Surgeon Dr Henry Hook talks roadblocks in fight to combat morbid obesity in Central West

But the region's obesity data remains weighty nonetheless - showing every Central West location bar Lithgow, ranking alarmingly higher than the national average.

With some of the topmost rates of heart disease included, the Orange population pegged fourth spot on the overweight and obese scales - more than 70 per cent of residents fall into one of the two categories.

When compared with the rest of the state, Orange-based bariatric and upper GI surgeon, Dr Henry Hook says the data is essentially without parallel.

"The issue is certainly a big problem in our Local Health District and [the greater western region] is one of the worst in New South Wales, if not the worst," Dr Hook said.

"And it's probably one of the worst in the country in terms of the numbers of people who are morbidly obese."

With long waiting lists for patients just to secure a consult, the issue goes even deeper still.

With genetics and science playing key roles, Dr Hook says morbid obesity is a complex issue involving a mix of contributing factors.

While largely due to modern-day lifestyle and diet choices, he also believes that what's standing in the way of people reaching out for help, partly boils down to outlooks.

This lack of understanding belittles those struggling with excessive weight concerns - which only adds to an already-blazing fire.

"The frustration in dealing with society's attitude is highly derogatory in many ways, it's harsh ... and that goes through even to levels of government; where the attitude is that if someone's got a weight problem, they should just eat less and exercise more," he said.

"Ultimately the control of weight will be about diet and lifestyle changes, but it just misses the point about exactly how much change has to be made and it's just not realistic to expect people to be able to do that.

"If people think that that's the answer, then why is half of our adult population morbidly obese?"

Using the Body Mass Index [BMI] as a rough guide, Dr Hooks says higher numbers on the scales can reach a "tipping point" and gradually reset a person's body weight.

Without medical intervention this tipping point then ups the kilograms - rebounding weight back to its original starting block and then some.

"Weight memory is very strongly preserved in humans and you tend to go back to your heaviest weight once you've reached a certain point," he said.

"And the data that looks at morbid obesity across the United States and Australia shows us again and again that the standard dietary interventions do not work for morbid obesity.

"Most patients will have a zig zag line where interventions will result in quite a good weight loss but then the rebound is very, very rapid.

"Most people just simply can't do it and they're giving up."

Dr Hooks says "the big data" also shows that 97 per cent of people will fail with these repeated attempts.

Every time success isn't reached it's adding more and more shades of depression to the canvas.

Patients are left feeling embarrassed to ask for outside support or feeling that they can't be helped, regardless of fad diets.

A compounded pattern of failure, high emotions and harsh judgement, the outcome is literally deathly.

"If morbid obesity was simply something which society found unpleasant, because it didn't like the way that people looked but it didn't kill people, you wouldn't be doing operations," he said.

"But the fact is that morbid obesity does kill people [and] the only reason for [medically] intervening is because it's lethal."

Which also points to gaps within the public health system.

Dr Hook duly notes the difficult hoops that any government would have to jump through to get qualified specialists on board.

Because for those presenting - who are essentially penniless or who can only afford Medicare-covered surgeries - need to be prioritised.

"We've been campaigning to try and get that to change for 20 years and the data's been out for longer than that [but] from a medical point of view, there's nothing glamorous about weight loss surgery," he said.

"It's hard to sell that when there's so much prejudice that says 'why would you invest all of this money in something which is not particularly 'attractive'?"

The main obesity-related comorbidities are type two diabetes, sleep apnea, hypertension, and osteoarthritis at the hips and knees - leading to functional decline at an early stage.

Increased risks across breast, bowel, endometrial, esophageal and pancreas cancers also have much greater prevalence in people with the condition.

Treating these implications costs the public health sector enormously - though it's also not as simple as just whacking an upper GI surgeon on the ward.

An entire team of specialists are required, both pre and post-operatively, to provide patients with an ongoing support network and close monitoring.

"It just isn't in the order of billions of dollars each year," Dr Hook said.

"So the health system is struggling to look after the complications from excess weight, but having a treatment [like bariatric surgery] at least has a reasonable chance of being effective.

"But that's looking at the bigger picture [and] designing those systems from scratch in the public sector is quite a big job.

"So there's a lot of work to be done, it's not easy."

More common in low socioeconomic groups Dr Hook says private weight surgeries aren't even "scratching the surface" of a nationwide problem in need of fixing.

Though it's this that stands to reason why accessible treatment in the public system could be the epidemic's most logical answer.

"Selling expensive procedures to deal with malignant [cancers], that's an easy sell because people go 'okay, that's cancer, you must treat that'," he said.

"But the actual impact from a societal and a population point of view of morbid obesity is actually greater than all of those rare diseases.

"If we want to have a weight loss service that has a decent reputation and up and running in the public hospital, it's critical that we get the right people doing it and people who are passionate about it."

To deal with demand, the Central West is "absolutely" in need of more upper GI surgeons, though the bariatric expert notes how hard it is to entice big city specialists to country areas.

But treating the chronic condition aggressively and better supporting it is also "no-brainer", particularly in regional areas.

Amidst these challenges that remain a deadly health problem in need of dire attention, Dr Hook's adoration for his career will continue nonetheless.

Even in spite of the demanding and arduous work he does, he also considers it the best.

"It's not like being a cardiac surgeon or a neurosurgeon, it doesn't have any of the glamourous kudos attached to the title," he said.

"It's very challenging, but it's very rewarding [because] it's helping a patient deal with a problem that they've had absolutely no success with over a long period of time.

"But I love it."

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