More than 5% of adults in England qualify for bariatric surgery, according to a study by researchers from Imperial College, London, UK. Although this equates to more than 2.1 million adults, unsurprisingly, the paper found that the number of people eligible for surgery ‘far exceeds’ the estimated number of people having procedures.
The study, published in the Journal of the Royal Society of Medicine, found that despite evidence of the cost-effectiveness of weight loss surgery, surgery rates were estimated to be a third of the NHS’s benchmark rate. Researchers, who examined the health of nearly 9,500 people, acknowledged the huge financial implications for the NHS if treatments were carried out in such greater numbers.
Nevertheless, they said more investment may be necessary to meet a growing need for the procedures
“Despite clear guidelines outlining who can undergo such surgery with the NHS, and evidence that these procedures are cost-effective in the long run, less than 1% of those eligible have weight loss surgery each year,” said lead researcher Dr Sonia Saxena. “This raises questions about why more procedures are not currently being carried out.”
Dr Sonia Saxena
NHS guidelines state that bariatric surgery may be offered to those whose morbid obesity could kill them, or to people who are morbidly obese and who have a serious condition such as type 2 diabetes or high blood pressure that could be improved if they lost weight.
The study found that those meeting the criteria for bariatric surgery were more likely to be women, retired with lower educational qualifications and of lower socio-economic status.
“Recent hospital episode statistic data show surgery rates from 2003/4 to 2009/10 have risen year on year in England; with rates highest in women and those aged 40-54 years,” the authors write. “However, service delivery rates still fall significantly below the level needed to support all those who could potentially benefit.”
Several factors contributed to surgery rates being so low, including:
- Those with greatest need for surgery were more often in the lowest socio-economic groups, who are least likely to use healthcare services;
- Patients’ awareness of the possibility of surgery and their commitment to make the necessary lifestyle changes prior to the treatments may also be barriers; and
- Doctors might not be correctly identifying or referring those eligible, and service provision may also be insufficient.
“5.4% of the general adult population is eligible for bariatric surgery in England, far exceeding the current bariatric surgery uptake. Due to the limited capacity of health services to meet demand under existing criteria, greater investment into service provision may be required to meet a growing need,” the study concluded. “This would have significant resource implications. Since those eligible are more likely to be of a lower social class and have lower qualifications, such resources would need careful allocation to ensure equitable access on the basis of need.”
Tam Fry of the National Obesity Forum, said: “The failure to provide appropriate bariatric surgery is a disgrace, the worse so since the surgery pays for itself in two to three years.”
Reportage courtesy of Bariatric News
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Magdalena French says
I live in Australia and I’ve been very interested in the UK TV series ‘Fat Doctor’ since my girlfriend had bariatric surgery almost 12 months ago. My friend weighed 212kg, she had to lose 60 kg before she would be considered for bariatric surgery, which she lost with the help of appetite suppressants. However towards the end of that 60 kg weight loss the appetite suppressants began to lose their effectiveness. Since having the surgery my girlfriend has only lost another 30 kg in 11 months.
My friend truly believed that once she had the surgery she wouldn’t ever crave food again (which is what she was told during the 6 or so psychological sessions she had leading up to her surgery), and that she would become full very quickly and have very little appetite.
My friends attitude towards food is very much the same as it was prior to her surgery, which was that she thinks about food all the time and she cannot wait till her next meal, even though she can only eat a small amount of food at a time, she still manages to eat biscuits, chocolate, sweets and anything that easily slides down her throat. Since the surgery she had she is now back on the appetite suppressants – 3 months on and then 3 months off, and she has gained back 7kg.
My friend never dealt with the underlying issues that cause her to eat – she knows this and she was hoping that the surgery would give her ‘space’ away from food (by making her feel so full) and eating so that she would be able to face the feelings that caused her to eat without hunger in the first place – she says she has never been hungry or allowed herself to get hungry before and after the surgery, she says she always ate from non hunger.
The reason I started watching ‘Fat Doctor’ was so that I was hoping to get a better insight into seeing if the obese people knew the emotional/psychological reasons why they ate or if they ate out of genuine non hunger.
My friend had the surgery paid for by the government. She has never worked and has received a social security payment from the government all her adult life. Our health system, like the NHS is so overburdened and over taxed. I work in the health system and in the disciplines I work in the majority of conditions, diseases and illnesses are related to what we call ‘lifestyle diseases’ – ignorance or non compliance with a healthy diet and the role exercise and activity play in good health, as well as having fulfilling relationships and occupations or hobbies and passions.
My friend admitted she spent a lot of money on food – almost triple the amount of money a person with no eating problems would and yet when I suggested she put some money aside to pay for her own operation and go privately, she refused, she said that food was all she had and she was prepared to wait about 5 years to have her operation done for free, even if she died in the meantime……
I’m torn – which came first the chicken or the egg? I resent having my taxes going to pay to treat people with lifestyle diseases (as well as overweight people, the alcoholics and smokers…). I have no answers but the obvious one is educating the population on a grand scale. Sadly the only time anything will change is when governments realise how much all these overweight people, alcoholics and smokers etc., are costing us.
Carol Ball says
Magdalena, I can really appreciate your frustration with your friend and the poor outcome and non-compliance with her surgical regime. Sadly she is not alone and countless others do not not get the results they hope for because they are either ill-informed, do not appreciate what they are taking on – and taking on for life, and the changes required to make their costly surgery a success. I am a fervent advocate for excellent pre and post-op care that educates would-be WLS candidates about what they can expect from their surgical tool but also that they fully understand their responsibility and acceptance of the changes required. It would appear that your friend slipped through the net and even though she had counselling sessions they did not reveal the extent of her addiction and possible non-compliance to the ‘rules’ of eating after surgery. I am very surprised that she was given (or did she self-administer?) appetite suppressants to achieve her goal before surgery. Most regimes in the UK (especially if NHS or government supported) require the loss to come from a sensible weight-management regime that would not rely upon a chemical intervention of this kind – simply because it doesn’t rely upon lifestyle changes and dietary adjustments for long-term success. My latest blog (today) covers weight regain and may go some way to help with your friend but her situation certainly (I believe) needs and requires help from her surgeon and bariatric team. Her problems seem more complex than just getting back on track or making small adjustments to go back to basics. I hope you will urge her to seek out some help for her problems. I know how easy it is to criticise and resent lifestyle diseases that appear to be self-inflicted – I still nurture some guilt myself for ‘wasted’ years and yet I financed my own surgery and all the fall-out associated with making the decision to have it. I don’t have all the answers either but education will go some way to trying to address some of them. CAROL