Latest from the IFSO (International Federation for the surgery of Obesity & Metabolic Disorders): The NHS needs to carry out more obesity surgeries.
You may have seen our recent blogs about the lower numbers of weight loss procedures being done in the NHS and the impact this is having on public such, particularly on those suffering with type 2 diabetes.
The issue was again thrust into the public spotlight at the IFSO conference attended by many of the countries leading bariatric (weight loss surgery) surgeons.
The numbers really do make pretty appalling reading. We know that weight loss surgery is life changing and that it delivers a very fast return on the initial cost of the surgery. If we assume a gastric bypass procedure costs the NHS about £8,000, all of that cost will have been recovered in a type 2 diabetic patient within 2 years . This is because most diabetics comeoffall of their medication after gastric bypass surgery and the cost saving outweighs the £8,000 cost of the op within 2 years, in some patient the return is even quicker.
The latest data shows that about 5,000 weight loss procedures are being done each year in the NHS. To give some context that compares to over 35,000 in France, a country with a similar sized population and slightly smaller obesity problem. More startling is the fact that 7,000 are done in Sweden and even Belgium does 12,000. We are lagging far behind. Why is that? There seems to be two reasons:
1) The funding simply isn’t being made available.
Clinical commissioning groups, who control how NHS funds are used, are setting high barriers for NHS surgery. Many of these groups are setting barriers such as high BMIs (e.g. 50+), long pre-op weight loss programmes that patients find hard to follow and classifying some patients groups as ineligible on grounds of their lifestyle (e.g. smokers). These commissioning groups have limited funds and weight loss needs to be balanced with all of the other priorities impacting the public health budget, most notably meeting the health costs associated with an aging population. No one should pretend this is easy.
2) There isn’t the will to help weight loss patients in the UK.
The other reason, and this was articulated by Professor Francesco Rubino, a surgeon who is a world leader in metabolic surgery and diabetes, is that there simply doesn’t seem to be the public or political will to help weight loss patients in the UK that there is in other countries. He believes that there is a stigma attached to obesity here that sees people view the obese unsympathetically. They are considered the architects of their own problems. Put simply, if they chose to eat less, they wouldn’t have these problems. It’s the thin end of the wedge though as most disease can be traced back to some lifestyle choice that has been made. Certainly, we are more tolerant of those with smoking and alcohol related health issues than we are of the obese. Prof Rubino said, ‘If we start taking the approach that disease associated with lifestyle choice should be excluded from surgery, where are we going to draw the line? Pretty much every disease would have to be associated with lifestyle. I don’t think we should be here to judge.’
We asked our own Medical Director at Healthier Weight for his feelings on this, Mr Singhal. He’s a leading expert in bariatric surgery, having recently performed gastric bypass surgery on a patient with a BMI of 99. Mr Singhal said:
‘As a weight loss surgeon I’d like to see more weight loss surgery done in this country. The data supports numbers in line with those in France, if not higher. The truth however is that where the money gets spent reflects, to a degree, the will of the public and in this country the obese are regarded with little or no sympathy so there isn’t the public pressure to change things. What is not being taken into account is that every year we only do 5,000 cases we are building up a bigger problem, and more cost, for the future.’
So, where does it leave us? Well, although NICE is approved for use in the NHS for patients with BMIs of 35 and above, there seems no real prospect of surgery numbers increasing to the levels seen in France. Indeed, the prospect of numbers getting to those in Belgium seem remote given the downward trend we are seeing. It means that the only realistic prospect for those who are obese, and who want or would benefit from this life changing surgery, is to have it done privately.
Weight loss surgery is safe and effective, and enables people to transform their lives through better mobility, reduced risk of disease and death and all the benefits that come with that.