Decline in the number of patients seeking private BMS in the UK

There has been a marked decline in the number of patients seeking private bariatric and metabolic surgery (BMS) in the UK, from 5,900 in 2022 to 5,600 in 2023, according to a report, ‘Worth the weight? An analysis of weight loss surgery in England 2016 – 2023’, published by the Private Healthcare Information Network (PHIN). This latest report provides an analysis of BMS, in the independent healthcare sector in the UK, covering the years 2016 to 2023.

The report examines the annual trends of admission BMS, the variation across sex and age groups, the setting of surgery (i.e. inpatient or daycase) and the regional distribution of private surgery across the UK. In addition, the report includes procedural numbers on gastric bypass, sleeve gastrectomy, gastric banding and gastric balloons.

Between 2016 and 2023, there were over six million private care admissions recorded across all procedures. In total 31,500 (under 1%) of those admissions were for a BMS (the largest procedure reported by PHIN was cataract surgery which had 491,705 (7.5%) admissions).

In 2019 before the pandemic, peaked with 3,500 admissions (Figure 1). In 2022, there were 5,900 admissions, marking the highest peak before a decline. Admissions increased from 2,800 to 5,300 between 2020 and 2021 due to the backlog of elective procedures caused by pandemic lockdowns. The higher level of activity continued into 2022 with 5,900 admissions, exceeding any pre-pandemic year.

Figure 1: BMS admission by year, 2016-23

By comparison, the UK NBSR reported an average of 4,744 cases per year undertaken in the NHS between 2010 and 20193. In 2020, BMS increased as a proportion of all admissions despite the total number of admissions decreasing.

Omar Khan

“This report provides a valuable insight into the trends and regional variations in private bariatric surgery, offering analysis of over 31,500 admissions that will be beneficial to patients, healthcare providers and national bodies,” writes Professor Omar Khan (a Consultant Surgeon in Gastrointestinal and Bariatric Surgery and Chair of the National Bariatric Surgery Registry Committee (NBSR)) in a Foreword in the report. “It also mirrors some of the trends reported by the NBSR with for example the increasing popularity of sleeve gastrectomy over gastric banding.”

The report notes that when comparing 2019 and 2023, two years that were less impacted by the pandemic, the total number of weight loss surgery admissions increased by 40% from 3,500 in 2019 to 5,600 in 2023 (Figure 2). Although there was a peak in Q3 2021 (1,615 admissions), the data indicates a 21% decrease in weight loss surgery admissions from then to Q4 2023 (1,260).

Figure 2: BMS private admission by quarter, 2016-23

In 2023, there was a decrease of 6% for the first time since 2020. In contrast, the increase in 2022 was 11%, which was significantly smaller than the 94% increase observed in 2021 following the post-COVID period.

In the UK, the report found that only two private medical insurers offered partial coverage for BMS in their policies and had multiple eligibility criteria for a patient to obtain approval. Therefore, typically patients will use self-pay to fund their private BMS.

The age group with the highest private BMS activity is aged 35-39 and as reflected in the literature, the majority are female (the split was an average 84.5% female to 14.5% male). Likewise, sleeve gastrectomy is the most common bariatric procedure since and by a significant margin (153% higher than the second highest procedure, gastric bypass - Table 1).

Table 1: Bariatric procedures by volume and % of all bariatric admissions (2016-23)

Between 2016 and 2023, sleeve gastrectomy became the dominant procedure of BMS, rising from 46% to 71%. In contrast, gastric banding reduced from 36% in 2016 to only 5% in 2023. Comparing 2023 against 2019, sleeve gastrectomy increased 127% and bypass operations by 64%. However, gastric banding decreased by 70%. Since 2021, PHIN reported a decrease in admissions for gastric balloon insertion from 900 to 700.

Bariatric surgery is delivered predominantly in the inpatient setting. The report highlights that:

• 81.4% of bariatric surgery are delivered as inpatient

• 99.4% of sleeve gastrectomy surgery are delivered as inpatient

• 99.5% of bypass operations are delivered as inpatient

• 42.2% of gastric banding admissions are daycase

With regards to regional variations, London (17%) and the South East (17%) are the leading regions for the delivery of BMS, corresponding to the broader distribution of all private hospital admissions. The percentage of BMS admissions is higher in the West Midlands (11%) and North West (15%), compared to their market share of all hospital admissions. In contrast, London had 17% of weight loss admissions, but 32% of the total private activity.

The North West, West Midlands, Yorkshire and Humber, East Midlands and North West have higher rates of BMS compared to their share of total private admissions. However, the report highlights that this does not reflect obesity prevalence in England but rather the delivery of private bariatric services. The East of England, South West and North East also show high obesity rates higher than London, not reflected in independent sector activity. The difference between obesity rates and patient locations indicates that private bariatric surgery services may not correspond with their local population.

PHIN also produces its quarterly Private Healthcare Market Update as part of its work to increase transparency in the healthcare sector and ensure that ‘Everyone can make confident choices about their healthcare to get the best outcomes’.

To access the report, please click here to visit the PHIN website (link at the bottom of the page)