UK needs to perform thousands more obesity operations, say surgeons

Thousands more stomach-shrinking operations need to be carried out in the UK, say surgeons, who warn the country is lagging behind the rest of Europe despite the toll being taken on people’s health and warnings that the obesity crisis could bankrupt the NHS.

Reducing stomach size prevents people eating more than small amounts at a time, leading to dramatic weight loss. It can also reverse type 2 diabetes, which carries the risk of amputations, blindness, heart attacks and strokes.

France, with a population similar to that of Britain, carries out 37,000 obesity operations a year, compared with just 5,000 in the UK. Two countries with far smaller populations – Belgium and Sweden – perform 12,000 and 7,000 respectively, while Italy does 8,000.

It is a safe and cost-effective therapy for a deadly disease, according to bariatric surgeons speaking at an international conference in London. Yet the NHS is dragging its feet, they say.

“The UK data is overwhelming – surgery makes a difference to people’s health and we want commissioners to acknowledge this and act accordingly,” said Marco Adamo, a consultant surgeon at University College hospital and the chair of the National Bariatric Surgery Register, which records operations. “Severe and complex obesity is a serious, lifelong condition associated with many major medical conditions, the cost of which threatens to bankrupt the NHS.”

Bariatric surgery costs about £6,000 to £7,000 – only about a third of the cost of a knee replacement, a procedure which itself is often made necessary by obesity.

Prof Francesco Rubino, the chair of metabolic and bariatric surgery at King’s College London, said he used to think it was about cost. “But more recently I started to grow concerned that this may actually not be the real problem. The cost of bariatric surgery is very often offset by the health benefits, especially in diabetes, within a couple of years. Bariatric surgery is one of the most cost-effective interventions we have in modern medicine,” he said.

Instead, said Rubino, he thought it was about stigma and the judgments passed on obese people. “Looking at the science of obesity today, it is inconsistent with the evidence to conceive of obesity as a lifestyle choice,” he said. “It is not true that all patients who are obese are basically overeating.

“I would also submit that even if it were all about overeating – and I don’t believe it is the case – we don’t forgive obese patients for their poor lifestyle choices although we forgive those, such as smoking, that lead to cancer and transplant surgery.

“If we start taking the approach that disease associated with lifestyle choice should not be treated by surgical intervention, 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.”

Results of a freedom of information request by the British Obesity and Metabolic Surgery Society and the Royal College of Surgeons revealed in March that weight loss surgery was being rationed in parts of the NHS. Some clinical commissioning groups will not operate on a patient with a body mass index below 50, which is twice the safest weight for their height.

The surgeons, speaking at the world congress of the International Federation for the Surgery of Obesity and Metabolic Disorders, said they were operating on patients who had become sicker because they were having to wait so long for the operation.

Data collected for the register on 18,528 operations that took place between 2015 and 2017 shows that patients’ average BMI was 47.2. The normal range is 18.5 to 24.9. Two-thirds were not able to climb three flights of stairs without resting.

A year after surgery, more than half had no problem with the stairs. Half of those with type 2 diabetes had seen it disappear and had come off their drugs.

The National Institute for Health and Care Excellence says the NHS should offer surgery to tackle the diabetes epidemic and there is international agreement among professional organisations that it works. When people are still not getting the treatment they need “then it becomes clear that misconceptions and the stigma of obesity are the main barriers”, said Rubino.