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NICE updates its guidance on bariatric surgery

Medical negligence lawyers welcome announcement from NICE on availability of bariatric surgery

3 December 2014

The National Institute for Health and Care Excellence (NICE) has updated its guidance of when bariatric surgery should be offered to patients.

NICE now recommends that weight loss surgery should be available to thousands more patients than under the old guidelines in order to tackle the UK’s epidemic of obesity.

Patients with a BMI of 35 or more, or who have recent-onset type 2 diabetes should now be considered for bariatric surgery, as should people with a BMI of 30 – 34.9 who have poorly controlled type 2 diabetes.

Bariatric surgery is surgery of the digestive system to enable weight loss. The digestive system is altered so it takes less food meaning the patient feels fuller quicker after eating.

The two most common types of bariatric surgery are:
  • Gastric band – a band is placed around the stomach, reducing its size so less food is required to make the patient feel full; and
  • Gastric bypass –this is done in two stages :
    1. The stomach is divided using staples into a small upper section and a larger now redundant lower section, so the body can only handle a small amount of food (about 1 ounce); then
    2. the upper section is connected to part of the small intestine, effectively shortening the digestive system so the patient absorbs less food. 

A further method, known as a ‘sleeve gastrectomy’,  involves surgically removing part of the stomach (normally reducing it to about 25% of its’ original size). This is irreversible, unlike a gastric band.

All these methods can now be done laparoscopically, significantly reducing the risk to the patient.

However, despite the change in guidance not all over-weight patients will be suitable for bariatric surgery.  For example, if the patient is not in a position to fully commit to a lifestyle designed to keep the weight off they may be denied surgery. Alcoholism or drug abuse, mental health issues and/or a history of failing to comply with  previous medical recommendations may also mean that a patient is not considered suitable. The decision on eligibility will be made by the local clinic commissioning group.

Despite the guidance It is likely not everyone who wants to will  be able to undergo bariatric surgery on the NHS. Whilst such surgery is available privately as any surgeon’s primary concern is the health of the patient a private surgeon too would need to weigh up the risk and benefits.
Whilst bariatric surgery is seen as a “miracle” cure for some patients , as with all operations, weight loss surgery carries risks. In particular, there is a risk of infection, blood clots in legs or lungs and internal bleeding. 

Another problem is that after surgery patients may be left with excess skin which can lead to rashes and infections as well as being unsightly. Although surgery is available to remove excess skin, it is only available on the NHS if the problem is clinical, not if the problem is purely cosmetic.

Psychological problems are common after weight loss surgery. Many of the more successful patients, after losing a significant amount of weight, can become depressed because the vast majority of their pre-weight loss problems remain. Other types of self-harm can develop in the patient to replace the over-eating.

However, the risk of surgery needs to be compared with the risk of morbidity and mortality where patients continue as they are. These risks include strokes, heart attacks and kidney failure as consequences of diabetes, which most seriously obese patients will develop.

Potential patients should think carefully about whether bariatric surgery is right for them. Even if the criteria are satisfied the patient may be refused surgery for a host of other reasons.

Bariatric surgery might help to reduce the physical risks to the patient’s health but it does not address the underlying psychological issues which usually caused the weight gain in the first place. For those patients this is likely to be far more difficult that addressing the physical side. There is no quick-fix solution to the obesity epidemic, but bariatric surgery can, in some cases, be the first step. 

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