Weight loss surgery for obese diabetes patients
27th November 2014 – Obese people in England who have been recently diagnosed with type 2 diabetes should be offered assessment for weight loss surgery on the NHS, under new health guidelines.
The updated guidance from the National Institute for Health and Care Excellence (NICE) could lead to nearly double the number of people undergoing weight loss surgery each year.
NICE says the changes will be good for patients and save the NHS money, despite the extra cost of more weight loss operations – otherwise known as bariatric surgery.
Diabetes UK says that while weight loss surgery has a place in obesity-related diabetes, it should only be considered as a last resort once attempts to lose weight through exercise and healthy eating have proved unsuccessful.
A nation growing heavier
More than a quarter of adults are now classified as obese and a further 42% of men and a third of women are overweight.
NICE has updated its guideline on the identification, assessment and management of people who are overweight or obese.
It says that since the original recommendations were published in 2006 there is more evidence available on the best 'follow up' care for people who have undergone weight loss surgery and the role of surgery for people recently diagnosed with type 2 diabetes.
'A huge problem'
Professor John Wilding, head of the Department of Obesity and Endocrinology at the University of Liverpool, says: "Type 2 diabetes is very strongly associated with obesity. We have a huge problem with diabetes: it's costing 10% of the NHS budget, and 1 in 6 beds in the NHS are occupied by people with diabetes."
Professor Wilding, who helped develop the guidelines, tells BootsWebMD: "What we do know, particularly from gastric bypass operations, is that it is very effective at helping improve glucose control in people with diabetes as well as causing weight loss."
The updated guidelines say:
- People who have recently been diagnosed with type 2 diabetes – which will be defined as a diagnosis within the last 10 years --should usually be offered an early, rapid assessment for weight loss surgery if they have a body mass index ( BMI) of 35 or more
- An assessment for weight loss surgery for those with a BMI of 30 to 34.9 should usually be offered to those recently diagnosed with type 2 diabetes
- People with an Asian family background who have recently been diagnosed with type 2 diabetes should be considered for a weight loss surgery assessment at a lower BMI than those from other ethnic backgrounds.
The guidelines stress that bariatric surgery should not be considered as a stand-alone solution but should be accompanied with changes to diet, activity levels and lifestyle.
Big rise in bariatric surgery
Professor Wilding says the changes will lead to a big increase in the number of weight loss surgery operations being carried out at a current cost of around £6,000 each. "At the moment we do about 6,500 operations on the NHS [and] that could well increase maybe by as much as another 5,000 operations per year. But we think in the long term that this will be a very cost-effective way of managing some of these very severely obese patients with type 2 diabetes."
Patients who have undergone weight loss surgery should be offered a follow-up care package lasting for a minimum of 2 years, says NICE. This should include advice on diet and exercise, psychological support and a review of medication.