Obese peo­ple de­serve sur­gi­cal treat­ment, too

The Guardian Australia - - Opinion - Richard Wel­bourn

One in four peo­ple in the UK suf­fer with obe­sity. Se­vere and com­plex obe­sity is a life­long con­di­tion as­so­ci­ated with many ma­jor med­i­cal prob­lems, the costs of which threaten to bank­rupt the NHS. The ma­jor ail­ment caused by obe­sity – type 2 di­a­betes – is linked to shorter life ex­pectancy, de­creased qual­ity of life and in­creased so­cio-eco­nomic and psy­choso­cial prob­lems. A new re­port out this week sug­gests the global cost of treat­ing obe­sity will rise to $1.2tn a year from 2025.

Yet in the UK, less than 1% of those who can ben­e­fit from it re­ceive bariatric (some­times called weight­loss) surgery, such as gas­tric by­pass or gas­tric band­ing. So why is a safe, cost-ef­fec­tive ther­apy for a deadly dis­ease so un­der-utilised?

For se­verely obese peo­ple, the hor­monal ef­fects of be­ing obese mean that med­i­cal ther­a­pies, life­style changes and at­tempts at di­et­ing rarely suc­ceed in main­tain­ing longterm, clin­i­cally ben­e­fi­cial weight loss. It isn’t just sur­geons say­ing this – it is de­scribed in guid­ance by the Bri­tish Obe­sity and Meta­bolic Surgery So­ci­ety which is en­dorsed by 21 other pro­fes­sional or­gan­i­sa­tions, in­clud­ing nine med­i­cal royal col­leges.

The World Health Or­gan­i­sa­tion iden­ti­fies obe­sity as a chronic dis­ease. But on the other side we have the pop­u­lar per­cep­tion – shared by some health­care professionals – that it is purely a life­style choice. This to­tally dis­re­gards the fact that, driven by pow­er­ful food in­dus­try ad­ver­tis­ing, it is those who are poor who are most af­fected. Our ten­dency to­wards obe­sity is rooted in evo­lu­tion­ary bi­ol­ogy: hu­man be­ings have spent two mil­lion years de­vel­op­ing a meta­bolic sys­tem which con­serves en­ergy in times of scarcity. It is only in the last 70 years that we no longer eat be­cause of hunger alone.

The an­nual vol­ume of bariatric surgery in the UK – about 5,000 op­er­a­tions a year – is five to 10 times lower com­pared with other Euro­pean coun­tries with sim­i­lar pop­u­la­tion sizes and dis­ease preva­lence. In France, which has a sim­i­lar pop­u­la­tion size to the UK, more than 37,000 surg­eries are car­ried out each year. Bel­gium, with a pop­u­la­tion of 11.3 mil­lion, un­der­takes 12,000 surg­eries while Swe­den, with a pop­u­la­tion of 9.9 mil­lion, car­ries out more than 7,000 a year.

As a prac­tis­ing bariatric sur­geon, I and my col­leagues be­lieve the so­cial stigma of obe­sity is hold­ing back the de­ploy­ment of cost-ef­fec­tive treat­ments for vul­ner­a­ble peo­ple. Health com­mis­sion­ers are aware of the fig­ures, but re­main slow to in­crease pro­vi­sion. Cost can’t be the is­sue. Get­ting a pa­tient off in­sulin or other ex­pen­sive anti-di­a­betes med­i­ca­tions is cost-sav­ing within two to three years of surgery: a win-win for the GP, the NHS and the tax­payer. Pa­tients are also more likely to go back to work, and there­fore pay more tax and claim fewer ben­e­fits.

I be­lieve the prob­lem is that com­mis­sion­ers and med­i­cal professionals, like the pub­lic, still see obe­sity as a life­style choice, and so blame pa­tients. But there is a point of no re­turn with obe­sity. There are par­al­lels with other dis­eases. You may well sug­gest to some­one who is a bit down in var­i­ous ways for them to try and im­prove their mood, but once they be­come clin­i­cally de­pressed ex­pert treat­ment is needed. We en­cour­age our friends to stop smok­ing, but we don’t then be­grudge them treat­ment for lung cancer.

Yet the re­luc­tance to treat obe­sity lingers. Some ar­gue that re­sources should be di­rected to pre­ven­tion rather than treat­ment. When­ever pos­si­ble, pre­ven­tion is ob­vi­ously bet­ter than cure. But this is no longer an op­tion for peo­ple who have missed the boat of pre­ven­tion and have gone on to develop se­vere, com­plex obe­sity with con­di­tions such as di­a­betes.

Pa­tients should be given quicker ac­cess to sur­gi­cal as­sess­ment. If bariatric surgery is right for them, then the sooner the bet­ter. We al­ready know that the UK is one of the most obese coun­tries in Europe, and the pa­tients we op­er­ate on are the sick­est. The NHS should be per­form­ing 50,000 surg­eries a year, closer to the Euro­pean av­er­age.

To achieve this, health work­ers must be per­suaded to put prej­u­dice to one side and pro­mote surgery where ap­pro­pri­ate. GPs and com­mis­sion­ers alike must recog­nise both the health ben­e­fits and cost sav­ings.

All the clin­i­cal ev­i­dence points to the fact that, as a coun­try, we should be per­form­ing more weight-loss surg­eries. It is the so­cial stigma of obe­sity that is hold­ing us back. Mak­ing fun of obese peo­ple is an en­demic so­ci­etal prej­u­dice, and stig­ma­ti­sa­tion is al­lowed – and even en­cour­aged – by the me­dia. It’s time to stop judg­ing and let the ex­perts start treat­ing the con­di­tion.

• Richard Wel­bourn is a con­sul­tant bariatric sur­geon at Mus­grove Park Hospi­tal, Taun­ton

A sur­geon shows what a gas­tric band does. ‘Why is a safe, cost-ef­fec­tive ther­apy for a deadly dis­ease so un­der-utilised?’ Pho­to­graph: Murdo Ma­cleod for the Guardian

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