title: The efficacy of bariatric surgery performed in the public sector for obese patients with comorbid conditions.
abstract: OBJECTIVE
  To determine the efficacy of bariatric surgery in the public sector for the treatment of complicated obesity.
  
  
  METHODS
  A longitudinal observational study of obese participants with comorbid conditions, aged 21-73 years, who underwent publicly funded bariatric surgery. Data were extracted from clinical databases (1 October 2009 to 1 September 2013) and recorded at seven time points. Participants are from an ongoing public obesity program.
  
  
  METHODS
  Postoperative weight loss and partial or full resolution of: type 2 diabetes mellitus (T2DM), hypertension (HTN), dyslipidaemia and obstructive sleep apnoea (OSA).
  
  
  RESULTS
  The 65 participants in the cohort lost a mean weight of 22.6 kg (SD, 9.5 kg) by 3 months, 34.2.kg (SD, 20.1 kg) by 12 months and 39.9 kg (SD, 31.4 kg) by 24 months (P < 0.001). Body mass index (BMI) decreased from a preoperative mean of 48.2 kg/m(2) (SD, 9.5 kg/m(2)) to 35.7 kg/m(2) (SD, 7.7 kg/m(2)) by 24 months (P < 0.001). Full resolution of comorbid conditions by 18 months (P < 0.001) was achieved by almost half of those with baseline T2DM, nearly two-thirds with HTN and three-quarters of those with OSA, with continued improvements beyond 24 months.
  
  
  CONCLUSIONS
  Bariatric surgery performed in the public sector is efficacious in the treatment of obese patients with comorbid conditions. Our findings parallel similar studies suggesting that there is equal benefit in publicly funded and privately performed procedures. This study highlights that obese patients reliant on public health care maintain sufficient intrinsic motivation in the absence of payment and supposed value-driven incentive. Improved access to bariatric surgery in the public sector can justifiably reduce the health inequities for those most in need.
authors.affiliation: Royal North Shore Hospital, Sydney, NSW, Australia. tania.markovic@sydney.edu.au.
authors.forename: Natalie
authors.initials: N
authors.lastname: Lukas
authors.affiliation: Metabolism and Obesity Services Clinic, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
authors.forename: Janet
authors.initials: J
authors.lastname: Franklin
authors.affiliation: Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, NSW, Australia.
authors.forename: Crystal M Y
authors.initials: CM
authors.lastname: Lee
authors.affiliation: Concord Repatriation General Hospital, Sydney, NSW, Australia.
authors.forename: Craig J
authors.initials: CJ
authors.lastname: Taylor
authors.affiliation: Concord Repatriation General Hospital, Sydney, NSW, Australia.
authors.forename: David J
authors.initials: DJ
authors.lastname: Martin
authors.affiliation: Concord Repatriation General Hospital, Sydney, NSW, Australia.
authors.forename: Nic
authors.initials: N
authors.lastname: Kormas
authors.affiliation: Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, NSW, Australia.
authors.forename: Ian D
authors.initials: ID
authors.lastname: Caterson
authors.affiliation: Metabolism and Obesity Services Clinic, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
authors.forename: Tania P
authors.initials: TP
authors.lastname: Markovic
mesh_terms: D000328:Adult; D000368:Aged; D050110:Bariatric Surgery / Q000379:methods; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D050171:Dyslipidemias / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000379:methods; D006801:Humans; D006973:Hypertension / Q000150:complications; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D016896:Treatment Outcome; D015431:Weight Loss