The National Institute for Health & Care Excellence (NICE) officially updated the weight loss surgery criteria for people with type 2 diabetes recently.
Obese people with recently diagnosed type 2 diabetes should be assessed for weight loss surgery – it is good for patients and cost saving for the NHS.
More than a quarter of adults are now classified as obese and a further 42% of men and a third of women are overweight. It is an immense problem for society – with huge personal health cost to individuals and an enormous financial cost to the NHS.
NICE has updated its guideline on the identification, assessment and management of overweight and obesity. Since the original recommendations were published in 2006 there is more evidence available on the best ‘follow up’ care for people who have undergone weight loss surgery and the role of surgery for people recently diagnosed with type 2 diabetes. The guideline also considers more information on the effectiveness and safety of very-low-calorie diets in helping people lose weight.
Commenting on the newly updated guideline, Professor Mark Baker, Centre for Clinical Practice director, said: “As a nation we are getting heavier. The number of people classified as obese has nearly doubled over the last 20 years and continues to rise. Obesity is directly linked to type 2 diabetes, fatty liver disease, cancer, high blood pressure, heart disease, stroke, arthritis and it affects people’s mental health. The financial implications of obesity are huge – 10% of the NHS budget is used to treat diabetes and its complications alone. It is a major issue, if not the major issue, for the health service in the coming years.
NICE has published a range of guidelines to help prevent obesity and to help people lose weight. This guideline focuses on the clinical aspects – what a doctor should do to help an obese or overweight person. It sets out clearly what help and treatments should be offered and in what order.”
This newly updated NICE guideline says that very-low-calorie diets should only be used in certain circumstances; it includes new recommendations on weight loss surgery for people with type 2 diabetes and on follow up after surgery.
Professor John Wilding, Professor of Medicine and Honorary Consultant Physician in Diabetes, Endocrinology and General Medicine, University of Liverpool and Aintree University Hospitals NHS Foundation Trust, said: “Obesity has different causes – for some people it is down to lifestyle, for others it is genetics, but for most it is somewhere in between. But, whatever the reason, everyone who has a weight problem should be focusing on making changes to their diet and lifestyle. Weight loss surgery is not a quick fix or easy option, and although effective, it isn’t the answer for everyone. At the moment only 1% of people eligible for surgery actually have it; most people should try diet and exercise first. However, if someone is obese and they are diagnosed with type 2 diabetes it is really important that their doctor talks to them about the benefits undergoing surgery could provide for them.
“The new guideline also looked at very-low-calorie diets – after considering how well they work and if the weight loss can be sustained, we have recommended that they should not be used routinely for people who are obese. But we are not ruling them out entirely, they may be considered for people who have a clinical need to lose weight quickly, such as before joint replacement surgery.”
Dr Rachel Batterham, Head of Obesity and Bariatric services at University College London Hospital NHS Trust; and Head of the Centre for Obesity Research, UCL (University College London), said: “NICE already recommends that weight loss surgery should be available as an option for people with a BMI over 35, who have failed to lose weight through medical weight loss programmes and if they have another medical condition that could be improved if they lost weight. However, we now know that surgery can make a real difference for people with recently diagnosed type 2 diabetes, so the new guideline now recommends that if someone is diagnosed with type 2 diabetes and their BMI is 35 or over then they should be offered an early, rapid assessment for weight loss surgery.
“Type 2 diabetes is a chronic, disabling condition; it can lead to kidney disease, amputations and blindness. At the moment 1 in 6 NHS beds is taken up by people with diabetes and its complications. Bariatric surgery can help because it changes the way the body deals with sugar. Around 60% of people who undergo surgery will have more control over their diabetes immediately and they are less likely to have diabetes related illness.
“Bariatric surgery is not an easy option. It cannot be used alone. It must be accompanied with changes to diet, activity levels and lifestyle. There is an initial cost of around £6,000 in the short term, but preventing the long-term complications of diabetes is great for the individual and will save the NHS money.”
Professor Alex Blakemore, representing patients and carers on the group that developed the guideline, has had the surgery, said: “Surgery isn’t a magic spell or an easy option, it helps you lose weight, but it doesn’t happen overnight and there is still a lot of work to do, it requires changing your lifestyle.
“One of the most surprising effects for me was the rapid effect it has on diabetes, some of which happens immediately, before weight loss. On the day that I had my own surgery, another woman had her operation too. She had diabetes and was on insulin and already had severe complications including constant pain from nerve damage. Four days later she went home without her insulin and within six weeks she was off her other medication too. That all happened before weight loss. Sadly, although her diabetes went into remission the complications remained, if she had had surgery earlier, this could have been prevented.
“The updated guideline puts a lot of emphasis on follow up after surgery, ensuring that people have support to help improve their diets, be more active and make lifestyle changes to ensure they lose the weight and keep it off.”
The updated guideline is available on the NICE website.
Image source courtesy of The Guardian