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Bariatric Surgery in europe

Europe: Variations in bariatric surgery care

The most common bariatric surgery procedure in all countries was gastric bypass
The countries performing the most number of procedures were Belgium, Sweden and France

The clinical indications for bariatric surgery vary throughout Europe, with its use and funding also contrasting greatly between countries; these are some of the key findings from a paper published in Obesity Surgery.

Although bariatric surgery is known to be the most effective treatment for severe obesity, not much is known about the relative use of bariatric surgery in European countries, the authors note. As a result they evaluated and compared the utilisation of bariatric surgery, endorsement (by professional societies) reimbursement in Belgium, Denmark, England, France, Germany, Italy and Sweden.

Apart from Denmark and England, the criteria for surgery is BMI 40 with no serious comorbidities. For patients with comorbidities, the minimum BMI for all countries is 35. The most common comorbidities include

  • type 2 diabetes (all countries)
  • hypertension (all countries except Sweden)
  • knee osteoarthritis (Denmark, France, Italy, Sweden, and England) ;and
  • obstructive sleep apnoea (Belgium, Denmark, France, and Sweden).

The most common bariatric surgery procedure (Figure 1) was gastric bypass and this was evident in all countries, with the most procedures in Sweden (98 %), Denmark (96%) and Belgium (80%), whilst banding was only significantly performed in France (19 %), England (21%) and Italy (37%).

Figure 1: Number of bariatric surgeries performed in European countries. Note: types of surgery are plotted against the left vertical axis. Circles represent number of surgeries per 1 million of the population in each country and are plotted against the right vertical axis

The countries performing the most number of procedures were Belgium, Sweden and France. These countries also had the highest level of spending on bariatric surgery as a total spending per capita. Not surprisingly, the paper states that despite its effectiveness the provision of bariatric surgery is still far below demand.

Although there appears to be “strong agreement on the clinical guidelines” the indications for surgery differs between the countries. The authors note that some of these indications are against the latest data available. For example, in Denmark the coverage of surgery were raised to a BMI entry level of 50, and England has insisted on mandatory preoperative weight loss programs for which no supporting evidence exists.

“These changes are not consistent with the current evidence demonstrating the clinical benefit of bariatric surgery in patients with morbid obesity,” the authors note. “If left untreated, these patients have significant unmet needs and careful consideration of the clinical, and economic impact of policy changes is required.”

Although the study did not compare outcomes of bariatric surgery in different countries, the conclude that: “There are significant variations in the clinical indications, use, and funding of bariatric surgery in European countries. The update and revision of current clinical recommendations, based on the latest evidence available, are required to ensure optimal access to effective treatment options.”

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