Bariatric Surgery Could Save the NHS Money

What we have here is a bit of a love-hate story. In the midst of the COVID pandemic, Britain’s NHS has received an outpouring of love. But for folks living with obesity in the UK, it’s a little harder to find some of that love. Our own research suggests that some of the strongest weight bias in a sample of nine countries exists in the UK. A popular UK television host advocates for more fat shaming. A well-known journalist suggests letting people with obesity die to save money for the NHS. However, a new study in PLOS Medicine tells us that this is precisely wrong. Not just morally, but in dollars and cents. Bariatric surgery for people with obesity and insulin-dependent type 2 diabetes could actually save money for the NHS.

Balancing Benefits and Costs

This analysis by Emma Rose McGlone et al presents a complex picture of costs and benefits with surprising clarity. The researchers note that some studies tell us surgery has more benefit for putting diabetes into remission for patients with a more recent diagnosis. Thus NHS Scotland, for example, permits bariatric surgery referrals only for patients with a recent onset of type 2 diabetes.

In contrast, McGlone et al show that surgery for these patients can be cost saving. To do so, they analyze data from the UK National Bariatric Surgical Registry. From a total of 1,847 patients, they found that 72 percent of patients stopped their insulin after having gastric bypass surgery. Over five years after surgery, the operation could save £4,229 per patient for the NHS:

“While previous economic analyses have suggested that a surgical strategy for T2DM provides clinical benefits but with higher up-front cost to the healthcare payer, this study indicates that for patients with T2DM-Ins, the total cost to the health payer is reduced following bariatric surgery as compared to BMT over a 5-year time period. This pattern is seen even when the clinical benefits of bariatric surgery over BMT, in terms of avoidance of future complications, are not considered.”

Disconnected from Evidence

Zaher Toumi is a physician and surgeon who works both privately and within the NHS. He sees a profound disconnect from evidence-based practices in the NHS:

“The national Institute of Clinical Excellence recommends bariatric surgery for people with obesity. However, people with obesity are rarely referred to weight management services. When they are referred, they have to prove they ‘deserve’ bariatric surgery by meeting non evidence-based requirements like preoperative weight loss hurdles. The result is one of the lowest relative number of operations in the Western world, despite having one of the highest levels of obesity.”

The Impulse to Restrict and Punish

Falsely, many people – including health professionals – see obesity as evidence of “bad behavior.” Thus people rationalize punishment and restrictions on access to care. Patients describe years of “box-ticking and hoop-jumping” to obtain a referral for bariatric surgery in the NHS. The bias is clear: patients should solve this problem on their own. Said one:

“I was at my wit’s end, and I went to see one doctor, and said ‘I really need help’ … she said ‘well you need to exercise more’ … and that was it.”

But when the problem is biological, the evidence is clear. Surgery works better than willpower and even the best medical treatments for type 2 diabetes. Pretending otherwise is costly.

Click here for the study in PLOS Medicine.

Protect the NHS, photo mosaic for the NHS vigil © Trades Union Congress / flickr

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December 8, 2020