Experts call for NHS to boost bariatric surgery rates

The NHS should increase bariatric surgery rates to 50,000 procedures a year to bring major health benefits to patients and save money in the long run, according to a team of experts.

Writing in the BMJ, the team from Taunton and Somerset NHS Foundation Trust, the Universities of Bristol and Oxford, and University College Dublin, point out that less than one per cent of patients in the UK who could benefit from bariatric surgery actually receive it.

Around 2.6 million people in the UK meet the National Institute for Health and Care Excellence (NICE) criteria for bariatric surgery, which is based on a variety of factors including body mass index, the presence of co-morbidities such as diabetes and previous attempts to lose weight.

Richard Wellbourn, consultant bariatric surgeon at Taunton and Somerset NHS Foundation Trust said:

“GPs and commissioners need to recognise the health benefits gained from bariatric surgery – and the cost savings.

“There is good evidence that bariatric surgery is effective, both in terms of treatment and cost. Patients who have surgery lose, on average, 25 to 35 per cent of their body weight in the first year after surgery. Those who had diabetes before surgery are more likely to go into glycaemic remission, and fewer progress from prediabetes to diabetes. It is essential surgery is combined with multi-disciplinary care to support long term behaviour and life style change to maintain the success of surgery.

“The financial outlay is also justifiable. In patients with diabetes, for example, the cost of the surgery can be recouped within three years by savings on prescriptions and daily blood glucose monitoring. There are also indirect benefits. Improved activity levels may mean patients can to return to work following surgery, reducing the need for disability benefits.”

Despite the evidence on its effectiveness, the number of bariatric surgeries carried out by the NHS is falling. Between 2011 to 2012 and 2014 to 2015, the number of operations fell by 31 per cent from 8,794 to 6,032.

Professor Jane Blazeby, co-director of the University of Bristol’s Centre for Surgical Research, said:

“One of the reasons the rates are so low is that GPs cannot refer patients directly to surgical services. Instead, patients enter a four-tier system, to undergo diet and weight management treatment before they can be treated by a specialist clinic team or assessed for surgery. This prolonged process, which can take up to two years, may put patients off accessing the treatment.

“Moreover, clinical commission groups are no longer obliged to fund the specialist secondary care clinics so – with GPs still not able to refer patients direct to surgical services – access to surgery may stop.”

Professor Carel le Roux, of University College Dublin, said:

“The upfront cost may be another barrier, as commissioners restrict the number of operations they will fund, despite good evidence the costs can be recouped in the following years if we focus on surgery’s ability to make patients healthier instead of just thinner. Prejudice and stereotyping also have an impact, as some healthcare workers share societal implicit beliefs that patients with obesity ‘lack moral fibre. Those opposed to surgery often argue it will detract from prevention, but treating a disease does not stop important prevention activities.”

Richard Welbourn said:

“It’s not possible to operate on every patient who meet the criteria. We should, therefore, target those who have the greatest potential for improved health. For example, those with complications of type two diabetes, or sleep apnoea that prevents them working, are obvious priorities. “In terms of overcoming the barriers to surgery, we need to understand that both prevention and treatment are necessary for most diseases including obesity. Moreover communication skills workshops for staff, increased dietetic services, and investment in multidisciplinary team working would all contribute to improving access of patients.”

Article

‘Why the NHS should do more bariatric surgery; how much more should we do?’ by Richard Welbourn, Amanda Owen-Smith Carel W le Roux, Sarah Wordsworth and Jane M Blazeby inThe BMJ