Should the over 60s be bannned from having gastric surgery?
 EXCLUSIVE An inquest opened this week into the death of a 67-year-old gran who lost two thirds of her body weight in just seven months after having a gastric bypass. So should your age matter when it comes to weight-loss surgery?
Before 62-year-old Madeleine Clarke went in for gastric surgery last year she penned letters to her three children, knowing the moment the operating room doors closed could be the last time she ever saw them.
“I told them how much I loved them and who I wanted to have certain pieces of my jewellery and other sentimental items,” Madeleine says.“I knew the risks. I was a 61-year-old, 20-plus stone, size 30 woman with a BMI of 45 and a former cancer sufferer with high blood pressure who also needed a heart transplant. Let’s face it, I wasn’t the ideal candidate for any surgery.
“My surgeon was brilliant and warned me of the downsides – the risk of stroke, heart attack and infection – as well as the upsides.“But the fact of the matter was that I had to have the operation.“I had five years to live as I was and it sounds strange but I had to risk that life to get a life. I was so big and so ill I wasn’t living, I was existing.”
Madeleine, who lives in Gosport, Hants, with husband, Bill, 68, is one of the procedure’s success stories. In the 14 months after her bypass she has gone on to lose an amazing 10 stone and is now a size 8/10 with a BMI of 24.9 (the ideal is 20-25).“I read the letter I wrote to my daughter recently and it was full of sadness and so far from the person I am now. I took great pleasure in ripping it up.
“The operation cost £12,000 and I had to take out a loan to pay for it but it has at last given me, albeit in my pension years, the life I’d dreamed of.”But sadly, major weight-loss surgery doesn’t have such a happy ending for every older patient. This week an inquest into the death of 67-year-old grandmother Virginia Humphrey was opened. In the last few months of her life she needed round-the-clock care in her Brighton home. She was bed-bound after the gastric bypass surgery that her son, Kevin, says she hesitated over until the moment she went into theatre.
She hoped to achieve a healthy five stone weight loss and tackle her diabetes after the operation at University College Hospital, London. But instead, unable to keep any food down, her weight plummeted from 21 to eight stone – two thirds of her body weight – in just seven months. She died in May. Whatever the inquest’s outcome, one fact is clear.
Virginia was at greater risk of death because of her age. According to NHS statistics, one person in 200 dies shortly after a gastric band is fitted and one in 100 after a gastric bypass operation. Those aged over 45 are more at risk. And the cause of death is often due to heart attack or stroke, which are both conditions more likely to affect older people anyway.
Dr David Haslam, chair of the National Obesity Forum, says it’s more complicated than that. “Elderly people simply have different kinds of obesity to young people,” he explains. “They may have the same weight and BMI as a younger person but a lack of muscle and different fat distribution throughout the body means you can get very misleading results.” In addition, there is emerging evidence to suggest that some who are overweight and have heart and kidney disease actually do better staying fat.
 “It’s the obesity paradox,” he says. “Although being grossly overweight puts you at risk of heart and kidney disease, those who already have those conditions sometimes do better staying fat as it somehow protects those organs.“Whereas an older obese patient with type 2 diabetes and no heart disease may be an excellent candidate for bariatric (weight-loss) surgery, one with a high BMI and heart disease may not be. We have to think very carefully about who is appropriate to have gastric bands or bypasses and who is not.”
And Dr Haslam believes that although the NHS bariatric surgery service is second to none, that’s not always the case in the private sector.“On the NHS you are given six months to try other ways to lose weight before surgery and all candidates are very carefully judged,” he says.“While there are beacons of excellence in the private sector there are still surgeons in the UK and certainly abroad who will offer patients – even those patients who are elderly and high risk – an operation when it is simply not appropriate.”
Bariatric surgeon, Richard Welbourn, who practices at The Bariatric Group (www.thebariatricgroup.co.uk) and the NHS Musgrove Park Hospital in Taunton, Somerset, says every case, young or old, has to be judged on its own merit.He says old age alone would never – and should never – be reason to reject someone.“According to National Institute for Health and Clinical Excellence guidelines the lowest age someone can have bariatric surgery is 18, but there is no upper limit and we have operated on several patients in their late 60s and even one in their 70s with very good results,” he explains. “Generally, when you operate on someone older you are not doing so to prolong their life as you are for a younger obese patient, you are doing so to improve the quality of it.”
Mr Welbourn says he’s seen an increase in referrals of older patients with limiting arthritis and people who have been to see an orthopaedic surgeon for problems with their knees. However, these have been told that unless they lose weight they cannot have a knee replacement. He recently wrote the first National Bariatric Surgery Registry report, which found that of the 70% of weight-loss surgery patients who couldn’t climb three flights of stairs before surgery, 50% of them could after a year In addition, 55% reported some form of limiting arthritis, but one year after surgery 38% reported no arthritic symptoms at all.
“It’s clear, especially in the elderly who are most likely to suffer arthritis, surgical weight loss is an extraordinarily cost-effective intervention.” But he admits that there are people – young and old – who are not well enough for surgery. And he also agrees that older people do have a different body composition of fat and muscle and a lower metabolic rate. “But we have to look at the overall picture. If someone is reasonably fit and well-motivated then we can transform their lives just as much as anyone elses, no matter how old.” Madeleine Clarke is proof of that. “I had battled with weight problems for 35 years,” she says.
“I’d done every diet under the sun, lost weight and gained more back. “I had suffered cancer of the womb because I was too big to have the pre-cancerous cells removed. “And eight years ago my heart started to fail when I had a bout of swelling in my leg and my heart couldn’t cope with it. “I hadn’t slept for more than two hours at a time for 10 years because I had weight-related sleep apnoea.” But after Mr Shaw Somers at Streamline Surgical (www.streamline-surgical.com) carried out her operation she has seen a dramatic change in her life. She adds: “Today I am constantly on the go and my husband says he can’t keep up with me.
“I’ve set up my own business offering counselling and support to overweight people. I walk two miles a day, dance and play with my two grandchildren.
“I’m alive in every sense, and apart from slightly raised blood pressure I am fit and well. I may be a pensioner but I deserve a good quality of life in my later years.
“Weight-loss surgery has given me that – and more.”
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