Gastric band surgery
Thursday, 13 April 2017
The increasing rates of obesity in the UK over the past few decades are alarming. The cost of obesity and its health-related issues for the NHS are now overwhelming. Although I strongly feel that we should be putting more energy and resources into primary prevention of obesity, we cannot ignore the treatments currently available for managing obesity.
Bariatric surgery has been shown in numerous studies to be very effective not only at treating obesity but rather impressively at reducing the prevalence of type II diabetes. NICE guidelines have been produced and these recommend that bariatric surgery should be considered for all patients with a BMI over 40kg/m2 or those with a BMI over 40kg/m2 and co-morbidities such as type II diabetes.
However, the Royal College of Surgeons recently announced that it has found growing evidence that health executives are unofficially rationing bariatric operations in some areas. They have changed the BMI threshold for surgery in some instances. In other areas, they have denied surgery to smokers, which means they are not adhering to the guidelines.
This really does seem a short-sighted action and CCGs should not be able to do this. Some of this is likely to be related to the cost of the operations and in some cases the availability of surgeons.
Clearly, offering bariatric surgery to obese and morbidly obese patients will reduce future NHS costs, so it is very important that this is taken into consideration when changing the guidelines.
With a limited amount of money in the NHS budget, I feel the argument for spending money on preventing rather than treating obesity can be discussed both ways. However, I certainly have seen numerous patients who are actively increasing their weight by eating more, so they can be referred for consideration of bariatric surgery. In my area, patients need to have a BMI of at least 50kg/m2, so if their BMI is near that, they tell me it is easier to increase weight to have surgery than to try and lose weight on their own.
This is all certainly “food” for thought!