The UK’s National Obesity Forum has criticised a Welsh health board for insisting that severely overweight patients have to go on weight management courses before undergoing non-urgent surgery, claiming that the policy is expensive and could yield few benefits.
It has long been accepted as conventional wisdom that obese patients applying to the NHS for funding to undergo weight loss surgery have to be subjected to various weight management programs, psychological assessment and other increasingly difficult hurdles to jump over.
On the face of it, it seems the health authorities have obese individual’s welfare at heart. The expectation is that people will show their motivation and commitment to surgery by losing weight and responding to all the assessments in a positive way which would “entitle” them to have the privilege of being considered for surgery. In reality it is probably a mechanism to ensure that the numbers of patients going through for surgery is limited and hence limiting the pull on the government’s purse strings.
By examining the evidence, most observers have now arrived at a conclusion that all pre-surgery obstacles are probably unnecessary. The best weight management programs including diet, exercise and behaviour therapy in combination rarely achieve a 10% weight reduction in closely controlled studies. This is hardly the solution that obese individuals with a BMI of 40 or above are looking to achieve. Furthermore, long term studies have shown that the incidence of weight regain following successful weight management, otherwise known as the “yo-yo” effect is considerable.
On the other hand, studies comparing weight management to weight loss surgery have shown how effective surgery can be with an expected 50-80% of excess weight lost according to the type of procedure and patient compliance.
There is no doubt that the financial situation has put considerable strain on NHS resources and as a consequence weight loss surgery will have to be rationed for the time being. However by adding an extra layer of pre-surgery assessments and weight management courses, this only serves to dishearten obese individuals seeking surgery and increases the overall cost to the NHS for an intervention which is not proven to yield any benefit.
Pre-surgery hurdles should be abolished and regional quotas introduced which would mean that heavier patients with multiple medical conditions would be given priority. In the future, more funds should be channelled to prevention and early surgery.
“In the end I think it is just wasting money because, of course, these courses are going to cost the NHS as well,” said Tam Fry, spokesman for the National Obesity Forum. “We don’t know what the course is and whether, or how successful they will be. Then, during the course, the dropout rate may be quite high and you’ve wasted that money as well. Why bother to go through this, in my opinion.”
By Ahmed Hamouda. Bariatric Surgeon at Weight Loss Surgery Kent. You can find him on Google+.