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Access to surgery

Access to surgery would improve health of thousands

Surgery could potentially prevent and/or resolve tens of thousands of cases of hypertension and type 2 diabetes in the UK

Bariatric surgery can reduce the risk of developing serious health conditions such as heart attacks and type 2 diabetes, as well improve existing conditions, according to a study published in PLOS Medicine. The paper, ‘Bariatric Surgery in the United Kingdom: A Cohort Study of Weight Loss and Clinical Outcomes in Routine Clinical Care’, is the result of the largest comprehensive study of longer-term outcomes post-surgery in the UK, and the paper suggests that widening the availability of bariatric surgery could boost the health prospects for thousands of people who are severely obese (BMI>40).

Rachel Batterham

The research, led by the London School of Hygiene & Tropical Medicine in partnership with UCL and the UCLH Bariatric Centre for Weight Management and Metabolic Surgery, London, UK, states that bariatric surgery could potentially be used to prevent and/or resolve tens of thousands of cases of hypertension and type 2 diabetes, as well as prevent other obesity-related illnesses among the estimated 1.4 million morbidly obese people in the UK.

"Bariatric surgery is safe and produces unrivalled health benefits that are life-changing for patients and cost-saving for the NHS,” said study co-author, Professor Rachel Batterham, Head of the UCLH Bariatric Centre for Weight Management and Metabolic Surgery and the UCL Centre for Obesity Research. “Unfortunately, less than 1% of the patients who could benefit from this surgery currently receive surgery. This represents a major missed opportunity in terms of improving health and economic savings. Action is now needed to remedy this situation."

Using primary care records, the researchers compared weight, BMI and obesity-related illnesses between 3,882 bariatric surgery patients and similar control patients who did not have surgery, over an average period of three and a half years. They found that weight-loss surgery can significantly improve existing type 2 diabetes and reduce abnormally high blood pressure.

They also applied the findings to estimate that if the 1.4 million people believed to be morbidly obese in the UK had bariatric surgery, it could prevent;

  • 80,000 cases of hypertension
  • 40,000 cases of type 2 diabetes, and;
  • 5,000 heart attacks over a four year period

They also report that 110,000 people with type 2 diabetes and 13,000 people with hypertension could significantly improve their condition.

"Obesity is one of the biggest health problems of our generation. Rates of cardiovascular disease, although slowly declining, are still alarmingly high while type 2 diabetes is on the rise, affecting 3.5 million people in Britain. Finding effective ways to tackle the obesity crisis is therefore a key public health strategy,” said lead author, Dr Ian Douglas from the London School of Hygiene & Tropical Medicine. “Whilst effective prevention is clearly needed, our findings show that as well as helping patients substantially lose weight, bariatric surgery improves serious obesity-related illnesses as well as reducing the risk of developing them. People having weight-loss surgery were 70% less likely to have a heart attack, and those with type 2 diabetes were nine times more likely to see major improvements in their diabetes. We also found positive effects on angina and the debilitating condition obstructive sleep apnoea.”

They also found that gastric bypass and sleeve gastrectomy were associated with greater weight loss than gastric band, with estimated four year weight loss of 38kg for gastric bypass, 31kg for sleeve gastrectomy and 20kg for gastric banding.

“Although we acknowledge that not all patients are suitable for bariatric surgery, it appears that better access to bariatric surgery, where appropriate, could lead to a considerable reduction in the burden of disease and substantial cost savings for the health system,” the authors write. “…Resolution of T2DM and hypertension was more common in people receiving gastric bypass or sleeve gastrectomy than in those undergoing gastric band surgery. For other outcomes, there was little evidence of differential associations by surgery type.”

To access this paper, please click here

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