Obesity in Wales 'just behind USA', Dr Nadim Haboubi warns
Wales' obesity "epidemic" is so bad that it lags just behind world leader the USA and it is getting worse, a prominent obesity doctor has warned.
Dr Nadim Haboubi said a lack of NHS resources in Wales meant thousands of people were missing out on essential surgery and community help.
He added that the NHS in England intervened earlier to prevent related health issues such as diabetes.
The Welsh government said health boards were deciding where to focus resources.
Dr Haboubi, who is also chair of the National Obesity Forum for Wales and runs the country's only NHS-funded obesity clinic, said the problem was "huge, massive, worse than England, worse than anywhere in the UK and among the worst in the western world, I would argue".
"The worst is probably the USA but we're certainly not far behind," he said.Gastric banding
"It's a drastic epidemic and it's worsening. It's because of so many reasons, such as inequalities, social deprivation and unemployment."
In a critical assessment of the help available for obese people in Wales, the doctor said that:
- A lack of funding means only 50 people are operated on each year at the Welsh Institute of Metabolic and Obesity Surgery, based at Morriston Hospital in Swansea. That is despite the fact that 5,000 people meet the criteria for bariatric surgery - such as gastric banding or gastric bypasses - which limits the capacity of their stomachs
- The criteria in Wales for surgery is stricter than in England. In England, he said people must have a Body Mass Index (BMI) of 35 with related health problems, such as diabetes or sleep apnoea, or 40 without. In Wales, he said the figure was a BMI of 50 with related health problems. This means patients can only be operated on once they are in poor health
- There is only one NHS-funded obesity clinic - but needed to be more
Dr Haboubi, who is a consultant physician at Nevill Hall Hospital in Abergavenny, added: "It's all down to money. There's hardly any surgery done in Wales because of resources.
"Yes, it's costly, but treating it now is going to be a long-term saving of money. If you deal with obesity you deal with problems like diabetes, coronary heart disease..."
'I lost 13 stone thanks to clinic'
Pam Bland, 45, a senior systems engineer, from Abergavenny, Monmouthshire, was referred to the Aneurin Bevan multi-disciplinary specialist weight management clinic in Ebbw Vale - the only one funded by the NHS in Wales.
"At Christmas 2010 I was a size 32 and weighed 25 and a half stone, with a BMI well over 40.
"I felt absolutely awful and I had medical problems, although I don't know for sure if they were linked to my weight.
"At my first one-to-one session, the doctor just told me to cut out take-aways. I lost a stone.
"Since then I have lost 13 stone and for the last four months I have just been maintaining my weight.
"I am now a size 14 to 16 and I feel so happy.
"I wouldn't say I'm terribly dim but I had no idea about what I was eating and nutrition.
"At the clinic I meet with a councillor as a lot of the problem is psychological and about our relationship with food.
"I also keep a diary of what I eat, and now exercise loads. I love it - I'm in the gym nearly every day. I'm also doing the Cardiff half marathon.
"My family are proud. My mum has type 2 diabetes and one of her biggest fears was that I would pick up the phone to say I have also got it.
"There absolutely needs to be more of these clinics around Wales."
He said for many who were morbidly obese, it was too late to change their lifestyles.
"I have a patient who aged 29 has a BMI of 71. The normal BMI is 25. This young man needs surgery otherwise he will die," he said.
"But he doesn't meet the Welsh government criteria for surgery in Wales because he's not got any of the comorbidities [related health problems]. He will get them but they're waiting until he gets them before they do anything."Last resort
The Welsh Health Survey, published in 2010, found that 57% of adults were overweight or obese, while a a Welsh government-commissioned study by Swansea University calculated that obesity was costing the NHS in Wales £73m each year.
Dr Haboubi said that surgery was a last resort and that the majority of people needed help to change their lifestyles.
He said his clinic in Blaenau Gwent, where patients were referred by GPs to have help from a dietician, doctor, physiotherapist and councillor, has "hundreds and hundreds of people" waiting at least 18 months for help.
"Unfortunately we are the only NHS-funded clinic in Wales. There should be more," he added.
The Welsh government said that around 50 patients, mainly from the south Wales area, are referred to the Welsh Institute of Metabolic and Obesity Surgery at Morriston Hospital each year, but patients in north Wales have surgery in Salford.
It said that NHS resources were "finite", and that its framework All Wales Obesity Pathway "ensures best value for the NHS pound and required all health boards in Wales to map local policies, services and activities for both children and adults against all possible interventions".
"Health boards are currently determining where to focus efforts locally," it said.
It said funding for bariatric surgery in Wales is restricted to those with pressing health issues, and "suitability for surgery takes physical and psychological factors into consideration".
"Bariatric surgery is a major procedure and, once the potential complications are explained, up to 40% of patients for whom funding is agreed decide not to proceed," it added.