Despite the call last week from the Royal College of Surgeons to stop the postcode lottery in PCT funding of Obesity Surgery, cash-strapped PCTs are making it even harder for patients to get the surgery they need.
Oxfordshire has raised the entry criteria for bariatric surgery to people with a BMI of more than 50.
The move to raise the criteria in the couty was agreed at a board meeting of NHS Gloucestershire. Shona Arora, director of public health, said: “This will help strike the right balance between early intervention and care for those who are morbidly obese and helping to meet demand. We are continuing to deliver a programme to support people in community settings to become more physically active and to eat more healthily.”
Dr Helen Miller, professional executive committee chairwoman, said: “Just because a BMI is 40 or even 50 it doesn’t mean you can’t lose weight.
Bariatric surgery is not a quick fix. It’s about saying to people it’s an absolute last resort. We know if people lose a stone or two they improve their risks of developing diabetes or heart disease.”

Michael Dermody of Cosmetic Bliss - specialist provider of Weight Loss Surgery examines the reasons why some patients who undergo surgery are unable to maintain weight loss after the procedure, and offers some possible solutions.

After all else has failed over years - all the various diets, fitness and exercise plans, all the various weight loss regimes and appetite suppressing or “fat busting� drugs, Bariatric Surgery is seen the last chance to lose weight permanently by those suffering from Morbid Obesity. Rightly so! It isn’t a soft option or a quick fix, and many patients only reach the conclusion that surgery is the sole option left to them after months - often years - of pondering on it.

Many healthcare companies are in the market offering to organise and assist patients who have decided to “go private� for their procedures – either as a first choice or because surgery is simply not available to them under the national health scheme.
Most prospective patients, certainly in the UK and Republic of Ireland, arrange their private treatment through commercial providers and/or facilitators, rather than attempting to deal direct with the surgeon, and many providers offer a range of procedures, from Cosmetic Surgery, Dental Treatment or Laser Eye Surgery to Obesity Surgery and General Surgery.
It can be quite bewildering for the prospective patient who must not only attempt to learn as much as possible about the procedure they wish to undergo, but also try to select a surgeon and medical team they are willing to put their trust in, and to choose a company which will inform and guide them honestly and put the patient’s best interests above their own desire to “make a sale�.
Michael Dermody and Deborah Darling of Cosmetic Bliss – a private healthcare company which arranges weight loss surgery and post-weight loss cosmetic surgery in the Czech Republic for English-speaking patients are calling for better standards of clear communication and improved support by healthcare facilitators for their patients – especially in the field of weight loss surgery , their own specialist area.
Michael Dermody is quoted as saying
“Our company’s high reputation on the various weight loss forums is founded on our being able to provide thorough and extensive information to our patients pre-operatively, ensuring that they are properly prepared for their surgery; supporting them whilst they make the visit for the surgical procedure and being available to them during the period of weight loss after their surgery.
I think what makes us special is the “hand-holding� service we give whilst the patient is with us for surgery. We make sure we are there – in the hospital – with them throughout their stay, and this is something our patients really value above everything else. Of course we couldn’t do it without the co-operation we get from our partner hospital and surgeon.
We realised a long time ago that taking patients through weight loss surgery was very different from arranging Cosmetic Surgery – it is much more demanding, and requires a much greater commitment by the provider
Firstly, there is the matter of assessing the patient’s suitability for surgery. Quite apart from fairly rigorous pre-operative preparation and testing, some of which should be done well before the surgery itself, there is the issue of making sure the patient is really ready for surgery and prepared to make the mental adjustments, in terms of relationship to food which are necessary if the surgery is to achieve long-term weight loss. Then there is the question of putting in place for the patient an adequate system of support and monitoring during the months and years after the surgery. Unless all these things are done, and done correctly, there’s every chance a patient is wasting their money in having the surgery, as the whole point of the exercise is for the patient to achieve sustained, long term weight loss, not merely a good safe operation with clean scars!
It disheartens and worries me when I see that there are still some companies out there that sell weight loss surgery in a way I would expect to see furniture sold, with “special offer� discounts, and “last minute deals�. It all seems to diminish the serious nature of the surgery and the commitment the patient has to make. More alarming, though, is the lack of quality information provided by some companies – and in some cases positively inaccurate and misleading information is openly advertised on websites. There are still providers of weight loss procedures who advertise a Gastric Bands as being “the same as Gastric Bypass�, and even one promoting Intragastric balloons (a non-surgical temporary endoscopic procedure) as “Lap Bands� .
That’s no different from selling someone a cat, and telling them it’s a dog, on the grounds that “it’s the same thing�!
I know that many companies do a good job, but it is not fair or right to expect the enquiring prospective patient to be able to distinguish between accurate and misleading or inadequate information – especially as they often come to the marketplace having done very little research before contacting providers.
I firmly believe that there is a crying need for Private Healthcare providers and Medical Tourism companies to get together – probably in the form of a trade organisation - to set agreed standards of care, support and accuracy of information, and devise a form of accreditation – not only for the sake of their own reputations but in the interests of true patient care.
Our own facilities in Breclav Hospital are specifically geared to Obesity Surgery, and there are emergency and ICU departments on hand at this modern major hospital to enable us to safely cater for those morbidly obese patients who have other serious health problems. We are working closely with the hospital and Dr Michal Cierny PhD, the Specialist Bariatric Surgeon in charge of the Bariatric and Metabolic Centre there in creating a European Centre of Excellence in Bariatric Surgery.
We are currently actively seeking to co-operate with other providers and facilitators of Private Healthcare - especially in the UK, Eire, and North America - who have a close and trusting relationship with their patients and who share our own commitment to the quality of information and pre- and post-operative care standards for Bariatric patients I have described.
We are willing to develop working relationships with companies who wish to take full advantage of our facilities for safe surgery, and who will value the round the clock support we will be able to provide to their patients when they are with us for surgery. This will enable the provider to focus on putting in place a solid system of pre-and post operative support, and we would welcome enquiries from other Private Healthcare companies working in this field who are interested in developing such a relationship, and promoting standards of excellence in the area of Obesity Surgery and care and support in managing weight loss post-surgery.
We would welcome enquiries from Healthcare Providers and Facilitators, initial contact can be made with us through our website: http://www.cosmeticbliss.co.uk/p/contact

