Weight-loss surgery in England: many who need it aren’t getting it
Obese people who have weight-loss surgery (also known as bariatric surgery) live longer than those who don’t and they have a better quality of life. It is a relatively safe procedure, and it is cost-effective for the NHS.
In 2014, the National Institute for Health and Care Excellence (NICE) updated its guidance on obesity making weight-loss surgery available to people with type 2 diabetes. NICE now recommends that anyone who has been diagnosed with type 2 diabetes in the last ten years should be given an assessment of whether surgery is right for them if their body mass index (BMI) is over 30. This surgery is particularly beneficial for people with type 2 diabetes, allowing many who need drug treatment to stop taking medication within two years of surgery.
Considering how many people are obese in England, it appears that about 0.2% of eligible people are getting surgery. This is far lower than in other countries where similar methods of estimation suggest that 1.2% of eligible people in the US receive surgery and 0.5% in Canada. In 2016, the BMJ published an opinion piece suggesting that we should aim for 50,000 weight-loss surgeries a year to be operating at a similar rate (operations per head of population) to the rest of Europe (about 1.4% of eligible people).
Why are rates so low in England?
Surprisingly, after the 2014 guidance update, which should have increased the availability of surgery for those with type 2 diabetes, the number of people receiving surgery each year in England fell from a high of 8,794 in 2011-12 to 6,032 in 2014-15, although the numbers have been creeping up again more recently.
One reason for the low number of operations performed in England is low demand from patients. A lot of weight bias exists in the UK. This might mean health professionals think that an obese person is to blame for their condition and doesn’t deserve surgery. The Royal College of Physicians recently called for obesity to be recognised as a disease, which might help to promote treatment for those who could benefit from it.
Another worrying statistic is that, while women are more likely than men to be eligible for surgery (58% vs 42%), the proportion of women receiving surgery is significantly higher (76% vs 24%). We know that men are less likely to go to the doctor with a health problem, so they are probably also less likely to ask for help with their weight.
Who is eligible?
People who have tried to lose weight through exercise, diet or drugs but whose BMI remains higher than 40, are eligible for weight-loss surgery, as are people with a BMI over 35 who have a serious disease that might be worsened by their weight, such as high cholesterol, high blood pressure or osteoarthritis. And people with a BMI over 50 are eligible for surgery even if they haven’t tried to lose weight.
People with recent-onset type 2 diabetes and a BMI over 30 are also eligible for weight-loss surgery. (Type 2 diabetes diagnosed in the last ten years counts as “recent onset”.)
Weight-loss surgery is also recommended for people with a South-Asian ethnic background at lower BMIs than stated above. For example, people with recent onset diabetes with a BMI under 30.
Not everyone who is eligible for surgery should have it, though. Those who are eligible should be assessed to see if it’s right for them. People who have had weight-loss surgery describe lifelong physical, psychological and social consequences, both positive and negative. The assessment should examine, for each individual, whether the potential benefits outweigh the risks.
Even though there is a group for whom weight loss surgery will not be right, the latest figures tell us that there is a very large group for whom it is right – and we know that that group isn’t having this life-changing procedure. There’s now a need to find out why.
Oyinlola Oyebode receives funding from National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands. She is a Fellow of the Faculty of Public Health.