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UK report shows disparities in bariatric surgery provision

Report claims inequalities in bariatric care based on a location not need
New analyses on the health outcomes of people who are overweight or obese
Tam Fry from the UK's National Obesity Forum

According to a new report from the UK’s NHS Information Centre, there are still inequalities in bariatric care depending on a patient’s location, rather than need. The report entitled, "Statistics on Obesity, Physical Activity and Diet: England, 2012", presents a comprehensive picture of obesity in the country by combining new analyses on the health outcomes of people who are overweight or obese with a summary of already published diet, exercise and weight-related information. 

The findings confirm earlier reports that whether a patient receives bariatric care is ultimately a ‘postcode lottery’. For example, data reveals that East Midlands had the highest rate of weight-loss stomach surgery with 32 procedures for every 100,000 of the population, compared with the North West had the lowest rate of weight-loss stomach surgery with six procedures for every 100,000 of the population, followed by the East of England and South Central with nine procedures for every 100,000. These significant regional variations in hospital admissions shows that patients in the East Midlands are almost six times more likely to gain access to operations compared with those in the North West and twice as likely as those in Yorkshire. 

In addition, the report also showed that there had been a slight increase in the number of bariatric procedures, although by not the headline figure of 12 per cent some news sources were reporting. The number of hospital procedures for bariatric surgery rose to 8,087 in 2010/11 from 7,214 in 2009/10, a rise of 12 per cent. However, due to changes in procedure coding practices it is now possible to see how many procedures were for the maintenance of an existing band. There were a total of 1,444 such procedures in 2010/11, meaning the actual numbers of procedures was 6,643, although whether this is an increase from 2009/10 is unknown. In Yorkshire, it was noted that the numbers of patients undergoing surgery decreased from 866 in 2009/10 to 837 in 2010/11.

“The regional variations in admissions and surgery are very concerning. Having examined the variations, the forum believes that they illustrate a postcode lottery which still exists in England. It is deplorable,” said Tam Fry, from the National Obesity Forum. “Some primary care trusts abide by National Institute for Health and Clinical Excellence guidance in offering bariatric operation to obese patients but others flout it by making it virtually impossible to qualify for the surgery.”

The report also shows that hospital admissions with a primary diagnosis of obesity rose over the past decade from 1,054 to 11,574. In 2010/11, they rose 1,003 from 10,571 in 2009/10. The number of female admissions with a primary diagnosis of obesity (8,654) was almost three times higher than male admissions (2,919) in 2010/11. Of the regions, the North East had the highest rate of admissions with a primary diagnosis of obesity (40 per 100,000 of the population), followed by the East Midlands (36 per 100,000) and London (35 per 100,000). The South West, South Central and North West had the lowest rates of admission with 14 admissions with a primary diagnosis of obesity for every 100,000 of the population. 

On prescriptions, the report shows that 2010 saw the first recorded decrease in seven years in the number of prescription items dispensed to treat obesity. In the year 1.1 million items were dispensed, a 24 per cent fall on the previous year when 1.4 million items were dispensed. The decrease could reflect the withdrawal from use of two of the three drugs reported on which had been used to treat obesity (sibutramine in 2010 and rimonabant in 2009). 

“The report charts the growing impact of obesity on both people’s health and NHS resources. It also examines changes in physical activity and diet,” said Chief Executive of the NHS Information Centre Tim Straughan. “Those working in this field may want to examine closely the findings of the report, including the significant regional variations that appear to exist in both the admissions for obesity and those for weight-loss stomach surgery.” 

In November 2011, UK Health Secretary Andrew Lansley announced a “national ambition” to bring down obesity levels by 2020, although he ruled out regulating against the food industry and urged people to take responsibility for their own health. 

A Department of Health spokesman said: “We want people to live healthier lives so they do not need to resort to surgery. We are working with charities, local government and industry to make it easier for people to make better choices.

However, campaigners seeking greater action and increased resources claim the Government campaign to tackle obesity is woefully inadequate and amounts to little more than telling people to eat less.

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