Despite the yearly rise in the numbers classified as “Morbidly Obese” in the UK, and the drain on public health resources due to the costs of treating chronic illnesses which are caused by this epidemic of obesity, the provision of Surgery as an option for patients is still very scant in most areas of the UK. An article in the Scotsman on 27/12/2009 stated that only 0.8% of Scots eligible and willing to go ahead with Obesity Surgery receive it. In England the situation is marginally better – 1.2%!!
When NICE (The National Institute for Clinical Excellence) issued Guideline 43 in December 2006, it clearly stated who should be considered for surgery – patients with a BMI of over 40 (or over 35 with obesity-related “co-morbidities�) who have exhausted attempts to maintain weight loss through more conventional methods. The guidelines also recommend Surgery as a “first line option� for patients with a BMI of over 50.
In Jan 2008 BOSPA (the British Obesity Surgery Patients’ Association) published a survey of the attitude of PCTs – those bodies in the UK who are responsible for allocating funding for surgery. Many did not respond, but of those who did around half confirmed they applied much stricter criteria when approving funding of surgery than the NICE guidelines. There remains no clinical justification whatever for denying surgery to patients who meet the NICE guidelines – so the practice of insisting on much more severe criteria before allowing surgery is clearly based on limiting cost. Local PCTs clearly have a finite budget with many competing demands, and Obesity surgery is potentially a great drain on their resources. The NICE guidelines are, after all, only guidelines and are not legally enforceable – though some patients have sought legal redress for the failure of their PCTs to adequately deal with their health problem.
It seems a very short-sighted approach, in terms of the PCTs duty to provide adequate healthcare, condemning obese patients to become more ill as the obesity-related diseases develop, and even from the cost point of view studies have shown that Obesity Surgery pays for itself over approx. 3 years, as the cost burden of treating co-morbidities such as Type II Diabetes is reduced in patients who have lost significant weight. The government makes little provision for tackling this epidemic, and largely leaves PCTs to “get on with it as best they can�
So, what can someone who is classified as Morbidly Obese, and needs surgery do?
It is possible to attempt to put pressure on your local PCT through your GP to approve surgery, but it is a long uphill battle, with very little prospect of success.
You can look for surgery privately, which is the course most obese patients follow.
There are problems and pitfalls here, quite apart from the cost you will have to meet.
Firstly you have to be careful to choose a surgeon, hospital/clinic and company, (if you arrange your surgery through a Healthcare company as most do) who are not only experienced in the type of surgery which will be best for you, but also you must be sure that all the pre-operative health checks and tests are at least as extensive as in the NHS. It goes without saying that every effort should be made to ensure your surgery is as safe as possible. Psychological evaluation and some counselling to ensure a patient is at the right point to be able to succeed with weight loss following surgery is absolutely vital. NICE recommends that obesity should be managed by a multi-disciplinary team, and that post-operative support is essential
Post-operative support – whatever the surgery - is very important and you should be careful to chose a surgery provider who is willing to offer this, and not simply prepared to leave it to your GP to give advice and help after the surgery.
Cosmetic Bliss http://www.cosmeticbliss.co.uk/p/weight-loss-surgery is a weight loss surgery company who arrange safe Obesity Surgery for English-speaking patients at the Bariatric and Metabolic Centre – Breclav Hospital in the Czech Republic with Dr Michal Cierny PhD the Bariatric surgeon. They have a great deal of experience in preparing patients and giving them sufficient information to ensure safe surgery. The hospital is working to become a European Centre of Excellence in Bariatric Surgery, and the pre-operative health checks and tests for patients are very extensive. Cosmetic Bliss accompany all patients throughout their stay at the hospital and provide a full system of post operative support, nutrition diet and exercise advice. They encourage regular post-operative contact and follow up with patients for a minimum of 2 years after surgery, and monitor post-operative outcomes and weight loss following surgery on behalf of Dr Cierny. They are keen to work with UK GPs in providing post operative support to all patients. Although initially many patients are a little intimidated by the prospect of having surgery abroad, the quality of care, the system of safeguards Cosmetic Bliss and the Hospital have put in place, and the hand-holding service Cosmetic Bliss provide whilst the patient is in Hospital make it a very reassuring experience. Prices are fully inclusive and the cost is significantly lower than arranging for surgery in the UK also.

