Obesity Abstracts

Bariatric surgery remains the only long–term effective treatment for patients with severe and complex obesity. Many studies have shown its superiority over lifestyle interventions and dieting. There are also many cost effectiveness studies indicating that the cost/QALY for bariatric surgery is well below the threshold set by NICE. Bariatric surgery is also safe, with HES data to indicate that 30-day mortality rates are less than 1 in 1000 in NHS England. The data are representative of bariatric surgery around the world. Despite this the provision of surgery remains extremely low. Only ca. 5500 operations are done annually in the English NHS, much less than 1% of those potentially eligible for surgery according to NICE Guidance. Most NHS surgery is carried out in England, there is very little done in Wales and Scotland and none in N Ireland. The 2014 NICE Guidance recommended an expedited referral for consideration of surgery for people with recent onset type 2 diabetes (within 10 years) and a Body Mass Index (BMI) of 35 or more, but Clinical Commissioning Groups and referrers have largely ignored this. Patients are also eligible with BMI of 40 or more. Clinical inertia and weight prejudice likely play a role. To begin change, all healthcare workers starting at undergraduate level need education on nutrition. Clinicians should lead a change in mindset for all healthcare professionals towards opportunistic identification and recommending eligible patients to Weight Assessment and Management clinics. In other healthcare settings such as Sweden bariatric surgery has been prioritised over less cost-effective treatments e.g. minimally symptomatic hernias or gallstones. The NHS needs extra capacity but it cannot continue largely to ignore treatment for the major health problem affecting the most obese population in Western Europe. The NHS cannot afford not to offer bariatric surgery.