Obese Scots die waiting for surgery during pandemic
Leading surgeon warns a number of patients have passed away due to op delays – with some now so overweight they are ‘no longer fit for anaesthetic’
OBESE patients have “died waiting” for weight-loss operations during the pandemic, according to one of Scotland’s leading bariatric surgeons.
Professor Majid Ali said the few procedures which have taken place over the past two years are mostly the result of patients requiring emergency surgery as a result of complications suffered after they paid to undergo treatment privately abroad. He said: “Patients suffered and because of the long waiting lists they are no longer fit for anaesthetic.
“Some of them, their diseases progressed – complications due to diabetes increased, became uncontrolled, for some of them heart disease progressed over the past two years, and some of them died while waiting for an operation.
“These things happened all over Scotland and will have happened all over Britain, and probably Europe too.”
Prof Ali, who was speaking to The Herald on Sunday in a personal capacity, heads up the department of surgical specialities and endoscopy at University Hospital Ayrshire – one of four main NHS bariatric centres in Scotland.
Gastric surgery
WEIGHT loss procedures including gastric bands, gastric balloons, and gastric sleeves reduce the size of the stomach so that less food is eaten and digested. In other operations the intestines can be bypassed to reduce absorption of food.
The number of procedures being performed on the NHS had been increasing pre-pandemic, but was still limited to those with BMI of 35 or above who also have Type 2 diabetes, sleep apnoea or, occasionally, who are on a waiting list for hip or knee replacements that cannot proceed unless they lose weight.
Prof Ali said his own unit had gone from performing 40-50 bariatric operations a year on average before Covid to “maybe one or two in the whole of the pandemic” as elective surgery was cut back.
Most of the patients receiving bariatric surgery in Scotland over the past two years had paid for private operations which had gone wrong, he added.
He said: “Because of NHS regulations, they went to Turkey or Poland or other places where it’s cheaper.
“It’s not a small number, it’s become a trend. A lot of them have gone to Turkey and had the operation there but the package isn’t right, some of them develop complications, and we have to operate on them to try to sort out these complications. They are desperate, that’s the reason. Our criteria is very restrictive and the majority of patients are rejected for treatment on the NHS.
“In Turkey, the price is about a third of what it is in the UK, but you are going to a ‘shop’ – you are not getting a complete package of medical services so they end up with serious complications.”
Prof Ali said patients awaiting bariatric surgery on the NHS have been “shoved to the end of the queue” as a result of the pandemic, and were unlikely to be prioritised in future despite evidence that the operations cut costs for the health service long-term.
“Obesity is a complex disease which comes at a huge cost to the NHS and taxpayers if left untreated, but bariatric patients are still seen unfortunately by some clinicians as ‘cosmetic’ surgery – life quality operations, instead of lifesaving operations.
“The managers and the budget holders don’t see bariatric surgery as a priority at all, unfortunately.”
Obesity crisis
THE crisis facing bariatric surgery has coincided with a spiralling obesity crisis. In 2018, the Scottish Government set a target to halve childhood obesity by 2030, but figures published in December show that 15.5 per cent of Primary One children were at risk of obesity in 2020/21 – up from 10% in the year before the pandemic.
Overall, rates of overweight and obesity in P1 children were rising faster than at any point since monitoring began in 2001, and the obesity gap between the poorest and most affluent pupils is now wider than ever, at 21% and 8% respectively.
Maternal obesity rates in 2021 were the highest on record, with 54% of expectant mothers overweight or obese, and 35% of all adults reporting they had gained weight during the first lockdown.
However, the pandemic also saw legislation to transform Scotland’s food environment paused by the Scottish Government in June 2020 amid concerns over the impact on businesses and retailers already adversely affected by Covid restrictions.
The plans – hailed as trailblazing when they were first mooted in 2017 – would have seen bans on supermarket junk food promotions, mandatory calorie labelling on menus, caps on portion sizes for takeaways, and curbs on “upselling” (where consumers get more for their money if they upgrade to a larger size).
The Scottish Government says it remains “committed” to introducing legislation to restrict the promotion of foods high in fat, sugar or salt during this
Because of NHS regulations, they went to Turkey or Poland. They are desperate, that’s the reason. Our criteria is very restrictive and the majority are rejected for treatment
Parliament, and “will consult again this spring”.
A spokesman added: “We want to make it easier for people to make healthier choices and to reduce health harm caused by poor diet and excess weight which is why we will also consult on the introduction of mandatory calorie labelling.”
Meanwhile, patients with obesity – especially those in their 40s and 50s, independent of other risk factors such as diabetes – have been significantly more likely than their healthy weight peers to become seriously ill or die as a result of Covid, for reasons that are still not fully understood.
“Covid has made a bad situation worse,” said Dr Andrew Fraser, steering group chair for Obesity Action Scotland.
“Before Covid we were drifting, we were flatlining, we weren’t going in the right direction. Covid has blown us right off course.”
He said the years ahead will require “transformative and radical” interventions to turn the crisis around.
Prevention ‘key’
PREVENTION at the earliest possible stage – even pre-conception – is key, he added. “The children who are going to be in P1 by 2030 aren’t born yet,” said Dr Fraser. “Their mothers are three years short of having them.
“We have to take measures immediately to get people – mothers and fathers – into shape to have babies that, from day one, have a good chance of being of normal weight. Not even from day one, from in utero. The health of people of reproductive age is extremely important to improve the health of people going to school, because by the time they get to school it’s kind of late.”
Measures should also be “tilted proportionately”, said Dr Fraser, to benefit those in the poorest neighbourhoods where takeaways, fast food outlets and off-licences tend to cluster, and access to fresh food is more expensive.
He said: “In poorer areas and rural areas the cost of food – fresh fruit and vegetables – is three times the price compared to wealthier areas, it’s not available, it’s not attractive.
“We have a bigger obesity problem than other countries so we have to be more radical in tackling it, and that goes down to what people choose to buy and whether people can afford nutritious food. That’s a huge issue.”
New drug
TAM Fry, chair of the National Obesity Forum, said the “only good news” for patients with obesity is the recent decision by NICE to recommend an appetite suppressant for prescription on the NHS in England and Wales.
Advice for NHS Scotland will be issued separately, by the Scottish Medicines Consortium.
The drug was dubbed a “gamechanger” after trials showed that patients taking semaglutide (brand name Wegovy) lost 12% more weight compared to those on a placebo.
As for the UK’s approach to bariatric surgery, Fry blasts it as “absolutely crazy”.
“Bariatric surgery has been shown for years and years to pay for itself. It might cost a bit of money – £5,0006,000 – at the initial stage of the operation, but by preventing people becoming fatter and fatter, which bariatric surgery is very successful at, you are lessening the chance that you will have to pay more for the very expensive treatment of diabetes, cancer and heart problems.
“It is woeful that bariatric surgery has been cut back in this way. France, which is about the same population as England, does something like two to three times more bariatric surgery, because they’ve seen the light.
“We haven’t, and we’re suffering as a result. Everywhere you turn in the obesity problem there are stupid decisions being made.”
A spokesman for the Scottish Government said: “We understand it has been difficult for those who are waiting for treatment but as we see Covid-19 case numbers falling we are focused on remobilising services impacted by the challenges of the pandemic.”