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.

Cosmetic Bliss have announced that they are now able to offer patients the Heliosphere Air-Filled Intragastric Balloon weight loss programme at their partner hospital Nemocnice Breclav in the Czech Republic. The cost - fully inclusive of flights, accommodation, transport, procedure - including removal of the Balloon after 6 months - AND a 2 year support package is only £3,400 (3,990 euro)
The procedure, which is performed by an endoscopic specialist (no surgical incisions required!) is a very useful addition to the range of Bariatric procedures (Gastric Banding & Sleeve Gastrectomy) the company provides. All weight loss patients are under the care of Dr Michal Cierny PhD – the renowned Bariatric Surgeon who performs all Cosmetic Bliss Obesity surgery, but this procedure will be carried out by Dr Martin Kriz, the Hospital’s Chief Surgeon and specialist endoscopist, and Dr Otto Riebel, the senior endoscopist.
Michael Dermody of Cosmetic Bliss said:
“The Gastric Balloon, which is put into the stomach for 6 months and allows patients to eat much less, thereby reducing food volume and calorie intake, is a very useful and proven medical Weight Loss procedure. It is ideal for those patients who are either just that bit too small for surgery such as a Lap Band or a Sleeve Gastrectomy, but still find it impossible to sustain weight loss by other methods. Also it can be useful if a patient has a medical condition which would not allow them to have surgery, or if their BMI is so high that surgery would be unsafe without first losing some weight.
We offered the saline filled BIB Balloon to patients for several years, but found that it was hard for some of them to tolerate it inside their stomachs. It took a lot to get used to – weighing more than half a Kilo when inflated! This new air-filled balloon, being double skinned and coated with pure gold on the inside (to prevent air molecules from escaping and causing the balloon to deflate) is more expensive, but because it weighs only 30g, patients find it much easier to get used to.
We tell everyone who comes to us for weight loss that NO procedure is a magic wand, and if they are to be successful they must change their diet and eating habits. The real secret is taking full advantage of the support we offer before and after the procedure. This is especially the case with the Balloon. It comes out after 6 months, and our patients must use the time it is inside to re-educate themselves and keep up the eating habits, portion control and increased exercise activity they have learnt. That’s why we have an extended 2 year support programme with nutrition, diet exercise and behaviour modification advice for Balloon patients – this is absolutely vital to make sure they get the most from it�
For more information visit http://www.cosmeticbliss.co.uk/p/weight-loss-surgery/gastric-balloon

