You are unlikely to get a gastric band, or any other weight loss surgery on the NHS, unless you have a very high BMI and/or obesity-related health conditions such as diabetes and hypertension. In this article we look at the NHS criteria for gastric band surgery, the reasons why the NHS offers fewer bands, the provision of other weight loss procedures and how we might need to expect less from the NHS.

NHS gastric band criteria

The NHS is lacking resources in every area of healthcare, and for this reason, it’s becoming increasingly difficult to meet the specific criteria laid out by the NHS to be eligible for weight loss surgery. The NHS criteria are as follows:

• you have a body mass index (BMI) of 40 or more, or a BMI between 35 and 40 and a serious condition that might improve if you lost weight (such as type 2 diabetes or high blood pressure)
• you’ve tried all other weight loss methods, such as dieting and exercise, but have struggled to lose weight or keep it off
• you agree to long-term follow-up after surgery – such as making healthy lifestyle changes and attending regular check-ups
• you’re fit and healthy enough to have surgery under general anaesthetic (where you’re asleep)
• you’ve been receiving or will receive treatment from a specialist obesity team

After being able to prove that you’ve exhausted all other methods of weight loss, you would have to get a GP referral, then go through a 6-12 month weight loss programme before eventually making it on to a surgeons waiting list. A process which would likely take 18 months at the very least.

The nationwide obesity problem

Obesity is a problem that continues to worsen in the UK. Statistics published on the 6^th August 2019 revealed that 28.7% of adults in England are obese and a further 35.6% are overweight but not obese. Obesity is usually defined as having a body mass index (BMI) of 30 or above, and a BMI between 25 and 30 is classified as overweight. In 2007 the NHS carried out 12,000 weight loss procedures, yet in 2018, that figure has been sliced to a mere 4,500. It is argued that bariatric surgery will pay for itself in 2 to 3 years, so as the problem gets bigger, why is it becoming less and less likely that you will be eligible for a gastric band on the NHS?

It’s not the NHS’s fault

The NHS is full of great people. We probably all have personal experience of that. However, costs for drugs and instruments are running ahead of inflation as well as the amount being spent on defending legal claims (the disgraceful increase in spurious medical malpractice claims against the NHS are a topic for another blog!) is escalating very rapidly. The truth is that there are just so many challenging logistical issues and competing priorities that many patients who would benefit from surgery, whether weight loss patients or patients with other diseases, have to wait and wait and wait. The bariatric surgeons we speak to and deal with day to day tell us their NHS numbers are down year on year, and there is no realistic prospect of that number going up soon.

Money is not the answer because there simply isn’t enough money to make the mammoth investment in the NHS that would be needed to deliver the service most of us would like to see, one in which you get treated for your disease quickly, regardless of what it is. When you consider that the cost of drugs and instruments that the NHS uses are all going up quickly, and also that the amount being spent on defending legal claims (the disgraceful increase in spurious medical malpractice claims against the NHS are a topic for another blog!) is escalating very rapidly, there simply isn’t the money to pay for more gastric band surgery.

3 reasons why the NHS won’t pay for a gastric band

• Gastric band results are only as good as the aftercare that patients receive. Good aftercare requires the right ‘coaching’ for the patient about what to eat and what not to eat, responsible adjustment of the band and the early diagnosis of problems. When these things are done, complication rates over a 5 year period can be kept well below 10%. When the aftercare is poor however, band removal rates were shown to be as high as 40% in one large study recently. So, bands are great but you need the right aftercare.
• The aftercare programmes required to support band patients are expensive and complicated to manage. You need regular clinics with specially trained nurses and other clinicians. The same requirements do not exist for the other procedures. In summary, it is more hassle and more expensive to manage gastric band patients. The gastric sleeve and gastric bypass need less maintenance after surgery.
• The NHS has to direct it’s resources to those patients who are most in need. This means surgery is rationed to those patients who are at the greatest risk to their health as a result of their weight. Very often these are patients with Type 2 diabetes or other conditions that would be remedied by weight loss. Sleep apnoea and hypertension are two other examples. For patients with these health problems, the gastric bypass or the gastric sleeve can be a better option than the band as they deliver health improvements more quickly. For patients with higher BMIs, for example in the super obese category (BMI over 50), they are more powerful and will deliver more weight loss quickly.

What about other weight loss procedures?

Other weight loss procedure including gastric sleeve and gastric bypass are options that are carried out (on a small scale) within the NHS. These procedures are much more intrusive than the band and are bigger operations to do, but the story is still the same. The criteria won’t change between your preferred procedure, and still, NHS resources for these procedures will be dictated by how much the surgery is needed by the individual. Even though the gastric band isn’t the only weight loss procedure, the waiting list and lack of resources are relevant for all.

We need to expect less

The truth is we need to change our minds about what the NHS can offer us. With the NHS is fast becoming focused on emergency care and cancer treatments, weight loss surgery along with several other procedures are becoming more and more elective and the latest statistics prove this. Although obesity is becoming more and more of a problem in the UK, the NHS list of priorities is likely to carry on pushing weight loss surgery further down.

Weight loss surgery is at present the best long-term treatment for obesity, especially for groups with a BMI above 40. However, when politicians are forced to make hard choices about how to spend the NHS budget, they prioritise other things. As a result, it’s highly unlikely that the NHS will pay for your gastric band. If you’re thinking of having a procedure you are likely to have to go private. You will have to pay (see our gastric band finance packages), but it will be a much quicker process without having to jump through the hoops of eligibility.

By Mr Rishi Singhal MBBS, MRCS, FRCS, MD

Last review: 14/02/2020. All content on this page is reviewed by a multi-disciplinary team lead by Mr Rishi Singhal.