Weight-loss Surgery Becoming Increasingly Popular in Israel, the Land of Milk and Honey

But while obesity has been spreading, Israelis are still notably trimmer than many of their Western counterparts.

Zeev Sztern‎‏, Emil Salman

Too much milk and honey has been taking its toll on the Israeli physique, but for many, the solution is now less conventional.

Fed up with calorie counting, exercising and more standard methods for shedding pounds, thousands of Israelis are today opting for bariatric, or weight loss, surgery. Undoubtedly the best known in the bunch is the country’s formerly portly education minister, Shay Piron, seen around sporting skinny jeans and tailored shirts as part of his new svelte look (a far cry from the ill-fitting suits that were once his trademark) since undergoing the procedure about a year ago.

“Relative to the size of the population, bariatric surgery is very big in Israel today,” observes Dr. Mordechai Shimonov, director of the department of surgery at Wolfson Medical Center and a specialist in the procedure. To prove it, he notes that the number of surgeries performed in Israel is almost identical to that in Italy, a country whose population is more than seven times as large.

“It’s perceived as an easy solution,” he explains, “with a much higher success rate than dieting. We’re seeing an 80 percent improvement in all the relevant indexes [such as weight, insulin levels and cholesterol] within five years of the operation, and that’s compared with a 5 percent success rate with dieting.”

Fatter patients, better surgeons

A confluence of factors, says Professor Ehud Klein, head of surgery at the Maccabi health fund, can explain the growing popularity of bariatric surgery in Israel. “First of all, obesity is on the rise here, as it is elsewhere in the Western world. Secondly, as surgeons in Israel gain more experience with bariatric surgery, there are fewer risks and complications involved.”

The most recent Health Ministry figures show that in 2013, more than 9,600 bariatric surgeries were performed in Israel – compared with barely 2,300 in 2006, the first year for which figures are available. Out of the total, 5 percent were second-time weight-loss surgeries.

By far, the most popular form of bariatric surgery in Israel is the sleeve gastrectomy, a relatively simple procedure in which about 75 percent of the stomach is removed. What remains is a narrow banana-shaped tube that connects to the intestines. In 2013, more than 6,400 sleeve gastrectomies were performed in the country – compared with less than the 30 performed seven years earlier.

Adjustable gastric banding, a procedure in which an inflatable band is used to restrict the stomach, is next in terms of popularity, followed by gastric bypass surgery, in which a shortcut is created for the food so that it bypasses part of the digestive tract, allowing the body to absorb fewer calories. Relatively more complicated than the other operations, the gastric bypass procedure is the most popular form of bariatric surgery in the United States.

Although the criteria for undergoing weight loss surgery are similar around the world, in Israel, says Shimonov, it is common to find individuals with lower levels of obesity opting for these operations. “That is probably because the sleeve procedure, which is the most popular here, is relatively simple,” he speculates.

Bariatric surgery is paid for in full by the national health insurance system for those who qualify. To be eligible, a prospective patient must have a body mass index (BMI) that exceeds 40 or, alternatively a BMI that exceeds 35 with two other medical conditions. BMI is a measure of body fat calculated by dividing weight (in kilograms) by height (in meters) squared. Individuals with BMI ranging from 25 to 30 are considered overweight, those with a BMI ranging from 30 to 40 are considered moderately obese, and those with a BMI exceeding 40 are considered severely obese. “In Israel, we see a lot of people who are with a borderline BMI of 35 doing the procedure,” says Shimonov.

According to Klein, roughly half the patients in Israel who undergo bariatric surgery manage to keep the weight off in the long term. “We always tell our patients that the surgical treatment is just one part of this and that if it’s going to work, they need to be diligent about maintaining a healthy diet and lifestyle.”

Though the Middle Eastern diet has a reputation for being healthy, in fact, fast food and junk food have infiltrated the local diet over the past few decades, perhaps not to the extent that they have in the United States, but far more than in the past. Moreover, Israelis – like many of their peers around the world – have grown progressively sedentary over the years. The latest comprehensive Health Ministry study, based on figures collected between 2010 and 2012, found that almost half of all Israeli adults (49.8 percent) are either overweight or obese. Among them, 34.1 percent qualify as overweight (BMI ranging from 25 to 30) and 15.7 percent as obese (BMI exceeding 30). Far more Israeli men are overweight than women, but obesity rates are more or less equivalent among men and women. Arab men and women tend to be much heavier than their Jewish counterparts.

Israelis still slimmer than most

The good news is that Israelis are still slimmer and trimmer than many of their counterparts abroad. The survey notes that obesity rates in Israel are still much lower than the OECD average, trailing far behind countries like the United States, Canada, Australia, Britain and Finland, where rates exceed the average. Israelis are still heavier, though, than Scandinavians, Germans, French, Italians and Japanese.

And they’re also heavier than they were 15 years ago, when the government began monitoring weight gain, according Dr. Dror Dicker, a leading Israeli specialist on obesity. “Israelis have been getting fatter over time,” he says, “although in the past few years, we’re seeing a stabilization and even a slight fall in obesity rates.”

Dicker, who serves as head of internal medicine and director of the obesity clinic at Rabin Medical Center, Hasharon Hospital, notes that Israel is also in a much better place than other Western countries, particularly the United States, when it comes to extreme obesity (BMI exceeding 40) – a phenomenon still relatively rare in the country. “We do eat a Mediterranean diet here with more olive oil and less carbs,” he notes. “There’s more awareness these days of the importance of diet and physical activity.”

That doesn’t mean, says Dicker, that Israelis should be resting on their laurels. “We still do have a relatively large percentage of overweight people in this country,” he notes.

Dr. Mariela Glandt, an endocrinologist who has practiced both in Israel and the United States, notes that even though bariatric surgery “is on the rise like crazy here,” Israelis have lots to be thankful for about their health, especially when comparing themselves to Americans.

“First of all the culture of fast food isn’t as ingrained here. It’s not like America where wherever you turn your head, there’s a McDonald’s,” she notes. “And this is the only place in the world I’ve seen where people eat vegetables for breakfast. That’s strikingly different from the rest of the world where the standard is a croissant or a muffin. Here, there’s still this incredible appreciation for anything that comes from the land. It’s almost considered sacred.”