Health: Dr Ann Robinson's brother is risking surgery tol help him lose weight

Morris is my brother, affectionately known in the family as Mo. He has been very fat since I can remember, though our mother dates his weight gain from the removal of his tonsils at the age of five.

Family photographs show a progression from normal stockiness at two, through childhood chubbiness, to frank fatness by 10. From then on, he is notably large in all but his wedding photographs. For the love of a good woman, Mo slimmed down.

He still loves her and has three (slim) children with her. But the weight has piled back on, and now Mo is desperate. He has tried the lot: diets, counselling, swimming 50 lengths a night, jaw wiring and liquid-only diets. Now he wants an operation. A quick-fix, long-term, irreversible solution that will shift the blubber for ever. "I'm 39 now and weigh about 140kg that I'll admit to. I'm finding it harder to move around now and that frightens me," says Mo.

"I had my jaw wired twice and lost around eight stone each time. But when the wires came off, I gradually regained the weight over a year or so. I react best to mechanical solutions but the jaw wiring was too short-term for me, which is why I'm considering surgery."

Professor John Baxter is one of only a handful of surgeons in the UK who regularly performs obesity surgery. He is apoplectic in his rage over the paucity of options available to people like my brother.

"Between 1% and 2% of the UK population is seriously obese, with a body mass index (weight in kilograms divided by height in metres, squared) over 40. We know that lifestyle and dietary advice don't work for this group of people and we also know that left untreated, six out of seven of them will die prematurely as a result of their obesity. Yet only 200 obesity operations are carried out a year in the UK, many of them privately," says Baxter.

"We are totally hopeless with regard to obesity surgery in this country. There seems to be an attitude that obesity is a self-imposed condition caused by lack of self-control. But it is a metabolic disease, like diabetes, and needs treating. Drug and genetic cures are still a long way off and there is absolutely no doubt that surgery offers the best hope for this group."

The dilemma for people like my brother is this: he is currently well and enjoying a full, happy life building up a successful business and enjoying his young family. If he opts for surgery he stands a one in 100 risk of dying as a result of the operation. If he remains as obese as he is now, he has only a one in seven chance of reaching his normal life expectancy and has a high probability of developing diabetes, joint pains, high blood pressure predisposing him to stroke and heart attacks, acid reflux, asthma and urinary incontinence.

Dr Pierre Bouloux, consultant endocrinologist at the Royal Free Hospital in London, understands why people like Mo opt for surgery, but he sounds a note of caution. "Surgery is no better or worse than wearing a tight belt round your midriff. In the fullness of time, surgery will be seen as rather barbaric as we develop better drugs to speed up energy expenditure or ways of modifying the gene defects that cause extreme obesity. It's unlikely we'll ever have one drug to suit everyone because there are at least 20 different genes involved, as well as differences in eating behaviour." Bouloux recommends a 650-calorie-a-day liquid diet of one litre of semi-skimmed milk, fresh orange juice and vitamins.

He favours wiring the jaws so you can't eat solid food in the event that willpower alone is not enough. Drugs such as metformin, used to increase the body's sensitivity to insulin, and orlistat, which prevents the absorption of fat from the diet, can also be offered.

But prof Baxter says the success rate after surgery is better than any of these measures. There are three main operations in current use; bypassing the stomach so that food isn't absorbed, putting a band round the stomach, or stapling across it to reduce stomach capacity drastically.

Bypass surgery remains the gold standard, according to Baxter. But both bypass and stapling the stomach involve a major operation and a large incision. Banding the stomach by putting an inflatable band round the top of the stomach can be done by keyhole surgery.

The band is inflated by injecting a small chamber which is implanted in the abdominal muscle. The staples or band reduce the volume of the stomach so that it can hold only tiny amounts at a time; overfill it and you vomit. "If you cheat, you chunder," says New Zealand-born Baxter.

The results are good; most will lose 60-70% of their excess weight, although Baxter warns that few ever reach normal weight. And 90% of a US series of patients followed up for 10 years managed to maintain their weight loss. "There are some oddballs who liquidise Mars bars and so on and could out-eat any operation. But they are the exception," says Baxter. Most will lose over half their excess weight, but at a price.

In a recent fiery editorial in the British Medical Journal, Baxter quoted a Swedish study comparing 2,000 obese patients treated with surgery with 2,000 treated with drugs. He says surgery has been shown to be overwhelmingly better than drugs in improving quality of life, curing diabetes, controlling high blood pressure, improving rates of employment and reducing costs to the health service. He asks why fewer than 200 operations a year are carried out in the UK and blames the lack of specialist training for surgeons in obesity surgery and society's ignorance and prejudice. He admits that there is a risk, but says that 93% of those operated on have no significant problems as a result.

There are fewer than 23 surgeons in the UK doing these operations and the UK lags far behind the rest of Europe, the US and Australasia. Baxter wants to see an obesity surgeon, supported by a team of specialist dieticians, psychologists, anaesthetists and nurses, in every large hospital in the country.

The operations are not a quick fix. They represent a life sentence of never being able to eat normally, having to nibble at tiny morsels at family occasions and meals out with friends. It means forever forgoing the pleasures of a good meal. And you have to be a gambler to walk into an operation which carries a 1% risk of killing you when there's nothing wrong with you, apart from being fat. But for those who are willing to take the risk, there should surely be better availability.

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