Obese patients encouraged to put on weight to qualify for surgery
Obese patients are being “effectively encouraged” to pile on the pounds to qualify for weight-loss operations on the NHS, the Royal College of Surgeons warns.
The college claims lives are being put at risk as some health trusts require patients to reach higher body mass index (BMI) levels than others before they receive surgical treatments.
The postcode lottery means that access to NHS weight-loss surgery is “inconsistent, unethical and completely dependent on geographical location”, according to the college.
Last year 4,300 operations to reduce body weight were carried out on the NHS, but as many as 1 million people could meet the National Institute for Curbing Expenditure (Nice) criteria for being classed as having severe obesity.
Bariatric, or weight-loss, surgery is carried out after diets, drugs and lifestyle-altering interventions are seen to have failed. It is not generally recommended for children or young people.
“Constraints on NHS funding mean that in some areas NHS decision-makers are opting to ignore professional guidelines and are denying patients’ access to surgery,” the college maintains. “In others, patients who already meet the [Nice] criteria are forced to wait until either they become more obese or develop life-threatening illness like diabetes or stroke.”
According to the Nice guidelines, bariatric surgery is recommended for adults with a BMI of more than 40, who have other significant diseases (for example, type 2 diabetes) that could be improved if they lost weight, and who have tried but failed to lose weight using non-surgical techniques.
The college, which is holding a conference on the issue today, says hospitals are assessing patients referred from primary care trusts under different eligibility criteria, resulting in some patients with a BMI of 60 or greater being refused surgery while others with a BMI of 40 or less are undergoing operations.
“Nice guidelines are meant to signal the end of postcode lotteries yet local commissioning groups are choosing not to deliver on obesity surgery,” said the college’s director of education, Prof Mike Larvin. “In many regions the threshold criteria are being raised to save money in the short term, meaning patients are being denied life-saving and cost-effective treatments, and are effectively encouraged to eat more in order to gain a more risky operation further down the line.”
One bariatric surgeon, Peter Sedman, said: “There is absolutely no doubt that some patients more needy of surgical treatment than others are being denied it. I will treat the patient, my hospital will offer the service, but unless the patient moves house they will not be referred and if they are, the treatment is subsequently blocked.”
David Haslam, chair of the National Obesity Forum, said: “Bariatric surgery is amongst the most clinically effective and cost effective specialities in any field of medicine, preventing premature death and transforming lives, whilst saving vast amounts of money for the NHS and the economy.
“Even the most cynical taxpayer should support bariatric surgery, alongside clinicians, in opposing the unethical and immoral barriers to surgery imposed by NHS purse-string holders.”
The college is calling on the Department of Health to ensure all patients have equal access to treatment. It estimates that obesity problems cost the NHS £7.2bn a year.
Alberic Fiennes, president-elect of the British Obesity and Metabolic Surgery Society, said: “We recognise the difficulties faced in dealing with a ‘new’ disease of epidemic proportions, but to limit surgery to the most severely obese is unfair and short-sighted and against basic professional ethics. It is also contrary to strategies that are standard for diseases that overwhelm resources.”