Stitched up? Why the risks of offshore weight loss surgery are troubling NZ doctors

NZ doctors are finding themselves caring for patients who require medical help following gastric bypass and gastric sleeve procedures undergone in other countries. Photo / Getty Images

Going overseas for weight-loss surgery may seem a cheap ticket to better health, but post-op complications can outweigh any gains.

Medical tourism is ringing alarm bells both here and overseas, with patients returning home then suffering complications following low-cost surgeries.

In the UK in the five years to March 2024,
at least 28 people died from complications following medical procedures in Türkiye, believed to be mainly from weight-loss surgeries. Doctors here are finding themselves caring for patients who require medical help following gastric bypass and gastric sleeve procedures undergone in other countries.

“It’s an increasing problem that we’re seeing,” says bariatric surgeon Suheelan Kulasegaran. “Patients might come in with an acute issue such as a leak or blockage. We’re also seeing more malnutrition and other chronic problems like weight regain and reflux.”

Gastric bypass involves bypassing much of the stomach and part of the small intestine, and creating a small pouch for food to sit in. With sleeve gastrectomy, 80% of the stomach is removed leaving a narrow tube. These procedures reduce food intake and alter hunger hormones, resulting in significant weight loss, and both are considered safe. But as with any surgery, there are risks. “When a problem arises you need to be able to fix it as early as possible to avoid running into more trouble,” says Kulasegaran, who works at Auckland’s North Shore Hospital and in private practice.

If a patient is already on a plane or back home, it falls to the public healthcare system here to look after them. “And if they have an acute complication, they may be in hospital for weeks,” he says.

Guidelines from the International Federation for the Surgery of Obesity and Metabolic Disorders say people with a BMI of 35 and above should be considered for bariatric surgery. The threshold is lowered to a BMI of 30 if people have metabolic syndrome, and 27.5 for Asian people who are at higher risk of type 2 diabetes at a lower weight.

“Bariatric surgery is very effective at treating issues like type 2 diabetes or hypertension and may lower the risk of some cancers, too,” says Kulasegaran. “But part of the success of a bariatric programme is the post-operative care. The surgery is just one part of a very complex journey a patient has to go through and they need the help of a multidisciplinary team – a specialist dietitian, bariatric nurse and psychologist as well as a surgeon – for a protracted period of time afterwards. The actual operation is only one part of the journey.”

Many patients who take bariatric trips to places like Türkiye don’t get that kind of long-term support. “They come back with almost no post-operative information and sometimes they’ve had a different surgery than the one they thought they were having.”

Dr Suheelan Kulasegaran: ­Advertising of bariatric ­tourism should be better controlled. Photo / Supplied

Weight-loss tourism is being marketed heavily in New Zealand. In November, the Mexico Bariatric Centre had its surgeons fly over to appear at events in Auckland, Christchurch and Palmerston North, and other clinics have representatives based here.

“There has been quite aggressive advertisement in this part of the world and I have concerns, particularly with the targeting of our most deprived populations,” says Kulasegaran.

Yet the cost saving is significant. Here, patients pay up to $28,000 for private bariatric treatment whereas overseas clinics are offering all-inclusive package deals for less than a third of that price.

Around one in three New Zealand adults is obese and it is increasingly being seen as a disease that requires medical intervention, yet treatment is difficult to access. Only about 500 bariatric surgeries are funded each year and many health insurance plans don’t cover the full cost.

“This is driving the increase in bariatric tourism,” says Kulasegaran. “I can understand why people would choose an option that is more affordable. It’s an attractive package: the flights are included, and the stay, but that doesn’t necessarily equate to good care.”

Guidelines for bariatric tourism published in the International Journal of Surgery last February say patients should stay at least five days post-operatively in the country of their surgery before travelling home, and that follow-up should be provided for two years by the unit performing the procedure.

Kulasegaran would like to see more regulation to control the way bariatric tourism is advertised in New Zealand, as well as greater accessibility for publicly funded surgical weight-loss programmes here.

“Bariatric surgery is often seen as an easy way out, and it’s not, really,” he says. “It’s giving the patient a powerful tool to take care of their health.”

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