Is it right that seriously obese patients should get bariatric, or weight loss surgery, on the NHS? A new report shows that there was a ten-fold increase in the surgery between 2000 and 2007.
In pure economic terms it appears to make sense. A report in the British Medical Journal today quoted studies which suggest that bariatric surgery reduces hospital admissions and cuts the long term costs to the health service. So a procedure that costs upwards of £7,000 actually saves money in the long term.
The National Institute for Health and Clinical Excellence says the surgery should be available to the morbidly obese - those with a Body Mass Index (BMI) of 40+ or patients with existing health problems who have a BMI of at least 35 - and where all other treatment options have failed. The resulting weight loss leads to fewer health problems such as type 2 diabetes, high blood pressure and cardiovascular disease.
Surgeons and patients I have spoken to have all said it is not an easy option or a quick fix. Patients have to demonstrate a commitment to weight loss and go through a lengthy procedure before the operation is approved. One obesity expert said the requirement to have a very high BMI created a perverse incentive to gain weight in order to become eligible for the procedure.
I can understand that for medical teams dealing with obesity, weight loss surgery is a vital tool. But it does raise some wider issues about how we tackle our growing obesity problem. Bariatric surgery deals with the consequences of obesity, rather than the causes. Exercise and a balanced diet remain the best solutions to the epidemic of weight gain which is sweeping the globe.
I met a delightful woman today who recently had a gastric bypass. She has type 2 diabetes and her daily insulin intake has fallen by 75% since the surgery. Doctors no longer fear that she will need a kidney transplant. So she is a medical success story.
But I wonder what parents of children with type 1 diabetes will think? Some have been unable to persuade PCTs to pay for insulin pumps which cost around £3000. These have been shown to improve glucose control and so reduce the risks of complications, such as heart and kidney disease and blindness. These conditions can take decades to surface and so may be less pressing problems for the NHS.
Many cancer patients may also have a view. Earlier this week NICE refused the drug Avastin for people with advanced bowel cancer because it costs almost £21,000 per patient and typically adds an extra six weeks of life.
Bariatric surgery may make sound economic sense and produce significant benefits. But others denied treatment may feel that, somewhere along the line, the NHS has got its priorities wrong.