The State of Obesity and Bariatric Surgery in the United Kingdom

| June 11, 2014

 An Interview with Dr. Ahmed Ahmed

Dr. Ahmed is a Consultant Upper Gastrointestinal and Bariatric Surgeon, Department of Bariatric Surgery, Imperial College Healthcare, Charing Cross Hospital, London, United Kingdom.

The state of obesity and bariatric surgery varies from country to country. In this series, authors from around the world discuss obesity and bariatrics in their country, answering questions on the most recent trends, most frequently performed procedures, access to care, health coverage, requirements, accreditation, and cultural considerations. This series is dedicated to providing updates on the global state of obesity.

How did you become a bariatric surgeon? How many bariatric surgeons are there in the United Kingdom today?

Dr. Ahmed: During my surgical residency in the 1990s, I specialized in upper gastrointestinal and foregut surgery, including oncological resections of the stomach and esophagus. These procedures were usually performed through the open technique. Each procedure took an average of 4 to 8 hours, involved a lot of back and neck strain, and, despite the surgeon’s best effort, would still result in significant risk of tumor recurrence. It was at this stage that I became fascinated with the specialty of bariatrics, where the operations were on the same organs but were being done quicker, more ergonomically laparoscopically, and with fantastic patient outcomes.

The number of bariatric surgeons in the United Kingdom is on the rise, and bariatric surgery remains a popular speciality with our residents. The current estimate of practicing bariatric surgeons in the United Kingdom is around 120 to 1301; however, there is great variation in the number of cases performed by each surgeon. Many surgeons who do bariatric surgery are still doing upper GI cancer surgery as well.

Do you need a special certification to conduct bariatric procedures in the United Kingdom?

Dr. Ahmed: Unfortunately, you do not need special certification to conduct bariatric procedures in the United Kingdom. Any qualified surgeon could, in theory, do bariatric surgery; however, they would not necessarily receive referrals from the National Health Service (NHS) or privately, both of which dictate minimum standards for surgeons who practice bariatric surgery.

Are centers that perform bariatric surgery accredited by any society in the United Kingdom?

Dr. Ahmed: No, at the moment there is no national accreditation program. However, some centers, like my program at Imperial, have signed up for international accreditation with the American Society for Metabolic and Bariatric Surgery (ASMBS) or the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Center of Excellence programs. Furthermore. all NHS units performing bariatric surgery have to submit data to the National Bariatric Surgery Registry (NBSR), as well as more recently individual bariatric surgeons outcome data must also be submitted (derived from the NBSR registry). These data are made available to the public via the NHS website. Any surgeon refusing to share his data can be “named” and “shamed.”

What is the obesity rate in the United Kingdom? Is it increasing or decreasing? How about in children?

Dr. Ahmed: Current adult obesity rates are such that approximately five percent of the adult population would qualify for bariatric surgery.[2] This means that roughly two million people in England could be eligible for weight loss surgery. Although it has been growing in popularity, only 8,000 people per year are currently receiving the treatment.2 The prevalence of excess weight (overweight including obese) among children in reception (4–5 year olds) seems to remain stable between 2006 and 2007 and 2011 and 2012 (22%).[3] However, prevalence of excess weight (34%) is increasing year-on-year among boys and girls in Year 6 (10–11 year olds).[3]

Is there anything unique about the country culture/lifestyle that may contribute to the obesity rate (e.g., extreme cold or heat, dominant occupations, access to food and drink)?

Dr. Ahmed: As in most Westernized countries, the ease of access to high-fat, energy-dense foods combined with a sedentary lifestyle is a main contributing factor to the obesity epidemic in the United Kingdom.

What percentage of the obese population actually undergo bariatric surgery? Are those numbers increasing or decreasing?

Dr. Ahmed: Although bariatric surgery has been growing in popularity, only 8,000 people per year are currently receiving the treatment. However, recent changes in national commissioning for bariatric surgery as of April 2013 have led to a fall in weight loss surgery rates.[4] This is because the NHS now dictates that all patients being referred by their family physician for bariatric surgery must first enter a supervised lifestyle weight loss program for 12 to 24 months before being referred to a bariatric surgery unit. This has caused a wave of discontent among bariatric surgery providers and considerable effort is being placed on rationalizing the dictum imposed by the NHS.

What are the current trends in bariatric surgery in your country? Meaning what are the most popular procedures?

Dr. Ahmed: In the United Kingdom, the gastric bypass remains the most popular procedure. The incidence of gastric banding is reducing, and that of the sleeve gastrectomy is rising.

What procedures do you perform at your center—order from most frequent to least frequent with statistics, if available.

Dr. Ahmed: Personally, I perform high-risk gastric bypasses and revisional surgery most often. I perform sleeve gastrectomies the second most frequently and bands the least frequently.

What is the healthcare/ insurance system like in your country? How do patients pay for weight loss surgeries?

Dr. Ahmed: Two separate models of healthcare exist in the United Kingdom: 1) The NHS in which the surgery is provided for free and 2) private market where depending on where you are performing the surgery, the costs can vary.

What is your prediction for the future of bariatric surgery in your country?

Dr. Ahmed: I think the recent commissioning change may cause a temporary delay and drop in bariatric surgery rates in the United Kingdom. However, as patients come out of the lifestyle programs, they will get referred for bariatric surgery. Overall I think obesity surgery rates will remain the same or increase with time.

If you would have to choose a bariatric procedure for yourself or a relative of yours, which one would you choose?

Dr. Ahmed: Gastric bypass because we have the longest follow-up studies with this showing that in the majority, the beneficial effects of surgery are maintained in the long term.

FUNDING: No funding was provided.
DISCLOSURES: The author reports no relevant conflicts of interest.

References
1.    National Bariatric Surgery Registry. The United Kingdom National Bariatric Surgery Registry. http://www.bomss.org.uk/wp-content/uploads/2014/04/Bariatric-Surgeon-Level-Outcomes-Data-Report-2-July-2013.pdf. Accessed June 2, 2014.
2.    Shedding the Pounds: Obesity Management,NICE Guidance and Bariatric Surgery in England. http://www.rcseng.ac.uk/news/docs/BariatricReport.pdf. Accessed June 2, 2014.
3.    Public Health England. Child Obesity. http://www.noo.org.uk/
NOO_about_obesity/child_obesity. Accessed June 2, 2014.
4.    Biglari, J, Mustafa S, Buckroyd J. Tier 3 weight management intervention. Bariatric News. October 15, 2013.

Category: International Perspective, Past Articles

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