NHS patients have to be referred through a weight management clinic, known as ‘Tier Three services’, and waiting lists can stretch to a year or more. Alternatively, patients can pay for a private procedure – a bypass typically costs about £9,000 to £9,500, doctors say.
Prof David Kerrigan, president of the British Obesity and Metabolic Surgery Society, says his private clinic, Phoenix Health, now receives about 50 enquiries a week despite doing no advertising – “definitely far more than we normally would”. Weight loss surgery is a Category Four NHS treatment, meaning that all procedures are currently on hold due to the pandemic. But Kerrigan expects a drastic increase in bookings once treatment resumes, which he hopes will be in July.
He wants the number of bariatric procedures carried out annually in the UK to rise from its current 6,000 to about 20,000 – “a modest increase”, he says, given that France carries out about 60,000 each year, despite having a similar number of obese people to the UK.
“It’s been looked at by the National Institute for Health and Care Excellence [NICE] and it’s one of the cost effective treatments there is,” he says. “It works, and the UK is one of the safest places in the world to have bariatric surgery.”
The issue is a thorny and emotive one. Despite a large body of evidence now pointing to the role of genetics and epigenetics, there are many who still regard obesity as a lifestyle issue, and do not think taxpayers should have to foot the bill. On the other side of the debate are “fat acceptance” campaigners, who dislike attempts to medicalise what they regard as a natural and healthy way of life.
“It’s a political hot potato, and there’s a lot of vitriol out there,” says Prof Kerrigan. “[People ask], ‘Why should the NHS spend money on these people, and why don’t they just fund it for themselves?’. The fact is, obesity is not simply a lifestyle choice. There is strong scientific evidence that the drivers behind it are very complex, and genetics certainly does play a part in the way it interacts with our current environment.”
Weight loss surgery also has a strong record against type 2 diabetes, he adds, which eats up about a tenth of the NHS’s overall budget.
Shaw Sommers, a consultant bariatric surgeon, says his private clinic has also seen a sharp increase in enquiries during the Covid pandemic. He thinks the NHS’s focus on preventative measures like diet and exercise does little to help the very fattest of patients, with a BMI over 40, for whom “you can diet all you like, your body’s just going to go straight back as soon as you take your foot off the brake”.
He says that surgery also makes financial sense, with obesity and its related illnesses costing the NHS about £4.3bn each year.