Obese patients have as much right to be offered effective treatment as those with other serious diseases such as cancer, yet for some patients the road to life saving stomach surgery is blocked. Research can help clear a path, writes Prof John Wilding, the national specialty lead for metabolic and endocrine disorders at the National Institute for Health Research (NIHR)
Obesity is not the lifestyle choice many would have us believe. Far from it. Tackling the obesity epidemic is not as simple as telling people to eat less and exercise more.
The causes of obesity are complex and include a strong genetic predisposition to weight gain in some people, which is cruelly exposed in our modern world, where high fat, sugary foods are within easy reach and people are too busy to take regular exercise.
Obesity increases the risk of illness and affects quality of life. It is a major public health issue that requires action on so many levels.
Indeed, Chief Nurses have made it a priority in recent years, and nurses continue to play their part in prevention: building strong links with families and communities, identifying those at risk from weight gain and offering advice and support.
“Increasing access to surgery for obese patients is likely to save lives, reduce diabetes and be a cost-effective use of NHS resources”
And as a clinician, I know from experience that for some people with severe and complex obesity the best treatment is bariatric surgery. Yet the myths around obesity are such that surgery is often seen as a ‘quick fix’ and an unnecessary drain on NHS funds.
Too often patients are blamed. This is wrong.
Bariatric surgery can help people reclaim their health. A previous study supported by the NIHR found that increasing access to surgery for obese patients is likely to save lives, reduce diabetes and be a cost-effective use of NHS resources.
Obesity increases the risk of illness and affects quality of life. One in four people in the UK suffer with obesity, with 3.6% of women and 1.8% of men severely obese, and many of these have significant complications such as diabetes and obstructive sleep apnoea.
These numbers are projected to rise.
Yet fewer than 7,000 patients have weight-loss surgery on the NHS each year, when the number entitled exceeds a million. Why? Replace obesity with cancer and it would be national scandal — quite rightly to.
“The one size fits all approach to tackling obesity is not working and in the long run it will end up costing the NHS more”
Currently in the UK NICE recommends that intensive weight management programmes incorporating diet, activity and support for behavioural change are a prerequisite to surgery. Importantly, these programmes provide treatment for those with severe obesity who are not seeking surgery or where surgery is not advised (in some cases sufficient weight loss means surgery is not needed).
Yet across large parts of the country they are not being commissioned. Patients want surgery, they are entitled to it, and we know it’s the best option, but the road ahead is blocked. Research can help us clear a path.
One of the obstacles to getting weight loss services commissioned is a lack of evidence showing their clinical and cost-effectiveness.
Several service evaluations have been published, including our own at Aintree University Hospital in Liverpool, and a systematic review of the available evidence is already underway (led by the NIHR’s Health Technology Assessment Programme), but there remains a dearth of randomised control trial evidence in the non-surgical management of severe and complex obesity.
Bariatric surgery is not the ‘easy’ option. Patients who have surgery have to commit to lifelong changes in their diet and lifestyle, and I have seen first-hand the determination of patients to reclaim their health.
They come to my programme driven by various reasons, not only to help them control complications such as diabetes, but also to help them do things that most of us take for granted such as walking to the bathroom, tying their shoelaces or being able to play with their grandchildren.
The one size fits all approach to tackling obesity is not working and in the long run it will end up costing the NHS more. Whilst prevention is key, those who are already obese (with complications) have as much right to be offered effective interventions as those with other serious diseases such as cancer.
We must prove the value of weight management services to patients, to society, and to the taxpayer. For some patients with severe and complex obesity, research has never mattered more.
Put simply, it’s a matter of life and death.