Eligibility for bariatric surgery among adults in England: analysis of a national cross-sectional survey
From JRSM Open
Two million people in England could be eligible for weight loss surgery according to this new research. The figure far exceeds previous estimates of eligibility. In the first study to quantify the number of people in England eligible for bariatric surgery, researchers from Imperial College London concluded that people fulfilling the national criteria were more likely to be women, retired, have lower educational qualifications and have lower socioeconomic status. Bariatric surgery – a set of surgical procedures performed on obese people to decrease their stomach size – can greatly reduce the likelihood of death from obesity-related diseases including type 2 diabetes, stroke and coronary heart disease. Recent data show surgery rates have risen year-on-year in England, yet service delivery rates still fall significantly below the level needed to support all those who could potentially benefit.
Dr Sonia Saxena of Imperial College London said: “Despite clear guidelines outlining who can undergo such surgery with the NHS, and evidence that these procedures are cost-effective in the long run, less than one per cent of those eligible have weight loss surgery each year. This raises questions about why more procedures are not currently being carried out.” “Greater investment in service provision may be required as obesity rates continue to rise. Dr Saxena concludes: “Since those eligible are more likely to be of a lower social class and have lower qualifications, resources would need careful allocation to ensure equitable access on the basis of need.”
Objectives: This study aimed to determine the number eligible for bariatric surgery and their sociodemographic characteristics.
Design: We used Health Survey for England 2006 data, representative of the non-institutionalized English population.
Setting: The number of people eligible for bariatric surgery in England based on national guidance is unknown. The UK National Institute for Health and Clinical Excellence criteria for eligibility are those with body mass index (BMI) 35–40 kg/m2 with at least one comorbidity potentially improved by losing weight or a BMI > 40 kg/m2.
Participants: Of 13,742 adult respondents (≥18 years), we excluded participants with invalid BMI (n = 2103), comorbidities (n = 2187) or sociodemographic variables (n = 27) data, for a final study sample of 9425 participants.
Main outcome measures: The comorbidities examined were hypertension, type 2 diabetes, stroke, coronary heart disease and osteoarthritis. Sociodemographic variables assessed included age, sex, employment status, highest educational qualification, social class and smoking status.
Results: 5.4% (95% CI 5.0–5.9) of the non-institutionalized adult population in England could meet criteria for having bariatric surgery after accounting for survey weights. Those eligible were more likely than the general population to be women (60.1% vs. 39.9%, p<0.01), retired (22.4% vs. 12.8% p<0.01), and have no formal educational qualifications (35.7% vs. 21.3%, p<0.01).
Conclusions: The number of adults potentially eligible for bariatric surgery in England (2,147,683 people based on these results and 2006 population estimates) far exceeds previous estimates of eligibility. In view of the sociodemographic characteristics of this group, careful resource allocation is required to ensure equitable access on the basis of need.
Research: Ahmir Ahmad, Anthony A Laverty, Erlend Aasheim, Azeem Majeed, Christopher Millett, and Sonia Saxena
Eligibility for bariatric surgery among adults in England: analysis of a national cross-sectional survey JRSM Open January 2014 5: 2042533313512479, first published on January 16, 2014 doi:10.1177/2042533313512479