'Super-obesity' required factor in some cases before weight loss op, says report

Rationing of surgery to treat clinically obese people means that some need to become "super-obese" before they are allowed a weight loss operation, a new report suggests.

Some regions in England are demanding that patients must have a body mass index (BMI) score of over 50 before they qualify for bariatric surgery.

Health experts are concerned that the message sent to obese patients is to get fatter so they can access surgery.

A BMI is calculated using a person's weight and height.

Those who have a score of over 30 are classed as obese, people with a BMI over 35 are deemed to be severely obese, people with a BMI over 40 are classed as morbidly obese and those with a BMI score of over 50 are clinically classed as super-obese.

Others were found to be limiting access to smokers.

The new report from the British Obesity and Metabolic Surgery Society (BOMSS) and the Royal College of Surgeons (RCS) is based on Freedom of Information requests to all clinical commissioning groups (CCGs) across England.

Six were considered to be "restricting access" to surgery, the report authors said.

:: East Riding CCG said patients must have a BMI of at least 50 before they will be considered for surgery.

:: Mid Essex CCG said patients must be non-smokers before they qualify for bariatric surgery.

:: Solihull CCG said that diabetic patients would be considered if they had a BMI over 45. People with hypertension, obstructive sleep apnoea or dyslipidaemia would be considered with a BMI over 50.

:: Vale of York CCG said patients must have a BMI over 50, or a BMI over 45 if they had a co-morbidity such as diabetes.

:: Wolverhampton CCG said patients must have a BMI score of 50, with different requirements for patients with diabetes.

:: Those in the catchment area of North East Essex must be referred to smoking cessation services before their initial assessment appointment.

The authors of the report said there is "growing evidence of rationing" by CCGs in a bid to save money.

They said the policies create a "postcode lottery", adding: "Bariatric surgery can restore good health as well as lead to cost savings for the NHS in the long term and, as scientific studies have shown, the procedure is particularly beneficial for patients who also suffer from diabetes."

The organisations said the findings flout official guidance stating that surgery is cost effective and should be considered for patients with a BMI of over 35 with an additional medical condition, such as type 2 diabetes, or a BMI of 40 without a co-morbidity.

Many CCGs did not have their own bariatric surgery policy in place.

Meanwhile, 17% said they had their own policy and were following official guidance.

"Our survey reveals worrying evidence that some CCGs are effectively taking the law into their own hands and defying official guidance on surgical interventions which have been proved to help people with a serious medical condition and also save healthcare costs," said BOMSS president Shaw Somers.

"It typifies the second-class citizen manner in which bariatric patients seem to be viewed by some CCGs.

"We are calling on NHS England and the National Institute of Health and Care Excellence (Nice) to make it clear to CCGs that they must comply with the guidelines on who is eligible for this safe and effective treatment, not try to ration it in a misguided attempt to save money in the short term."

RCS president Clare Marx added: "Study after study shows bariatric surgery is highly effective, particularly in treating type 2 diabetes associated with obesity.

"It is therefore astounding that commissioning groups are effectively indicating that obese patients should get even more obese before they will consider surgery.

"This makes no sense and contradicts our very strong public health messages about the benefits of losing weight.

"Bariatric surgery is a significant medical innovation which should be made available to those patients who meet criteria which Nice have considered and published."

NHS Vale of York CCG spokeswoman said: "Bariatric surgery is not routinely commissioned as a first line treatment and NHS England currently commission this.

"NHS Vale of York Clinical Commissioning Group (CCG) funds referral to tier 3 obesity management services in line with Nice guidance."

An NHS England spokesman said: "Ultimately, these are legally decisions for CCGs, but informed by best evidence and national guidance where appropriate."

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