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Obese Suffering Avoidable Disease and Disability

Author: Royal College of Surgeons of England

Published: 2011-04-15


Patients with severe obesity face premature death disease and disability as a direct result of their condition which could be prevented or eliminated.

Main Digest

Obese Patients Suffering Avoidable Disease And Disability, Reveals First Ever UK Bariatric Surgery Audit.

Patients with severe obesity face premature death, disease and disability brought on as a direct result of their condition which could be prevented or eliminated following surgery.

The first UK report by the National Bariatric Surgery Registry (NBSR), published Wednesday April 13, 2011, includes data from 8710 operations carried out in the NHS and private sector.

The data shows for the first time the effects of UK obesity surgery in treating a whole range of life-threatening diseases, including an 85.5 per cent reduction in the number of patients with Type 2 Diabetes.

Surgeons say the figures provide yet more evidence that obesity surgery is one of the most clinically effective, safe and cost effective treatments available to the NHS.

Data from 86 hospitals show that, by the time they reach surgery, around two thirds of severely obese patients (those with a body mass index of 50+) will have three or more associated diseases, with one in ten having five or more.

Almost three quarters of patients have limited function:

unable to climb 3 flights of stairs without resting;

a third have high blood pressure;

over a quarter have diabetes;

nearly a fifth have high cholesterol;

one sixth suffer from sleep apnea.

Of patients with a 12 month follow up, figures show that as well as losing on, average, 57.8 per cent of excess weight, improvement is recorded in all associated disease.

% of patients with Co-morbiditiesType 2 diabetesHypertensionHigh cholesterolSleep apneaImpaired functional status
Before Surgery26.8%31.6%16.8%14.6%70.7%
12 months after surgery13.2%20.4%8.2%6.1%36.2%

For patients at a two-year follow up, the audit shows that 85.5 per cent of those affected by diabetes prior to surgery show no indication of the disease. Long term sufferers - some of whom have had the disease for more than ten years - take the longest to go into remission. This highlights that the best health gains for patients are to be made by operating early in the disease progression.

The figures, which record the success rates for four bariatric procedures, including gastric bypass and gastric band, also demonstrate that obesity surgery is being introduced into the UK safely. An in-hospital mortality rate of just 0.1 per cent, compares favorably with other forms of established surgery and equals the best published international data for bariatric surgery.

This UK based audit gives the clearest indication yet of the cost benefits to the NHS, particularly when considering bariatric surgery for the obese diabetic patient. Research shows that the cost of bariatric surgery is recouped within three years of surgery as obesity associated costs are eliminated, with diabetes alone estimated to cost the health service £3,000 per patient per year for life, while the direct costs of treating obesity related illness is £5bn per year, and set to double by 2050. Currently NICE guidelines state that people with a body mass index (BMI) of 40 or more or those with a BMI of 35 plus associated diseases should be considered for surgery.

Surgeons are calling for the Department of Health to invest in a long term strategy to ensure that all patients have equal access to treatment delivered by experienced teams, working out of properly equipped centers that can offer a full specialist assessment and a full range of treatment options. Providers of bariatric surgery must also be able to offer safe long-term follow up, emergency re-admission and commitment to audit.

Alberic Fiennes, Bariatric Surgeon and Chair of the NBSR Data Committee, said:

"This data shows that not only is UK bariatric surgery safe but it successfully treats a whole range of diseases ,including the rapid resolution of diabetes, yet commissioners continue to ignore the facts. An approach that limits treatment to a fraction of those who would benefit is one which the NHS will rue in years to come as these patients become an unsustainable burden on the health service. Prevention strategy alone has proved ineffective; there are at least two generations of morbidly obese patients who are now presenting with diabetes, stroke, heart disease and cancer for whom preventative measures are utterly irrelevant. The numbers are increasing - these people need to be treated."

David Haslam, GP and Clinical Director of the National Obesity Forum, said:

"Not only is this audit important in detailing the problems associated with obesity, it also outlines the remarkable benefits that bariatric surgery is routinely inducing. It is particularly timely, coming whilst the rules of engagement of GP commissioning are evolving - an era of immense opportunity for GPs to shake off the shackles of specialist and PCT commissioning and ensure that these methods of surgery are embraced to their full potential."

John Black, President of the Royal College of Surgeons said:

"This audit provides unquestionable evidence that bariatric surgery is cost-effective when the billions of pounds spent in the NHS treating obesity related problems are taken into account. It is a false economy to cut funding for this type of surgery. Any short term savings are tiny compared with the real ongoing cost of treating obese patients. We call upon the Department of Health to promote bariatric surgery. A modest amount of immediate expenditure provides massive returns very quickly, and it makes economic as well as clinical sense."

The National Bariatric Surgery Registry (NBSR) is operated as a consortium of the Association of Laparoscopic Surgeons (ALS), the Association of Upper Gastrointestinal Surgeons (AUGIS) and the British Obesity and Metabolic Surgical Society (BOMSS), and the reports are published jointly between the Associations and Dendrite Clinical Systems Ltd.

The operations reported were carried out between 1st April 2008 and 31st March 2010.

The Fourth EACTS Adult Cardiac Surgery Database Report, published by Dendrite Clinical Systems, has analyses based on just over one million cardiac surgical operations from 366 hospitals based in 29 countries. The report demonstrates regional and country-specific variations and global trends in some important determinants of patient outcomes. There are also references to and comparisons against World Health Organization data.

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