Bariatric lottery 'fuels obesity rise'

Experts call for wider access to surgery and warn England is 'years behind' Scotland. Stephen Robinson reports.

Specialists warn long-term costs of not treating severe obesity far outweigh short-term costs of surgery
Specialists warn long-term costs of not treating severe obesity far outweigh short-term costs of surgery

The growing obesity epidemic shows no sign of abating: one quarter of UK adults are now obese and this figure is set to double by 2050.

Besides the impact on health, obesity lands a huge financial blow to healthcare budgets. The NHS now spends £4.2 billion each year on obesity, and much of this is spent treating comorbidities in cases of severe and complicated obesity, where BMI exceeds 35.

So experts are understandably angry that bariatric surgery services, recognised as an effective treatment, are being sidelined. They say guidance is being ignored and patients are subjected to postcode lotteries when trying to access services.

Hertfordshire GP Dr David Haslam, chair of the National Obesity Forum (NOF), believes the attitude to bariatric surgery needs to change.

'It is one of the most clinically and cost-effective treatments in the field of medicine, but it is dramatically underused,' he says.

'Unmet need'
In Scotland, one in 20 middle-aged women are morbidly obese - double the figure from 1998.

It was with renewed optimism that specialists backed new obesity advice from SIGN at an event in Dundee in May.

Under the guideline, patients with a BMI more than 35 should be considered for bariatric surgery if they have comorbidities that would benefit from weight loss.

Obesity consultant Professor Mike Lean, member of the Severe and Complicated Obesity Treatment Service, says steps must be taken urgently within NHS Scotland to ensure implementation of the guideline.

Thousands of people in Scotland would be eligible for the treatment under the SIGN criteria, but at present just 200 procedures are performed each year.

Professor Lean warns radical changes must be made to the obesity care infrastructure to accommodate the guidance.

'There is a huge unmet need out there. Funding structures have to change,' he says. 'We do not have enough nutritionists or surgeons to provide sufficient bariatric surgery, and existing services are tucked into silos,' he said.

Obesity specialist Professor Nick Finer of the Experts in Severe and Complex Obesity group believes England and Wales are several years behind Scotland still in terms of developing dedicated specialist severe obesity clinics and services.

He is concerned by the 'enormous inequalities and postcode lotteries' patients face when accessing weight-loss services.

'In England there is patchy distribution of bariatric surgery services. Many SHAs have been unable to direct PCTs to implement (their own) policy, let alone NICE policy,' says Professor Finer.

Calls for change
At £5,000 to £10,000 per procedure, bariatric surgery is not cheap. But Professor Lean insists failing to treat severe obesity is far more costly in the long term. He proposes that PCTs use diabetes funding to pay for bariatric surgery.

'The cost of not treating it and carrying on with conventional diabetes treatment is a lot higher, and people continue to get ill,' he says.

Meanwhile, Professor Finer believes the time has come to incentivise obesity prevention through the QOF. It is 'completely bonkers' to only have a single public health intervention for obesity in the QOF, says Professor Finer. GPs are awarded eight points for creating a register of obese patients.

'There are various places we can intervene,' he says. 'One is societal. The second is when people present to their doctor.'

In July, specialists from the NOF and the Royal College of Surgeons will issue a report calling for improved availability of bariatric surgery.

Dr Haslam hopes the report's advice is heeded. 'It could make a huge difference to the lives of many people with severe and complicated obesity,' he says.

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