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A blog considering the benefits and risks of weight loss surgery following news that more patients may be offered such surgery,
I am following with interest the recent news that NICE (National Institute for Health and Care Excellence) have issued draft guidelines in relation to weight loss surgery (also known as bariatric surgery). Under the draft guidelines patients who are obese and have recently been diagnosed with type 2 diabetes would be offered an assessment for weight loss surgery.
Obesity is not a purely modern phenomenon (King Henry VIII had an estimated Body Mass Index (“BMI”) of 50 at the time of his death) however the proportion of the population that are defined as obese in countries that have been keeping such statistics has consistently increased over the past 30 years.
Obesity is now seen as one of the most important preventable diseases in the UK.
The difficulty is that obesity is usually more than just eating too much and is often a combination of many different factors including the need for medication, psychological attitude to food, cultural factors, education, physical inactivity, endocrine disorders and a genetic predisposition.
First-line management of obesity is based on healthy diet, adjustment of calorie intake, physical exercise and psychological support including addressing family and social factors affecting diet. This is very difficult to police long term and currently there is relatively little access on the NHS to psychological and dietetic support. There is also only one drug (Orlistat) licenced in the UK for treatment of obesity and when this fails NICE recommend weight loss surgery prompting complaints that this is an unnecessary drain on valuable NHS resources.
But is it?
The Department of Health estimated in 2013 that obesity related health problems currently cost the NHS in excess of £5 billion per year. In addition there is the cost to the economy as a whole through inability to work and with it loss of income tax revenue as well as increased benefit payments.
Gastric band surgery for instance costs the NHS around £7,000 to perform, gastric sleeve surgery and gastric bypass surgery cost more at around £12,000. Sleeve and bypass surgery have been shown to bring about a direct and immediate improvement in patients with type 2 diabetes in addition to the benefits of weight loss such as lowering of high blood pressure, lowering of high cholesterol and reducing the pressure on joints and therefore increasing mobility. Further, weight loss brings with it better sleep and a reduction in depression.
Gastric band surgery has a published mortality rate of around 0.1%, gastric sleeve surgery 0.3% and gastric bypass surgery 0.5% all of which are no more than hip replacement surgery (also 0.5%).
It is estimated that, provided there are no complications, weight loss surgery therefore pays for itself in less than 3 years.
From a purely financial point of view the argument for more NHS-funded weight loss surgery is impelling.
As with any surgery however there are risks involved. I act for a number of patients who have suffered serious injuries following weight loss surgery as a result of negligence. This can be, for example, because the surgery has been carried out by surgeons who are not competent, or where the patient has not been properly assessed as being suitable for the particular type of surgery. Whilst the majority of surgeons will do a good job for their patients it is essential, particularly if more patients will be offered weight loss surgery, that the surgeons undertaking the procedures are experienced and undertake full and proper assessments for each patient.