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Editorial comment: Bariatric surgery is the wrong target

A report by the Health Select Committee that has criticised NHS England for spending more money on bariatric surgery than on measures to prevent obesity. The authors may argue that the comparison was made to highlight the idiocy in spending more on surgery than prevention. But this misses the point. Comparing spending on obesity prevention to bariatric surgery is an illogical comparison and, in some respects, undermines the many positive aspects of bariatric surgery.

Instead, the report should have compared obesity prevention spending to the funding on preventing heart disease, cancer awareness or stroke education. Given that obesity is a known risk factor for all of these (as well as type 2 diabetes, liver disease, kidney disease, dementia…the list goes on), this would have been a more productive comparison and highlight how weight loss could have a positive impact on many other aspects of people’s health, and ease the strains obesity places on healthcare systems.

According to news reports, the Health Select Committee publication calls for a national lifestyle intervention programme, which if successful could mean that that “bariatric surgery would not be necessary if money was spent more wisely elsewhere.” An honourable intention – but what do we do about the 4% of the population in England that are morbidly obese? The Second National Bariatric Surgery Report published by the British Obesity & Metabolic Surgery Society in December 2015, reported that the average BMI of patients who had surgery was 48.8% and many could not walk three flights of stairs. I am not aware of any life-style intervention programme rolled out on a national scale that that has resulted in substantial and sustained weight loss in obese - never mind morbidly obese - patients (please let me know if you do!).

Are they seriously suggesting we place these patients on a diet and exercise driven lifestyle invention programme? Would this be cheaper and more effective than bariatric surgery?

The fact is that all countries need a coordinated programme of education, much early and targetted life-style intervention programmes and government legislation to curb obesity. We already know that such healthcare-based population initiattives work – just look at how people’s perceptions to tobacco have changed and the subsequent health benefits. This was brought about by a long-term vision realised through education and government legislation.

Preventing obesity (and therefore its associated diseases and conditions) is going to be the healthcare challenge on the 21st Century. It will take a generation before we see noticeable changes, and therefore bariatric surgery must be part of a range of treatments. The battle against obesity must begin with education and, where necessary, government intervention. It should not begin with undermining life-saving bariatric surgery that is helping thousands of people regain control of their lives.

To read the article - UK report: Funding for surgery is inexplicable - please click here