Friday, November 25, 2011

Why Bariatric Surgery Should be an Option for All by Daniel Harris

The UK has a serious obesity problem with one in four or 25% of people being classified as obese. Doctors involved in obesity management have seen a variety of changes to suitable treatments. Cognitive behavioural therapy (CBT) is simply unavailable or unfunded in many areas. Obesity drug therapies such as Accomplia and Reductil have been withdrawn after health-related fears. The only drug left is Orlistat available on NHS prescription or over the counter in a smaller dose. This drug reduces the amount of fat absorbed but can result in certain undesirable side effects such as diarrhoea or faecal incontinence.

Obesity costs the nation a lot of money. Health related problems such as diabetes, hypertension, high cholesterol and arthritis require numerous drugs, GP appointments and result in many days of lost productivity from the workforce in terms of sick days.

There are a variety of bariatric (weight-loss) operations used effectively to treat obesity. These weight loss operations include laparoscopic adjustable gastric banding and gastric bypass. These surgical treatments have been shown to be very effective in reducing excess weight by 50-75%. Furthermore, the Roux-en Y gastric bypass has been shown to have a hormonal effect and actually cure Type II diabetes.

NICE is an independent organisation responsible for providing national guidance on promoting good health and preventing and treating ill health. In December 2006, they published guidelines (CG43) relating the benefits of bariatric (obesity) surgery.

The recommendation was that surgery was appropriate and should be offered to morbidly obese individuals with a Body Mass Index (BMI) of 40 or over who had failed in other attempts to lose and maintain weight. In the presence of obesity related disorders such as diabetes and hypertension, this could be reduced to a BMI of 35. They further recommended that those with a BMI of 50 or over be offered surgery without delays or requirements for other treatments.

These guidelines are however not enforceable and so some of the primary care trusts (PCTs) who fund the operations set different criteria for those who are eligible for funding, limiting the service to some. There is a wide variation depending on geographical location re-enforcing the “post code lottery”.

Toni Russo (Consultant Nurse for Streamline Surgical) said, “There are so many people out there who feel there is no hope for them in terms of living a ‘normal’ life again and getting their health back on track due to their weight. There is more awareness of bariatric surgery now but access to it must also be increased which is a big frustration for medical professionals. A laparoscopic Roux-en Y gastric bypass costs from Ј10,000 but lifelong medications, a stroke or heart attack and months on sick leave costs the nation rather more.”

There is no denying that we are experiencing an obesity crisis in this country, as well as worldwide. Currently a quarter of people in the UK are obese and by the time of the Olympics in 2012 this is forecasted to rise to a third. The cost to the UK economy is predicted to be Ј4-5billion per annum and this will only increase unless something can be done to tackle the problem.

For those who have dieted for most of their lives with limited success bariatric surgery may be the only hope they have to regain their lives and their health. With proper management of obesity we can reduce the health risks and the associated costs.