Bariatric patients see post-surgical increase in earnings out to five years

Patients who received bariatric surgery saw a sustained average increase in earnings from six months to five years after surgery among working-age individuals in England between April 2014 and December 2022, according to a study by the Office of National Statistics (ONS). Importantly, the average increase in pay was largely the result of an increased probability of being in work, rather than an increase in working hours or hourly pay.

Figure 1: There was a sustained average increase in monthly employee pay from six months to five years after bariatric surgery, largely resulting from an increase in the probability of being a paid employee

Although bariatric surgery is the most effective intervention to improve the health of people living with obesity and help prevent the development of obesity associated health conditions, the impact of surgery on labour market outcomes is not well understood.

The researchers used ‘Pay As You Earn’ data (paid by employers directly to employee minus income tax) so the study used employees only, therefore self-employed people are recorded as receiving £0 pay and categorised as not a paid employee for the purposes of this analysis (approximately 13% of working people are self-employed rather than employees, as recorded in the Labour Force Survey). People who are employed but not currently receiving pay (for example, on maternity leave and not receiving maternity pay) were also categorised as not a paid employee. They were unable to distinguish changes in hours worked from hourly pay changes and were not able to distinguish sick pay from regular pay, thus they could not investigate the effects of bariatric surgery on long-term sickness absence.

They used fixed effects regression modelling to estimate average changes in monthly employee pay and employee status that are attributable to bariatric surgery, among working-age individuals in England at different time periods after NHS bariatric surgery compared with the six-month period before the month of surgery.

Sociodemographic information was linked to these individuals from the 2011 Census if available, and the 2021 Census if not. The resultant cohort contained 40,662 individuals who had an NHS bariatric surgery procedure between 1 April 2014 and 31 December 2022, with either a primary diagnosis of obesity or a secondary diagnosis of obesity with a primary diagnosis of an obesity related condition, aged 25 to 64 years at time of surgery and resident in England. 

Outcomes

Among everyone in the dataset (both employees and not), monthly pay initially decreased on average compared with pre-surgery, then reached pre-surgery levels by the fourth month after surgery and continued to increase, reaching an average of £84 more than pre-surgery levels 54 to 60 months after surgery (Figure 1).

Among those in work, very little average change was found in monthly pay up to five years after surgery, suggesting that an increase in working hours or hourly pay was not the main factor behind the average increase in pay, but largely the result of an increased probability of being in work.

The probability of being a paid employee initially decreased after surgery, before increasing to reach 4.3 percentage points higher than pre-surgery levels 54 to 60 months after surgery.

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