UK Debate: Are People with Obesity Worth It?

Are people with obesity and newly diagnosed type 2 diabetes worth a substantial investment in bariatric surgery? This question is woven into a vigorous debate about new bariatric surgery guidelines from the UK’s National Institute for Health and Care Excellence (NICE). Under draft guidelines recently published by NICE, a much broader patient population would be considered for bariatric surgery by the National Health Service (NHS).

The new guidelines suggest that people with a BMI between 30 and 35 who have newly diagnosed diabetes should be evaluated for bariatric surgery. Estimates are that this would result in a doubling of the number of bariatric surgeries done in the UK, though some estimates have ranged higher. Right now, only about 8,000 procedures are done each year in the UK. Based on the populations of people with obesity, it represents a rate that is less than one third of the rate of procedures done in the U.S.

The resulting debate brings biases to the surface. Baroness Barbara Young, CEO of Diabetes UK, characterized surgery as “a sign of failure.” She said, “Give me the £5,000 you’d spend on an operation and put it into a weight-reduction program and we could win.”

Roger Goss, of the advocacy group Patient Concern, said “Obese people should be encouraged to eat less and take more exercise – rather than having this expensive treatment paid for.”

How’s that approach working so far in the UK? It’s not. The UK now has the highest obesity rate in western Europe, except for Malta and Iceland.

Props to NICE for recognizing that eat-less-move-more strategies alone won’t solve a problem that’s so firmly established. Maybe they can succeed in reducing the downstream costs of untreated obesity.

Click here to read more from the BBC, here to read more from the Telegraph, and here to read more from NICE.

The Value of the Humble Mason Jar, photograph © Chiot’s Run / flickr

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