On 1st November 2009 Cosmetic Bliss and Dr Michal Cierny PhD (Bariatric Surgeon) moved from the BMI Clinic in Brno where they had worked for over two years performing Gastric Band operations and Sleeve Gastrectomies, to Breclav Hospital near Brno.
The move was carried out to enable Dr Cierny to create a European Centre of Excellence in Bariatric Surgery. Dr Cierny plans to develop and extend his activities in the field of Bariatric Surgery by offering a wider range of procedures for Czech patients and also for patients from English-speaking countries who are brought to him and cared for by Cosmetic Bliss. The new centre, The Bariatric and Metabolic Centre, Breclav Hospital will fully integrate the disciplines of the dietitians, diabetologists, internal medicine specialists, anaesthetists and surgeon, and the comprehensive resuscitation, cardiac and ICU facilities of this large and well equipped hospital enable those patients with serious health problems to safely undergo surgery. Breclav Hospital is currently the only hospital in Europe to hold certificates for international standards ISO 9001. ISO 13001 and OHSAS 18001.
Dr Cierny said “I am more than ever convinced that it is vital to have a complete multi-disciplinary approach to the problems of obesity. Surgery is shown to be the long-term solution to morbid obesity, but surgery is only truly effective when the patients can receive the support and continuing encouragement and guidance of other professionals in the journey through their weight loss after their surgical procedure.”
Michael Dermody, one of the directors of Cosmetic Bliss, the UK company that arranges for English-speaking patients from UK, Eire and the USA to come for Weight Loss Surgery to Dr Cierny and Breclav Hospital welcomed this move, and suppported Dr Cierny’s comments. He added “I believe that psychological preparation for surgery, whether it is Banding, a Sleeve Gastrectomy, a Gastric Bypass or even a non-surgical intervention such as a stomach balloon is the most important factor in enabling the outcome of the procedure to be successful. I became even more aware of this during my own journey through weight loss after Dr Cierny performed a Sleeve Gastrectomy on me in September 2008. I have seen many cases of patients - both through the NHS and privately in the UK - going through weight loss surgery with inadequate preparation and information beforehand and little follow-up or counselling afterwards to enable them to understand the emotional changes and the changes in their relationship with food that weight loss after surgery brings about. We invest a great deal of our time and resources to ensure our patients are fully prepared for their procedure, and do our utmost to create a network of support, in terms of diet, nutrition and psychological assistance which our patients can call on in the months and years after their surgery. We really encourage our patients to maintain regular contact with us and with fellow patients. Quite honestly, Weight Loss Surgery is not a cheap nor an easy option, and it is wrong that people should make such a major investment, emotionally and financially, only to be left to fail because of inadequate preparation or poor support and follow up. In the UK, NICE (the National Institute for Clinical Excellence) has embraced the IFSO (International Federation of Surgeons in Obesity) criteria for acceptance of patients for surgical weight loss treatment, and part of those criteria involve careful psychological evaluation to ensure the patient is well placed to benefit from surgery. I know many UK PCTs set much tougher standards in terms of arbitrarily imposing higher BMI requirements on local candidates for surgery and this is clearly an attempt to limit the costs to the NHS of surgical procedures, but I believe they would be much better advised to concentrate on providing adequate support and counselling for those morbidly obese candidates for surgery they are able to afford to treat; in the long run this would prove a much more cost-effective option in terms of successful weight loss and the reduction of NHS costs in dealing with some of the co-morbidities associated with obesity such as Type II Diabetes and Hypertension”
Cosmetic Bliss is well placed to accept new patients for surgery with Dr Cierny in Breclav Hospital because of the new unit, though there is a waiting list of approximately 1 month.