery. Talk about placebo effect!
But, the study period has ended. Although there was a lot of behavioral intervention early on, the later work is focused on making money and lots of it. And all that psychology (for a surgeon) is useless and extraneous to the real intervention. So, while they are cutting out the stomach (or part of it), they might cut back on the psychology, lifestyle change stuff. Though, they still highlight the need to exercise.
Why the enthusiasm for weight loss surgery and making money? Surgeons have to earn their keep. First, they love to cut and sew up tissue and they are not going to stop that and become a “regular” physician (thus there are “physicians and surgeons”). And they are getting fewer opportunities due to technology that:
- Makes surgery easier – as in laparoscopy
- Is replaced by “non-surgeons” – Lasix, engineers, and interventional radiologists
- Becomes demonstrably useless due to science
- Is less effective than medicine
So, the push for more weight-loss surgery is a push for income at the hospital and practitioner level. And, saving cost (increasing profit) is easily done by cutting out psychological interventions; especially if no one is tracking outcomes anymore. Those expenses are ancillary in a world where there’s no requirement to actually show outcomes and no mechanism by which remuneration is tied to outcomes.
To explain, imagine you bought a product that was never reviewed on Amazon and it didn’t really matter what people thought of the product. A five-star product and three-star product were indistinguishable. Would you bother to put in the extra cost to get a five-star product if no one noticed or no one cared? The more skeptical part of me says that this is actually quite desirable on the part of the business community. Who wouldn’t want a product of low-quality that no one can identify? Some airlines would be thrilled if we didn’t have access to their average departure delay, late arrival, cancellation risk, overbooking, or other metric tied to a flight. Google and eBay would be happier if they could go down and folks would all blame their network provider and not them. Transparency is key to getting folks to invest in quality. And there is no transparency in medical interventions.
Don’t look at university-based procedures either. Although universities remain somewhat interested, they have converted to focusing on profit and business. The hospitals of medical schools have become the profit center of the university; see the salaries of university hospital administrators. Over time, I’m sure they will be cutting back on any kind of behavioral intervention as well.
The point here is that behavioral interventions are going to become less a part of the medical care of obesity, not more. Even if they are effective, they are a cost that will be eliminated. And that is a loss that will have detrimental outcomes on the population’s health. All in the name of profit.