NHS surgeons demand gastric bands for the obese

Royal College says it has ‘growing evidence’ that health chiefs are rationing vital bariatric operations

OBESE patients should receive gastric bands on the NHS despite the health service’s attempts to save money, surgeons’ leaders have said.

The Royal College of Surgeons (RCS) said it had found “growing evidence” that health executives are unofficially rationing bariatric operations, such as fitting gastric bands, by imposing spurious criteria to restrict eligibility.

Some local commissioners are “taking the law into their own hands” by insisting patients have a body mass index (BMI) 20 points higher than the clinical threshold for obesity, the findings show.

Others are denying referrals to people who smoke, which is in breach of national rules. Clare Marx, president of the RCS, said: “Study after study shows bariatric surgery is highly effective, particularly in treating type 2 diabetes associated with obesity. It is therefore astounding that commissioning groups are effectively indicating that obese patients should get even more obese before they will consider surgery.

“Bariatric surgery is a significant medical innovation which should be made available to those patients who meet criteria which the National Institute for Health and Care Excellence [Nice] have considered and published.”

The report said obese patients are commonly treated as “second-class citizens”, even though surgery is known to be effective in helping people lose weight, which saves the NHS money in the long-term.

The RCS began its investigation after noticing that the number of bariatric procedures decreased in the three years up to 2016, despite an expanding population and rising rates of obesity.

The body found that seven Clinical Commissioning Groups (CCGs), the organisations responsible for referring patients for surgery, had drawn up criteria in breach of national guidelines. Nice states that surgery should be considered for patients with a BMI over 40, or a BMI of 35 if they have a further illness such as type 2 diabetes.

However, patients in the East Riding of Yorkshire, Vale of York and Nene, Northamptonshire, are being told they must have a BMI of at least 50, while Solihull and Wolverhampton CCGs say patients must have additional illnesses. Mid-Essex is restricting treatment to non-smokers, and North East Essex says smokers must be referred to a cessation service. A further 162 areas due to take control of bariatric commissioning from NHS England next month were found not to have policies in place.

“It typifies the second-class citizen manner in which bariatric patients seem to be viewed by some CCGs,” said Shaw Somers, president of the British Obesity and Metabolic Surgery Society.

An NHS England spokesman said: “Ultimately these are legally decisions for CCGs, but informed by best evidence and national guidance where appropriate.”