The National Institute for Health and Care Excellence (NICE) has updated its guidance for bariatric surgery for people suffering from type 2 diabetes.
Under the new NICE proposals, recently-diagnosed patients who have a Body Mass Index (BMI) of higher than 35 would be offered “expedited assessment” for the surgery, while those with BMIs between 30 and 35 would also be considered for a surgery assessment. Expedited assessments are currently only recommended for those with a BMI over 40.
Slimming World, the largest group-based commercial weight loss organisation in the UK and Ireland, helps its members to lose weight through a programme of healthy eating, facilitation towards an active lifestyle and weekly group support. The organisation which has a proven 45 years of affecting successful behaviour change, has expressed concern about the proposals and said they threatened to “normalise” surgery.
“Bringing down the minimum BMI that people must present to qualify for bariatric surgery sends out a worrying message and does not address the need to encourage families to live healthier lifestyles,” Dr Jacquie Lavin, Slimming World’s head of nutrition and research, said.
“Choosing surgery is not a light-hearted decision. It carries risks and, emotionally, it can heighten people’s feelings of failure and lack of control as it puts the solution well and truly in someone else’s hands. Surgery is expensive at anywhere between £5,000 and £15,000 on average per procedure. It's not always the quick fix people are hoping for and we’ve been surprised by how many people have come to us post-surgery, suggesting that they haven’t been getting the support they needed after treatment. Surgery is not the only option for people with a lot of weight to lose and it should not become the first port of call for people with a BMI of 30kg/m².
“It’s good that NICE recognises the value of peer support groups, which we know from experience are vital to helping people to make real lasting changes. However, we believe that bringing down the minimum BMI range for surgery risks normalising bariatric procedures that the NHS acknowledges can carry serious risks, when the focus should really be on educating and supporting families to make long-term healthy lifestyle changes.”
Labour MP Keith Vaz, who suffers from type 2 diabetes, described the changes as a “wakeup call on the seriousness of diabetes” but stressed that surgery needed to remain “a last resort”.
“NICE correctly emphasise the dangerous combination of obesity and diabetes. I also understand weight loss surgery can reduce the chances of serious and costly conditions such as heart failure, amputations and blindness,” Mr Vaz said.
“However, we should consider procedures such as bariatric surgery a last resort. All surgeries carry risks, do not guarantee changes in dietary habits, and come at an enormous cost to the health service. Diabetes UK estimate 850,000 people may be eligible for surgery under these guidelines. This is not a sustainable solution.
“We need to focus on prevention, advising people on how to manage their condition before their health problems escalate to a point where they require surgery. By doing so, we will save lives, and maintain the long term financial sustainability of the NHS.”