Shedding the pounds: Still more to consider

A new report entitled Shedding the Pounds, published this month by the Office of Health Economics, highlights that a failure by the NHS to provide surgical treatment for severe and complex obesity is currently costing the wider economy hundreds of millions of pounds a year from excess costs of disability, social care and inability to work.

ESCO (Experts in Severe and Complex Obesity), an independent multidisciplinary group of experts in obesity management, stresses that in addition to these wider societal costs of not treating severe and complex obesity, there are the direct healthcare costs from obesity-associated diseases such as diabetes, heart disease, obstructive sleep apnoea and certain cancers that are projected to rise to £6.3 billion by 2015.

Mr Alberic Fiennes, ESCO member and president of the British Obesity & Metabolic Surgery Society (BOMSS), comments: "I hope this report goes some way to ensure that everyone is signed up to the idea that however the severe and complex obese became overweight, their inability to lose weight is a dysregulatory disorder not a volitional issue and therefore their disease should be treated on its merit."

We know that bariatric surgery not only has the capacity to induce major weight loss in the long term, but also lead to the remission of diabetes in 84% of cases, sometimes within days, resulting in patients no longer needing costly treatments with drugs such as insulin. Sleep apnoea syndrome - thought to account for 300 deaths on the road each year where patients fall asleep at the wheel - enters remission, and over a seven year period, cancer death rate is halved in patients who have had surgery compared to those who did not.

Professor Nick Finer, Consultant Endocrinologist, Chairman of ESCO and the Education and Management Task Force of the International Association for the Study of Obesity, comments: "Currently 98% of eligible patients do not have access to this treatment, even though the NHS is currently spending approximately £4.3 billion on the consequences of obesity. The health economic outcomes of bariatric surgery are not only positive, but significantly better than non-surgical management, are sustained over at least 15 years and as this new report highlights bariatric surgery can not only be cost-neutral but essentially benefit the economy to the tune of £1.3 billion.

"The issue of severe and complex obesity is often met with prejudice and dogma. Would those who have responded negatively to the use of bariatric surgery prefer to squander NHS resources on chronic and poorly effective treatments of diabetes, liver disease, respiratory disease and obesity-related cancer? In many cases such an approach is far more costly and achieves far less benefit than surgery. Surgical approaches to obesity are not a 'quick-fix' but a serious medical intervention for a serious and often complex disease."

There are currently over one million people in the UK suffering with severe and complex obesity (defined by NICE as a BMI of over 40 or between 35 and 40 if suffering from other significant disease) with approximately a quarter of these both eligible and willing to have the surgery in the UK. However, only 3,600 NHS weight-loss operations were carried out 2009/10.

The rise in obesity is unrelenting and the UK is now the fifth most obese nation in the developed world. The management of this obesity epidemic is currently costing the NHS around £4.3 billion per annum, with indirect healthcare and societal costs estimated at around £16 billion; figures which have been predicted to more than double by 2050.

Professor David Haslam, ESCO member and Chair of The National Obesity Forum, said: "Healthcare professionals working in the field of obesity management are calling for the Department of Health to invest in long term strategies ensuring that patients have equal access to treatment by experienced multi-disciplinary teams in well-equipped centres offering full specialist assessment, and appropriate treatment providing safe long-term follow up and emergency re-admission."

Cost is often cited as a major barrier to NHS managers and other interested parties. However, surgery is cost-effective, and has been shown to pay for itself as a result of reduced drug costs and hospital admissions, this before taking into account the individual's renewed productivity, and benefit - rather than burden - to the economy.

Mr Alberic Fiennes concludes; "In treating the chronic illnesses associated with severe and complex obesity, weight loss surgery helps to make people healthier and more functional, while dramatically reducing the need for and cost of healthcare provision.

"We welcome this supportive report and hope this will prove helpful in further demonstrating the need to address the current inequalities in the treatment and management of the severe and complex obese patient."