No mention in this lengthy story of the costs of the two procedures or insurance coverage. Readers need this information, and the fact that the duodenal switch may not be covered by most insurance. The total cost of gastric bypass is about $20,000. The story makes clear that the duodenal switch surgery, in comparison with the bariatric surgery, may give patients greater weight loss in pounds but the value of that reduction is not clear. The additional information from the paper published by Livingston demonstrating no advantage to surgery over medical management was very useful. The story shines in its details about the delicate weighing of risk vs. benefits for weight-loss surgery in general, and then for the duodenal vs. gastric bypass method in particular. Some readers might find it confusing that the story includes two separate publications about weight-loss surgery. The story leads with the small study comparing duodenal with gastric bypass, published in the Annals of Internal Medicine, but then delves into a larger Veterans Administration study from the Journal of the American Medical Association that looked at the longer-term results of all surgeries for obesity. We salute Reuters for providing the context and the controversy within medical practice, and quoting a principal investigator on the VA study, Edward Livingstone, who wrote an editorial that appeared in the Annals beside the duodenal paper. The story reports on a very small study – just 58 patients in total and 29 received the duodenal surgery. Only one comment addressed the quality of the evidence: “Larger, longer-term studies are still needed to show whether the extra weight loss with duodenal switch” improves the health and lengthens the lives of obese patients, explained lead researcher Torgeir Sovik. We would have liked a reminder of the preliminary nature of the conclusions higher up in the story. This story does a good job of probing territory that is under-explored in most media accounts about obesity treatment. It poses the questions of long-term quality of life and life expectancy post treatment. Could obesity itself be less life-threatening than some of the radical treatments aimed at treating it? In addition to quoting the lead author of the Annals article, we liked the balance provided by Edward Livingston in his comments about both the duodenal switch procedure and his comments about the value of surgery in general over medical management. The story concentrates on patients receiving weight-loss surgery, and does not discuss non-surgical alternatives at much length. It does mention the study by Livingston questioning the value of surgery over medical management. Behavior coaching, diet and exercise are all potential treatments for obesity. The story explains that duodenal switch is “less common” and that “Duodenal switch is not a popular procedure.” In a 2008 study, it accounted for just 1 percent of weight-loss, or bariatric, surgeries done in the U.S., and 5 percent in Europe.” The story makes it clear that the duodenal switch procedure has been around for a number of years but is rarely used. No, it does not rely on a news release.
Rare surgery brings more weight loss, more risks