COVID-19: Prioritizing Bariatric and Metabolic Surgery

A healthy conversation is shaping up because of COVID-19. It’s all about the gap between talk and action on obesity. In the UK, it has a hashtag: #ActOnObsityNow. Though it’s happening more quietly in the U.S., the same conversation is in play. Will actions match our words about the urgency of obesity? The question of prioritizing bariatric and metabolic surgery brings it into sharp focus.

Delaying Medical and Surgical Care

As a matter of fact, COVID-19 has delayed all kinds of medical and surgical care. Some of it is unavoidable when a sharp spike in the virus puts a pinch in medical capacity. But some of it is simply a product of needless fear. And misplaced priorities. Strokes and heart attacks aren’t getting the attention they need. Necessary care for chronic diseases is slipping.

Health will suffer and needless deaths will come too soon.

Medical Necessity

At this point, it’s unmistakable. Obesity puts a person at risk for worse outcomes if they develop COVID-19. The more severe it is, the higher the risk. So for someone who needs bariatric surgery to improve their health and perhaps put diabetes into remission, it’s not a frivolous option. It’s a medical necessity. It may well be the best option they have for restoring more normal health.

In the face of the pandemic, prioritizing metabolic and bariatric surgery does not seem to be a difficult calculation.

Overcoming Bias

However, the subject of bias does get in the way. There’s the fundamental bias about obesity. It’s both common and false to think that obesity is a simple matter of choice. In fact, it’s a problem with a physiological basis, triggered by many different environmental factors.

On top of that is bias that’s specific about bariatric surgery. One would never hear family or friends tell someone with a tumor that they should try to shrink it themselves. But when someone needs bariatric surgery, they can count on someone in their circle of family and friends to cluck about the virtue of DIY obesity treatment. “Did you try this diet? Or that program?”

Health policy gets in the way, too. In the UK, for example, the NHS has limited the access to surgery for years. Bias makes it feel alright. Tight budgets make it an easy choice. But in the long run, the cost of leaving obesity untreated piles up. COVID-19 is making that more immediately obvious.

So we’re glad to see a robust conversation about treating obesity more aggressively. In the UK, that may start with an emerging plan to increase the resources for bariatric surgery. In the U.S., we need to get people back on track for surgeries that COVID-19 delayed. We also need to plan for the full range of care that obesity requires. Nutrition, physical therapy, pharmacotherapy, and post-surgical care.

It much more effective than trying to clean up the mess that ensues when obesity goes untreated. We can do this.

Click here for the latest on the conversation about bariatric surgery in the UK and here for more on prioritizing it in the U.S. For guidance published in Lancet Diabetes and Endocrinology, click here.

PPE, photograph © UK DFID / flickr

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July 21, 2020