Organisational Issues

All patients referred for consideration for weight-loss surgery (irrespective of route of referral) should be assessed in a standardised, rigorous manner in a joint medical-surgical pathway.

The delivery of bariatric surgery in NHS hospitals forms only part of the workload of the involved healthcare professionals, management and support staff. NHS resources across the country in general are very limited for all forms of obesity treatment, as this forms only a part of a wider prevention and management challenge.

The healthcare professionals involved in the assessment, surgical procedures and follow-up need to be suitably trained. They must be able to address the fact that even among obese individuals “meeting the criteria”, there is a wide variety of patient requirements: dietetic, surgical, psychological and medical.

There is a sizeable amount of bariatric surgical activity in the independent sector and in the overseas “heath tourism” market. Particularly in the latter situation, individuals looking for a quick weight loss solution may undergo a procedure overseas without a support and monitoring package available to them when they return home.

The extent of bariatric surgical activity is poorly defined, but moves to set up registries in England and Wales, and in Scotland may help clarify the situation.

The costs involved in bariatric surgery are significant. A number of published reports and Technology Assessments have drawn varying conclusions. However, the NHS HTA (Clegg et al, 2002) illustrates some important points: although the costs of the surgical procedures were in the range £3000 to £5000 for the procedure, the total cost for a surgical patient was approximately £10,000. This was contrasted in the report with total net costs for “usual care” of almost £7000 over 20 years.

A number of reports have shown the cost-effectiveness of bariatric surgery in improving diabetes, other related co-morbidities and overall health of severely obese individuals.