The net gains of weight-loss surgery

Any issues relating to weight-loss surgery will cause a good deal of media debate, and as expected, the general public were split on many of the issues raised in a report published last year. The report, Shedding the Pounds, was conducted by the Office of Health Economics (OHE) on behalf of the Royal College of Surgeons of England, the National Obesity Forum and several pharmaceutical companies. It was commissioned to provide an economic impact assessment of obesity surgery, and one of its most important findings was that conducting obesity surgery on NHS patients will actually pay for itself within 12 months. It concluded that the failure of the NHS to provide cost-effective surgical treatment for morbid obesity is actually costing the wider economy hundreds of millions of pounds a year. The conclusions of this report have been further backed up by the findings of the first UK report by the National Bariatrics Surgery Registry (NBSR), published in April. The audit includes data from 8710 operations carried out in the NHS and private sector and demonstrates the effects of UK obesity surgery in treating a range of lifethreatening diseases, including an 85.5% reduction in the number of patients with Type 2 diabetes. The figures quoted by the audit record the success rates for four bariatric procedures, including gastric bypass and gastric band. They also demonstrate that obesity surgery is being introduced into the UK safely. An in-hospital mortality rate of 0.1% was recorded, comparing favourably with other forms of established surgery and equaling the best published international data for bariatric surgery. Obesity is a significant and growing issue in England and has been identified as a strategic issue by the Government for at least 10 years. The Department of Health initially commissioned a costof- illness study to enable estimates to be prepared on the costs of obesity in England. The resulting National Audit Office report, Tackling Obesity in England, published in 2001, concluded that obesity accounted for 18 million lost working days due to associated illness and 30,000 deaths in 1998 across England. At this time, the direct cost of treatment for obesity and associated comorbidities was estimated at £480 m, or 1.5% of the total NHS expenditure in England.

Reversing the tide

In 2007 the Comprehensive Spending Review announced its aim that England was to be the first major country “to reverse the rising tide of obesity in the population, by ensuring that all individuals are able to maintain a healthy weight” (Treasury 2007). This aspiration was given a strategic framework with the launch of Healthy Weight, Healthy Lives (Department Health 2008). Much of the focus for this strategy, however, has been directed at children, with a key target to reduce the proportion of overweight and obese children to 2000 levels by 2020. Despite this awareness and the many and varied attempts to reduce obesity levels, the share of the population measured as obese in England continues to increase. Up to a quarter of the population in 2008 was obese, compared to a little less than 20% ten years earlier. The UK currently has the fifth largest rate of obesity among developed nations and the Government has estimated that, on current trends, 60% of all males and 50% of all females will be obese by 2050. These figures indicate that Government targets for tackling the obesity issue are not currently being met. The impact of obesity on the health service and the health of the nation has been recognised by the Department of Health. It estimates that obesity currently costs the NHS £4.3 bn per year. It also reports that obesity has been linked to 10% of all non-smoking cancer deaths. The risk of coronary artery disease increases 3.6 times for each unit increase in BMI, and the risk of developing type 2 diabetes is about 20 times greater for people who are very obese (BMI over 35), compared to individuals with a BMI of between 18 and 25. Indeed, some studies have shown that severely obese individuals are likely to die on average 11 years earlier than those with a healthy weight. The report was put together using data from a number of sources, including government data, National Institute for Health and Clinical Excellence (NICE) clinical guidelines, and published medical literature. It concluded that an increase in the number of weight-loss operations would pay for itself in one year by enabling many patients to return to paid employment.