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Policy initiative

Pre-surgical weight loss courses criticised

Patients needing bariatric surgery may be excluded from the weight management intervention.

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.

The Cardiff and Vale University Health Board approved an ‘optimising outcomes’ policy, under which any patient listed for elective surgery that has a BMI >40 or more will have to be offered, accept and complete weight management support programmes before being put on the waiting list.

Health board officials claim that the intervention programme is not intended to increase waiting times for surgery as it could take place while patients are waiting to be referred. They added that patients do not have to lose weight following the intervention course, but they hoped the scheme would lead to more long-term improvements in patients’ health.

Tam Fry

“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."

Exclusions will apply to patients needing emergency surgery and surgery for cancer treatment and if the need for surgery becomes urgent, patients will not be required to complete the programme.

“If you had high blood pressure we would ask you to go on a course of blood pressure tablets, we might ask you to go on - if you are stressed, stress-management or whatever, to take down that blood pressure,” said Dr Sharon Hopkins, director of public health at the Health Board. "Patients would be quite happy to do that, because people understand very well that high blood pressure is not a good thing to have. It is absolutely the same with weight management. Anything you can do to help you have a better weight prior to any surgery gives you a better outcome."

Patients needing bariatric surgery and those who have hormone-related conditions that make them medically unsuitable, may also be excluded from the weight management intervention.

"What these patients clearly need is bariatric surgery, which will be up to 40-50%. You are really just putting off the inevitable,” added Fry. “Our advice is that they should accept that the patient is extremely obese, act promptly now and that will start to save volumes of money for the NHS in the future. What you are really doing is putting a three-month barrier in their way - what is the purpose of that? Give them the surgery now, have it done and dusted, and they and the NHS will benefit in the long run."

“Healthcare is not something that you have done to you, it’s something that you participate in,” said Dr Mark Temple, co-chair of the British Medical Association’s public health medicine committee. “What the health board is asking the population that they care for to do is to help them to look after them. If we are going to get the best out of each other then we all need to be prepared to give assistance to each other.”

The health board is now working with GPs, community services and intervention programmes to develop the plan and a prototype is being tested by four GPs in the region.

“Healthcare professionals routinely manage clinical risks such as blood pressure before an operation, this is done in order to make sure that people experience the best possible outcomes both during and after surgery,” said Dr Sian Griffiths, a public health consultant and author of a report which was presented to the Board. “This will help people prepare as best they can for surgery by participating in programmes to support risk factor understanding and reduction. It will encourage people to consider the risks and give an opportunity to participate in support change programmes.”

The test phase is expected to continue over the next three months.

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