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11 Jul 2014

Overweight? Consider surgery. And the NHS should pay – Nice

Hundreds of thousands more overweight people with type 2 diabetes should be offered weight-loss surgery like gastric bands on the NHS, says draft guidance from Nice.

Weight-loss surgery is currently given to patients on the NHS if they are morbidly obese – with a body mass index (BMI) score of over 40 – or to patients with a lower BMI of over 35 but who have another serious health condition, such as type 2 diabetes.

Now the National Institute of Health and Care Excellence (Nice) wants more people to be considered for operations that promote weight loss: anyone with a BMI score of 30 to 35 and with type 2 diabetes, if they have been diagnosed within the last 10 years.

Around 10 per cent of the NHS budget is currently spent on treating people with type 2 diabetes.

More than half of people who undergo surgery have more control over their diabetes following surgery Professor Mark Baker

Bariatric surgery usually comes in two forms: either having a gastric band fitted to reduce the size of the stomach, or a gastric bypass, where the digestive system is re-routed past most of the stomach.

And the new rules mean an estimated 800,000 could now get the weight-loss surgery on the NHS, according to data from the National Diabetes.

It shows that around 71 per cent of people with type 2 diabetes were diagnosed in the last decade, and around half (47 per cent) of those with the condition have got a BMI over 30.

The draft guideline also recommends that people who have undergone bariatric surgery on the NHS should have a “follow-up care package” for at least two years after their operation.

In the UK around 2.9 million people have diabetes, with around 90 per cent of cases being type 2. There are also thought to be around 850,000 people with undiagnosed diabetes.

Fat and getting fatter

“Obesity rates have nearly doubled over the last 10 years and continue to rise, making obesity and overweight a major issue for the health service in the UK,” said Professor Mark Baker, director of the Centre for Clinical Practice at Nice.

“Since the publication of the existing guidance in 2006, more information has become available on how best to tackle the issue. Updated evidence suggests people who are obese and have been recently diagnosed with type 2 diabetes may benefit from weight loss surgery.

“More than half of people who undergo surgery have more control over their diabetes following surgery and are less likely to have diabetes related illness; in some cases surgery can even reverse the diagnosis.”

Commenting on the draft recommendations, Simon O’Neill, director of health intelligence at charity Diabetes UK, said that losing weight was very difficult for most people. But said he wanted people to remember that there were serious risks involved in surgery, and it should only be considered as a “last resort” alongside dieting and exercise.

The draft Nice guidance on obesity, which updates guidance published in 2006, also states that doctors should be “selective” about recommending very low-calorie diets to obese people trying to lose weight. Prof Baker added: “Very low-calorie diets have grown in popularity in recent years, so we now have more evidence to consider how well they work, if the weight loss can be sustained and the safety concerns, than we did in 2006.

“The new draft guidance now recommends that they should not be used routinely for people who are obese, only those who have who have a clinical need to lose weight quickly, such as before joint replacement surgery.”

The draft guideline has been issued for consultation.

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