Scots denied surgery that cuts diabetes
27 December 2009 - By Lyndsay Moss, The Scotsman
THOUSANDS of Scots are missing out on surgery that could transform their lives because not enough priority is being given to the treatment of obesity. Type 2 diabetes, which can lead to serious health complications, is one of the country’s fastest-growing conditions, largely because of poor diet and a lack of exercise.
But procedures such as gastric band and gastric bypass surgery that are proven to work are being denied to patients because health boards are not willing to finance them. Duff Bruce, an Aberdeen surgeon and chairman of the independent Severe and Complex Obesity Treatment Service (Scots), said that up to 25,000 Scots could be eligible and would be willing to have such surgery to improve their health.
If more patients were offered surgery, their health could be improved and the NHS would save money in the long term. But despite the growing problem, Scotland has one of the lowest rates of bariatric surgery in the world. In Scotland only 0.8 per cent of those eligible and willing to have weight-loss surgery receive treatment, compared with 1.2 per cent in England, 5.5 per cent in Sweden and 9 per cent in the United States.
Writing in the magazine of the Royal College of Surgeons of Edinburgh – published today – Bruce said patients with severe obesity, with complications such as diabetes and high blood pressure, are “one of Scotland’s fastest-growing and most difficult to manage populations”, taking up a disproportionately large share of the £171 million cost of treating weight-related problems.
But research has shown that obesity surgery can have a major effect on improving the health of obese patients.”With the data available to show that patients with Type 2 diabetes often go into remission following a (gastric) bypass, we are, as a nation, essentially withholding an intervention that could potentially cure not just sufferer’s obesity, but also much of their metabolic co-morbidities (conditions such as diabetes],” Bruce wrote.
He said: “There’s a significant percentage of patients who we know would be eligible and willing to have the operation who haven’t got access to the resource.”
Writing in the same issue, Dr Ingmar Naslund said Sweden has prioritised obesity surgery over other groups of surgery, such as gall bladder and hernia operations, and has reaped the benefits. “As we’ve helped more and more patients with obesity, it has become more obvious that these patients are the right ones to be prioritising,” he said. One in four men and women were classed as obese in 2008, and patients who are overweight are more likely to develop Type 2 diabetes. Severe obesity can also cause high blood pressure, heart disease, bone and joint problems, and sleep apnoea.
Almost 200,000 people north of the Border are estimated to have Type 2 diabetes, which is normally diagnosed in people over the age of 40.The number of bariatric procedures carried out in Scotland on the NHS each year is between 150 and 180, with a similar number carried out privately. A gastric band is an inflatable silicone device surgically placed around the top portion of the stomach. The device creates a small pouch at the top of the stomach that quickly fills with food, sending a message to the brain that the whole stomach is full. This sensation helps the person to be hungry less often, to feel sated for a longer period, to eat smaller portions and thus to lose weight. Gastric bypass surgery works in a similar way by also reducing the stomach’s volume.
One problem is the cost of the procedures compared with other surgical treatments. Obesity surgery and follow-up care costs the NHS between £3,500 and £5,500 per patient, so access to such operations in Scotland has so far been limited.
But Bruce said prioritising obesity surgery would save the NHS money over time, as it would spend less in the long term on weight-related conditions such as heart disease.
Research in Canada has suggested that bariatric surgery was “cost neutral” within three years because of the savings made on treating other complications.
Bruce said he hopes that with better and more clever use of resources, more patients could be given access to obesity surgery. He said: “In Scotland, we are starting from quite a low baseline. But Scotland is a small country, which means that everyone can work together well. We have good relationships with clinicians, health boards and government.”So hopefully, we have a chance of developing a national strategy that works well to deliver and develop this.”
A Scottish Government spokeswoman confirmed that obesity was one of the greatest health challenges facing Scotland. “That is why the Scottish Government is investing £56 million in our Healthy Eating, Active Living action plan which aims to improve diet, increase physical activity and tackle obesity,” she said. But she added it was a matter for individual health boards to decide what services to provide and how they allocated resources to meet needs.
• A £450,000 funding boost for the treatment of diabetes was announced yesterday by public health minister Shona Robison. The money will be invested in improving psychological support for people with the condition.
Case study
VICKI Simpson had to wait four years for surgery to treat her weight problems.
The 39-year-old from Aberdeen had a gastric band fitted in January 2007 and later a gastric bypass.
“It is the best thing I have ever done,” she says.
Before the surgery, Simpson weighed 21st 11lb.
She said she suffered from tiredness and sluggishness, and had problems sleeping. She was also told she was at risk of developing Type 2 diabetes.
With an active job as a hairdresser, she wanted to make sure she would continue to be able to do her job. She now weighs 12st 5lb.
“It has given me my life back. I was living in a shell, with no confidence. I was in a circle of eating for comfort and getting bigger and bigger. The problem gets bigger and it gets harder to get out of. The surgery has given me a new lease of life. I am not tired and it has been fantastic.”
