Spending More On Bariatric Surgery Could Save Millions

I am not a bariatric surgeon. My main clinical interest is in the prevention of obesity related chronic diseases.

I believe strongly that timely psychosocial and medical interventions can help most people successfully manage their weight problem – at a minimum, conservative treatment can help patients at least stop the weight gain.

Unfortunately, this is so far no more than a “belief”. Data from “conservative” weight management interventions pale in comparison to the often spectacular success of surgical treatments.

Not that surgery is the easy way out – patients have to work hard to make surgery work for them – but at least for most people, results are vastly better (and far more likely) than with non-surgical treatments.

So should we be doing more bariatric surgery?

According to a report (Shedding the pounds “Obesity management, NICE guidance and bariatric surgery in England”) released last week by the UK Office of Health Economics, an independent research body, a big increase in bariatric surgery among people who meet the current criteria would pay for itself in one year, by enabling many of them to return to paid employment.

According to this report, around one million people in England currently meet the criteria for bariatric surgery recommended by the National Institute for Health and Clinical Excellence, of whom only 5 to 10 % may actually be eligible for surgery.

If just 5% of eligible patients were to receive bariatric surgery the net gain to the UK economy within three years could be £382m.

Critics of the report point out that it was commissioned by the Royal College of Surgeons of England together with the National Obesity Forum and Allergan and Covidien, companies that make products for obesity surgery.

Critics also note that this money would be better spent on prevention efforts (though they don’t present any data showing that such efforts will actually prevent current costs of people who are already obese).

John Ashton, the chairman of the UK Public Health Association, is quoted in the British Medical Journal as raising the issue of opportunity cost of spending money on surgery that is then not available for other health services and conditions that are not preventable.

This is a moot argument as, irrespective of whether or not obesity is preventable, not spending the money on surgery for those who already have the problem, will just mean spending more money on managing their many complications.

After all, the whole point of the report is to demonstrate that it is far cheaper to treat obesity than to not treat it.

As I have pointed out before, no health system can afford not to treat obesity – the longer we wait, the more it will cost.

Adelphi, MD

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McGauran A (2010). More obesity surgery in England would save money, economic analysis shows. BMJ (Clinical research ed.), 341 PMID: 20826523