BOMSS promotes the safe and effective use of surgical strategies as part of a co-ordinated pathway of care for the severely obese individual. As such it recognises that Body Contouring surgery (BCS) is a crucial component of a continuum of care for post-bariatric surgery patients. It therefore strongly supports the process of development of clear, practical and clinically sensible guidance for commissioning Body Contouring practice.
Many successful bariatric surgery patients inevitably suffer from physical and psychological problems secondary to loose skin and we strongly concur with the evidence provided in the document that there are significant quality of life benefits following BCS.
Following weight-loss surgery (and all other forms of weight loss) there are predictable changes in weight and associated body mass index (BMI). BOMSS has a significant concern that the BMI cut-off of 27kg/m2 is set at a level that many successful patients may never reasonably attain. These patients often have significant functional impairment from copious excess skin, despite having a high residual BMI. It recognises that there is still uncertainty over risks and benefits of BCS at increasing BMIs but believes that the threshold in this document is set too low and believes this should be reviewed.
BOMSS recognises too that there are resource implications of any commissioning guidance. The distribution of resource may also be biased by this stringent guidance as many patients require more than one procedure. This mechanism of allocation may mean that some deserving patients may have no access to BCS, whilst others have access to multiple procedures. Another stance may be to increase the BMI of eligibility but place guidance on frequency of interventions.
Nevertheless, BOMSS recognises that it is likely that the guidance will need to stipulate a prioritisation group. It would strongly recommend that, in view of the evolving evidence on this clinical area, there is a commitment in the document for a timetabled review process and recommendation that resources should be developed to accommodate a likely increasing need in the near future.
As part of the ongoing process, we would like to hear views from our members. Please email firstname.lastname@example.org