The great weight debate: should you have gastric surgery on the NHS?
With obesity one of the biggest risk factors in developing coronavirus, Luke Mintz asks if it’s time we took more drastic measures to shape up
Aisha Walker had largely “fallen out of love with life” when she opted for weight-loss surgery at the age of 41. She weighed 15 stone and had suffered for nearly two decades from type 2 diabetes, as well as tendinitis in both of her knees. In 2017, she decided to pay £11,000 at a private clinic for a mini-gastric bypass, in which most of her stomach was removed.
It was an easy decision to make, remembers Walker, a mother-of-one from Kent. “I hated who I was. I didn’t want to be diabetic any more, I was sick of feeling ill and not being able to do anything. It was a very different life to the one I live now.”
She lost 6st after the operation, and her diabetes quickly went into remission, where it has remained ever since. The decision seems like a particularly good one now, she says, in light of the growing body of evidence that obesity is a major risk factor for coronavirus, with obese patients who develop Covid-19 far more likely to become seriously ill or die.
In a study of nearly 17,000 Covid patients in UK hospitals, those who were obese – with a body mass index (BMI) of more than 30 – had a 33 per cent increased chance of dying compared with those who were not obese. Another study found that 73 per cent of Covid patients in intensive care were either overweight or obese, compared with 64 per cent in the UK population.
Frightened by the pandemic, many are now looking to lose weight fast – and surgery seems like a convenient fix. Bariatric clinics say they have seen a surge in enquiries during the pandemic, and Walker has witnessed a flurry of activity on her website, The Gastric Guru, which she created after her operation so that others could share their experiences.
Doctors have called for a rapid expansion in Nhs-funded weight-loss surgery as a potential “quick fix” to loosen the impact of Covid over the next year or two, before scientists develop a vaccine. They hope their message will fall on receptive ears in Downing Street, where Boris Johnson reportedly told colleagues that he is preparing a “more interventionist” drive against obesity, following his own brush with the virus last month. The Prime Minister is said to have become convinced that his weight is the reason he ended up in intensive care while his colleagues suffered only mild symptoms – at 17.5 stone, Mr Johnson’s BMI is around 36, well above the threshold for obesity.
For NHS surgery, a patient needs a BMI of 40 or above; or a BMI of 35 or above with an obesity-related illness, such as diabetes or heart disease. Options include gastric band surgery, in which a rubber ring is placed around the top of the stomach, helping to soothe a patient’s hunger; a sleeve gastrectomy, in which 80 per cent of the stomach is removed, leaving just a thin “sleeve” through which food can pass; and a gastric bypass, in which the stomach is “short-circuited”.
It is a major operation, and patients are advised that, in a very small number of cases, they might be left with gallstones or a blood clot in the leg, or with extra folds of skin that might require extra surgery to remove. But most patients recover within a few days, doctors say. Those who do not want surgery can take a gastric balloon – a tablet which inflates inside a patient’s stomach, preventing them from feeling hungry. It starts to deflate after four months.
NHS patients have to be referred through a weight-management clinic, known as “Tier Three services”, and waiting lists can stretch to a year or more. Alternatively, patients can pay for a private procedure – a bypass typically costs about £9,000 to £9,500, doctors say.
Professor David Kerrigan, president of the British Obesity and Metabolic Surgery Society, says his private clinic, Phoenix Health, now receives about 50 inquiries a week, despite doing no advertising – “definitely far more than we normally would”. Weight-loss surgery is currently on hold due to the pandemic, but Prof Kerrigan expects a drastic increase in bookings once treatment resumes, maybe in July.
He wants the number of bariatric procedures carried out annually in the UK to rise from its current 6,000 to about 20,000 – “a modest increase”, he says, given that France carries out about 60,000 each year, despite having a similar number of obese people to the UK.
“It’s been looked at by the National Institute for Health and Care Excellence and it’s one of the most cost-effective treatments there is,” he says. “It works, and the UK is one of the safest places to have bariatric surgery.”
The issue is a thorny and emotive one. Despite a lot of evidence now pointing to the role of genetics and epigenetics, there are many who still regard obesity as a lifestyle issue, and do not think taxpayers should have to foot the bill. On the other side of the debate are “fat acceptance” campaigners, who dislike attempts to medicalise what they regard as a natural and healthy way of life.
“It’s a political hot potato, and there’s a lot of vitriol out there,” says Prof Kerrigan. “[People ask]: ‘Why should the NHS spend money on these people, and why don’t they just fund it for themselves?’ The fact is, obesity is not simply a lifestyle choice. There is strong scientific evidence that the drivers behind it are very complex, and genetics play a part in the way it interacts with our current environment.”
Weight-loss surgery also has a strong record against type 2 diabetes, he adds, which eats up about a tenth of the NHS’S overall budget.
Shaw Sommers, a consultant bariatric surgeon, says his private clinic has also seen a sharp increase in inquiries. He thinks the NHS’S focus on preventive measures such as diet and exercise does little to help the very fattest of patients, those with a BMI over 40.
He says that surgery also makes financial sense, with obesity and its related illnesses costing the NHS about £4.3 billion each year.
“There are certain genetically prone individuals who come from a family of heavy people, and it’s looking more and more likely that their weight regulation mechanism doesn’t work any more,” says Sommers. “It’s not just gluttony – these people can’t regulate their own weight because they still feel hungry even when they’re fat. It’s a proper illness. And for them, the only thing that currently works is either intensive drug treatment or surgery.”
But not all doctors are convinced. With 27 per cent of English adults classed as obese (and similar figures in the UK’S other nations), any attempt to expand weight-loss surgery would heap further pressure on an already burdened NHS budget. Some believe it makes more sense to plough that money into a mass preventive programme, including free weightloss classes for all overweight adults. In 2014, a group of surgeons criticised NHS plans to expand weight-loss surgery as “nonsensical”, and Diabetes UK said it is the right option only for “a very small number” of patients.
Becky Barnes, who weighed
24 stone in her twenties, says she regrets her decision to get a gastric bypass. Recounting her experience for the Plus Size website, Barnes says she lost 8 stone within 18 months of the procedure, but was then left “devastated” when her weight loss plateaued. She began to feel weak, and her health took a hit – she now believes she was absorbing very few nutrients after surgery.
Yet for others it is transformative. Walker is adamant that she would find the pandemic much more frightening had she not had her mini-gastric bypass three years ago. She believes her life improved dramatically after the operation.
“In work environments, in people’s attitudes towards you, in relationships, in doors being opened – it’s only really from having surgery that you realise how different life is.”
‘It’s not just gluttony – they just can’t regulate their own weight’