Why the NHS should do more bariatric surgery; how much should we do?:

Welbourn, Richard; Roux, Carel W. le; Owen-Smith, Amanda; Wordsworth, Sarah; Blazeby, Jane M

doi:10.1136/bmj.i1472

Cited by 82 publications

(81 citation statements)

References 26 publications

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“…However, there is concern that constraints on regional funding within the NHS mean that despite being eligible, many patients are not receiving bariatric surgery when indicated. 23 This has led to the emergence of a 'postcode lottery' in bariatric surgery, in which the likelihood that an eligible patient will receive surgery depends on their location of residence and not just their clinical need or the fulfilment of criteria. 24 25 The present study aims to investigate the role of socioeconomic deprivation on the regional provision of bariatric surgery by comparing the 10-year caseload of two specialist high-volume centres.…”

Section: Open Accessmentioning

confidence: 99%

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Influence of social deprivation on provision of bariatric surgery: 10-year comparative ecological study between two UK specialist centres

et al. 2017

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ObjectiveTo investigate the effect of residential location and socioeconomic deprivation on the provision of bariatric surgery.DesignRetrospective cross-sectional ecological study.SettingPatients resident local to one of two specialist bariatric units, in different regions of the UK, who received obesity surgery between 2003 and 2013.MethodsDemographic data were collected from prospectively collected databases. Index of Multiple Deprivation (IMD 2010) was used as a measure of socioeconomic status. Obesity prevalences were obtained from Public Health England (2006). Patients were split into three IMD tertiles (high, median, low) and also tertiles of time. A generalised linear model was generated for each time period to investigate the effect of socioeconomic deprivation on the relationship between bariatric case count and prevalence of obesity. We used these to estimate surgical intervention provided in each population in each period at differing levels of deprivation.ResultsData were included from 1163 bariatric cases (centre 1–414, centre 2–749). Incidence rate ratios (IRRs) were calculated to measure the associations between predictor and response variables. Associations were highly non-linear and changed over the 10-year study period. In general, the relationship between surgical case volume and obesity prevalence has weakened over time, with high volumes becoming less associated with prevalence of obesity.DiscussionAs bariatric services have matured, the associations between demand and supply factors have changed. Socioeconomic deprivation is not apparently a barrier to service provision more recently, but the positive relationships between obesity and surgical volume we would expect to find are absent. This suggests that interventions are not being taken up in the areas of need. We recommend a more detailed national analysis of the relationship between supply side and demand side factors in the provision of bariatric surgery.

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Section: Open Accessmentioning

confidence: 99%

“…47% of PCTs had placed extra criteria on top of those suggested by NICE or had interpreted the national guidelines more stringently. 23 The main reason for this is thought to be due to a lack of funding. 30 strengths and weaknesses of the study This study had a number of limitations.…”

Section: Meaning Of the Study: Possible Explanations And Implicationsmentioning

confidence: 99%

Influence of social deprivation on provision of bariatric surgery: 10-year comparative ecological study between two UK specialist centres

et al. 2017

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“…In England, the rate of bariatric surgical operations dropped by 31% between 2011‐2012 and 2014‐2015 (from 8794 to 6032 operations, respectively) . It is much worse in Scotland and Wales, and there is no NHS bariatric surgery performed in Northern Ireland . Provision of bariatric intervention by NHS is, therefore, less than 1% of the national need …”

Section: Introductionmentioning

confidence: 99%

Tier 3 specialist weight management service and pre‐bariatric multicomponent weight management programmes for adults with obesity living in the UK: A systematic review

Alkharaiji

Anyanwagu

Donnelly

et al. 2018

Endocrino Diabet & Metabol

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Summary Background NHS England has recommended a multidisciplinary weight management services (MWMS—Tier 3 services) for patients requiring specialized management of obesity, including bariatric surgery, but clinical and measurable health‐related outcomes from these services remains fragmented. We therefore undertook a systematic review to explore the evidence base of effect on body weight loss and comorbidities outcomes of Tier 3 or UK pre‐bariatric MWMPs. Methods AMED, CINAHL, EMBASE, HMIC, MEDLINE, PsycINFO, PubMed, HDAS search and Google Scholar were searched from January 2000 to September 2017 in a free‐text fashion and crossed‐references of included studies to identify potential illegibility. Inclusion criteria were as follows: (a) published Tier 3 original study abstracts/articles; (b) intervention studies with before and after data; (c) studies that included any sort of MWMPs conducted on British residents with obesity; and (d) studies included T2DM measurements in a MWMPs. Results In total, 19 studies met the inclusion criteria. The total number of participants analysed was N = 11,735. Baseline accumulative average BMI was calculated at 42.54 kg/m 2 , weight 117.88 kg and waist circumference 126.9 cm. And at 6 months, 40.73 kg/m 2 , 112.17 kg and 120.3 cm, respectively. Secondary outcome variables were as improved with reduction in HbA1c, fasting blood sugars, insulin usage and blood pressure. Physical activity increased at 3 months then declined after 6 months with no significant changes in cholesterol levels. Conclusion Tier 3 and MWMPs have a short to mid‐ranged positive effect on obese patients (BMI ≥30 kg/m 2 ) living in the UK regarding accumulated reduction in weight, glycaemic control, blood pressure and with subtle improvements in physical activity.

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“…Work commissioned on behalf of the transition coalition group of clinicians, formed to oversee the transition of tier 4 bariatric surgery commissioning from NHS England to CCGs, showed that in October 2015, only 20 % of CCGs were even aware of the pending changes, let alone had started preparing for the transfer of responsibility [21,22]. About 60 % of CCGs had access to some form of tier 3 intervention, implying that 40 % did not.…”

Section: Future Commissioning Responsibilitiesmentioning

confidence: 99%

“…Only 8 % reported a dedicated tier 3 service in a primary care setting. Further, in some areas (and despite the Department of Health recommendations), the tier 3 services were being commissioned by Public Heath England (and therefore local authorities), rather than the CCGs, leading to further variability in terms of access, funding and service provision [21,22].…”

Section: Future Commissioning Responsibilitiesmentioning

confidence: 99%

Obesity Treatment in the UK Health System

2016

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In the UK, as in most other countries in the world, levels of obesity are increasing. According to the Kinsey report, obesity has the second largest public health impact after smoking, and it is inextricably linked to physical inactivity. Since the UK Health and Social Care Act reforms of 2012, there has been a significant restructuring of the National Health Service (NHS). As a consequence, NHS England and the Department of Health have issued new policy guidelines regarding the commissioning of obesity treatment. A 4-tier model of care is now widely accepted and ranges from primary activity, through community weight management and specialist weight management for severe and complex obesity, to bariatric surgery. However, although there are clear care pathways and clinical guidelines for evidence-based practice, there remains no single stakeholder willing to take overall responsibility for obesity care. There is a lack of provision of adequate services characterised by a noticeable 'postcode lottery', and little political will to change the obesogenic environment.

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Why the NHS should do more bariatric surgery; how much should we do?:

Abstract: The number of people getting bariatric surgery is falling despite rising rates of obesity and diabetes. Richard Welbourn and colleagues examine why and argue that better access has potential to reduce long term costs of care

Cited by 82 publications

References 26 publications

Influence of social deprivation on provision of bariatric surgery: 10-year comparative ecological study between two UK specialist centres

Influence of social deprivation on provision of bariatric surgery: 10-year comparative ecological study between two UK specialist centres

Tier 3 specialist weight management service and pre‐bariatric multicomponent weight management programmes for adults with obesity living in the UK: A systematic review

Obesity Treatment in the UK Health System

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