A Doctor's Waiting Room

When Health Systems Delay Obesity Care

Care delayed is care denied. The truth of this is obvious in emergency medicine. In the case of a stroke or a traumatic injury, unnecessary delays in care lead to immediate harm. But with a chronic, progressive disease, the harm can be more subtle. Add in systemic bias and delayed care can become quite a problem for the health of people affected. Too often, this is the case for a person living with obesity. A new study from Scotland illustrates how problems multiply when health systems delay obesity care.

The SCOTS Study

These findings come from the SCOTS – SurgiCal Obesity Treatment Study – cohort of patients scheduled for bariatric surgery in Scotland. Jennifer Logue was the senior investigator on this study of 445 patients at 14 centers.

They had two major findings. To begin with, they found a profound delay in care:

“The low prioritisation of bariatric surgery and a lengthy preoperative pathway in the UK is associated with surgical treatment being reserved for individuals at an older age with a very high BMI.”

In addition, they found that delayed care means patients with this progressive disease land in a very debilitated state. They have poor physical function and a poor quality of life, comparable to cancer patients receiving only palliative care. Because of this, these patients need much more equipment and care at home than patients whose condition received better treatment and control at an earlier stage. In fact, these patients with delayed care have more complications. So their care is more costly.

Care Delayed Is Care Denied

Other research tells us quite clearly that care delayed is care denied. Delayed bariatric surgery is less likely to bring diabetes and hypertension under control. Adolescents who need bariatric surgery have better medical outcomes if they get it sooner rather than later.

Apart from simply discounting the lives of people living with severe obesity, there’s no good reason for health systems to delay and deny this obesity care. Logue sums it up nicely:

“Our findings demonstrate that we need to act much earlier to ensure that people with severe obesity are not significantly disabled by the time they are receiving treatment.”

Click here for the study and here for further reporting. For additional perspective on delayed obesity care, click here, here, and here.

A Doctor’s Waiting Room, painting by L. S. Lowry / WikiArt

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September 7, 2021