One in four people in the UK suffer with obesity. Severe and complex obesity is a lifelong condition associated with many major medical problems, the costs of which threaten to bankrupt the NHS. The major ailment caused by obesity – type 2 diabetes – is linked to shorter life expectancy, decreased quality of life and increased socio-economic and psychosocial problems. A new report out this week suggests the global cost of treating obesity will rise to $ 1.2tn a year from 2025.
Yet in the UK, less than 1% of those who can benefit from it receive bariatric (sometimes called weight-loss) surgery, such as gastric bypass or gastric banding. So why is a safe, cost-effective therapy for a deadly disease so under-utilised?
For severely obese people, the hormonal effects of being obese mean that medical therapies, lifestyle changes and attempts at dieting rarely succeed in maintaining long-term, clinically beneficial weight loss. It isn’t just surgeons saying this – it is described in guidance by the British Obesity and Metabolic Surgery Society which is endorsed by 21 other professional organisations, including nine medical royal colleges.
The World Health Organisation identifies obesity as a chronic disease. But on the other side we have the popular perception – shared by some healthcare professionals – that it is purely a lifestyle choice. This totally disregards the fact that, driven by powerful food industry advertising, it is those who are poor who are most affected. Our tendency towards obesity is rooted in evolutionary biology: human beings have spent two million years developing a metabolic system which conserves energy in times of scarcity. It is only in the last 70 years that we no longer eat because of hunger alone.
The annual volume of bariatric surgery in the UK – about 5,000 operations a year – is five to 10 times lower compared with other European countries with similar population sizes and disease prevalence. In France, which has a similar population size to the UK, more than 37,000 surgeries are carried out each year. Belgium, with a population of 11.3 million, undertakes 12,000 surgeries while Sweden, with a population of 9.9 million, carries out more than 7,000 a year.
As a practising bariatric surgeon, I and my colleagues believe the social stigma of obesity is holding back the deployment of cost-effective treatments for vulnerable people. Health commissioners are aware of the figures, but remain slow to increase provision. Cost can’t be the issue. Getting a patient off insulin or other expensive anti-diabetes medications is cost-saving within two to three years of surgery: a win-win for the GP, the NHS and the taxpayer. Patients are also more likely to go back to work, and therefore pay more tax and claim fewer benefits.
I believe the problem is that commissioners and medical professionals, like the public, still see obesity as a lifestyle choice, and so blame patients. But there is a point of no return with obesity. There are parallels with other diseases. You may well suggest to someone who is a bit down in various ways for them to try and improve their mood, but once they become clinically depressed expert treatment is needed. We encourage our friends to stop smoking, but we don’t then begrudge them treatment for lung cancer.
Yet the reluctance to treat obesity lingers. Some argue that resources should be directed to prevention rather than treatment. Whenever possible, prevention is obviously better than cure. But this is no longer an option for people who have missed the boat of prevention and have gone on to develop severe, complex obesity with conditions such as diabetes.
Patients should be given quicker access to surgical assessment. If bariatric surgery is right for them, then the sooner the better. We already know that the UK is one of the most obese countries in Europe, and the patients we operate on are the sickest. The NHS should be performing 50,000 surgeries a year, closer to the European average.
To achieve this, health workers must be persuaded to put prejudice to one side and promote surgery where appropriate. GPs and commissioners alike must recognise both the health benefits and cost savings.
All the clinical evidence points to the fact that, as a country, we should be performing more weight-loss surgeries. It is the social stigma of obesity that is holding us back. Making fun of obese people is an endemic societal prejudice, and stigmatisation is allowed – and even encouraged – by the media. It’s time to stop judging and let the experts start treating the condition.
• Richard Welbourn is a consultant bariatric surgeon at Musgrove Park Hospital, Taunton