Article Outline
1. Attitude to surgery for morbid obesity
2. Attitude to the role of the NHS in providing surgery for the morbidly obese
3. Effect of subspecialty on attitude to obesity surgery
References
Morbid obesity is a major public health risk, and obesity-related diseases cost the United Kingdom National Health Service (NHS) £500 million a year, equivalent to 1.5% of its total expenditures. It is well documented that surgery is more effective than conservative treatment for morbidly obese patients and that it is also likely to be cost-effective [1] and [2]. Despite this evidence, bariatric surgery in the UK lags behind than in most other western countries, the reasons for which are unclear. Some doctors doubt the value of bariatric surgery and such prejudices may result in obese patients being denied valuable and potentially life-saving treatment.
We carried out a survey of surgeons in the UK to explore their opinion of bariatric surgery and their thoughts regarding the provision of these services in the NHS (free of cost to the individual patient). A postal questionnaire was sent to 1793 surgeons in the UK. After 120 exclusions, 1673 were left for analysis. A total of 748 surgeons (44.7%) replied.
1. Attitude to surgery for morbid obesity
Some 269 (36.0%) respondents felt that surgery is very useful in the management of morbid obesity. Of these, 164 (61.2%) would like to see more of these procedures performed in the NHS. Ninety-three surgeons felt that bariatric surgery is dangerous and should rarely, if ever, be used in the management of obesity. It is alarming that over 10% of the surgical fraternity in the UK condemns bariatric surgery, despite strong evidence in the literature confirming its safety and effectiveness.
2. Attitude to the role of the NHS in providing surgery for the morbidly obese
Sixty-three surgeons held the opinion that bariatric surgery should not be funded by the NHS. The reasons they gave were that: obesity is a psychological problem for which surgery is not appropriate (n = 31), surgery is not effective enough for it to be used in this disease (n = 6), and the condition is self-inflicted and treatment for it should be paid for by the patient (n = 25). Obesity is, indeed, sometimes viewed as a problem that is self-inflicted, and health care providers may hesitate to pay for treatment. Reassuringly, in this study, over 96% of surgeons would not object to effective treatment being provided to the morbidly obese in the NHS. Obesity is clearly a multifactorial disease and it would be unfair to withhold treatment on the presumption that it is entirely the fault of the patient.
3. Effect of subspecialty on attitude to obesity surgery
Surgeons with an interest in upper gastrointestinal (GI) surgery were more likely to have performed bariatric procedures and twice as likely to view obesity operations favourably (61% versus 29%), regardless of whether or not they actually performed bariatric surgery. Less than 3% of upper GI surgeons felt that these operations should not be offered to patients in the NHS, whereas over 10% of other surgeons held this view.
This study shows that prejudice against the obese is uncommon amongst surgeons and is not the main cause of the poor provision of bariatric services in the NHS. However, considerable scepticism still exists regarding the role of surgery for obesity. There is an urgent need for increased awareness, amongst the public and the medical fraternity, of the health care problems caused by the continuing epidemic of obesity. It should be recognised that, until a breakthrough is achieved that enables morbid obesity to be treated without major surgery, surgery is currently the most effective remedy for this problem.
References
[1] M.A. Maggard, L.R. Shugarman, M. Suttorp, M. Maglione, H.J. Sugerman and E.H. Livingston et al., Meta-analysis: surgical treatment of obesity, Ann Intern Med 142 (Apr 5 2005) (7), pp. 547559.
[2] L. Sjostrom, A.K. Lindroos, M. Peltonen, J. Torgerson, C. Bouchard and B. Carlsson et al., Swedish obese subjects study scientific group. lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery, N Engl J Med 351 (Dec 23 2004) (26), pp. 26832693.