Press Releases and Statements

March 2016

NHS Commissioning Groups restricting weight loss surgery, surgeons warn – at a cost to patients and the public healthcare bill

A freedom of information (FOI) request made to all NHS commissioning groups (CCGs) shows that several have adopted policies which attempt to ration weight loss surgery to the super-obese, and ignore official advice on who should be eligible for surgery.

This has made it more difficult for overweight and obese people to get effective treatment to help them lose weight despite evidence that it is safe, effective and saves healthcare costs, according to the findings of a joint report from The British Obesity and Metabolic Surgery Society (BOMSS) and the Royal College of Surgeons (RCS).

Some CCGs either require patients to stop smoking or for patients to have a Body Mass Index (BMI) of over 50, despite NHS England and the National Institute for Health and Care Excellence (NICE) stating that surgery is cost effective and should be considered for patients with a BMI of over 35 with a co-morbidity (a further medical condition) such as Type II diabetes, or a BMI of 40 without a co-morbidity.

NHS England is currently delegating the commissioning of bariatric surgery to CCGs although most groups (80%) have yet to decide their own policies. Six CCGs admit they are not complying with the NHS England and NICE guidance. East Riding CCG says patients must have a BMI of at least 50 before they will be considered for surgery. Wolverhampton CCG imposes the same condition but will also consider some patients at a lower BMI who have diabetes. Solihull considers patients at BMI 50 with certain co-morbidities and will consider patients at BMI 45 or higher who have diabetes. Vale of York will look at patients at BMI or 50 or more but will consider patients at a lower BMI with certain co-morbidities. Mid-Essex is restricting treatment to non-smokers at the time of referral and NE Essex says smokers must be referred to a cessation service before they can be considered.

BOMSS and the RCS are warning this could harm patients and are demanding they revise their policies to bring them in line with the official guidelines.

The report showed that most CCGs have not yet adopted their own bariatric surgery policies – but will have to do so by next month under a phased government NHS reform.

Shaw Somers, Consultant surgeon and BOMSS President, said: “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.

“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 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.”

Royal College of Surgeons President Clare Marx said: “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.”

BOMSS and the RCS make five recommendations to health bosses.

  • The six CCGs with arbitrary requirements for bariatric surgery should revise their policies in line with national clinical guidance.
  • NHS England should reiterate that access to NHS bariatric surgical treatment should be based on clinical need and uniform across the UK.
  • NICE and NHS England should continue to highlight the benefits of bariatric surgery.
  • NHS England should confirm that all CCGs will be responsible for commissioning bariatric surgery from 1 April to address the confusion over who is responsible.
  • NHS England should provide CCGs with clinical guidance for commissioning bariatric surgery, in advance of the transfer of responsibilities.

As well as calling on the six CCGs to fall in line with guidance the RCS and BOMSS have pledged to review the policies of all CCGS once new commissioning rules are in place.

RCS and BOMSS Bariatric report 2017


 

August 2016

Obesity Health Alliance: Government obesity announcement lets down future generations

The Obesity Health Alliance – of which BOMSS is a member – says the measures announced this week are far from an ambitious strategy and let down the next generation who will pay the price for the Government’s failure to take strong action. The measures on their own will not tackle the obesity crisis and are not sufficient to reduce the rising toll of ill-health, premature deaths and unsustainable costs to the NHS.

The Alliance, a coalition of 33 leading national charities, Medical Royal Colleges, and campaign groups say that even after delaying publication for a whole year, the Government has fallen far short of what is needed and is failing to take the necessary measures to tackle childhood obesity.

While the launch of the Government’s soft drinks industry levy consultation is a bold and positive step forward, the plan outlined today lacks ambition and will fail to tackle childhood obesity as promised in the Government’s manifesto.

The Obesity Health Alliance’s key concerns include:

  • The Government has missed an opportunity to take action to protect children from junk food marketing – despite there being clear evidence of the impact advertising has on their food choices. The group say the Government must remove junk food advertising before the 9pm watershed to reduce exposure to children. This is because evidence shows that advertising of unhealthy food and drink makes it very difficult for children and their families to make healthy choices and greatly influences the food they eat.
  • The Government’s plan to introduce voluntary targets for food manufacturers to reduce the amount of added sugar falls well short of what is needed. The 20% sugar reduction target will not be sufficient to meet the Government’s own recommended level of free sugars making up no more than 5% of total energy intake. The Alliance say the previous Responsibility Deal demonstrated that we can’t rely on industry to do this on their own so there must be penalties issued for non-compliance. Many everyday foods are loaded with added salt, fat and sugar so setting targets for food manufacturers to reduce the amount of these nutrients in their products would make it far easier for people to eat more healthily. Making these targets regulatory is necessary to create a level playing field and ensure no manufacturer is penalised.

In a joint statement the Obesity Health Alliance said: “The Government’s plan is underwhelming and a missed opportunity to tackle the obesity crisis and its devastating burden on the health of both society and the NHS.

“We live in an environment where children and their families are bombarded by junk food advertising and many everyday foods and drinks are stuffed full of fat and sugar. This is fuelling the huge numbers of children we are seeing who are overweight and obese, and therefore at great risk of serious health conditions in adult life such as Type 2 diabetes, cardiovascular disease, liver disease and cancer as well as associated mental health problems. These conditions are not only personally devastating but are costly and pose a real threat to the sustainability of our already overstretched health service.

“This is why we need strong and bold Government action to make it as easy as possible for children and their families to make healthier choices and lead healthier lives. While the launch of the soft drinks industry levy consultation is an important step, the Government’s plan falls disappointingly short of what is needed. In particular, there is strong evidence that shows that targets, backed by regulation, for the food and drinks industry to make their products healthier and removing junk food advertising before the 9pm watershed would have a huge impact on reducing levels of obesity so it is very disappointing to see that both of these measures have been significantly watered down or removed entirely.

“These measures are critical to protecting public health and alleviating the devastating impact of obesity on the nation’s finances and they have strong support from the public. With the new school term approaching, one in three children will be starting secondary school overweight or obese. The Government cannot afford to shy away from this challenge. For the sake of the health of our children we need strong action right now.”

 

  1. The Obesity Health Alliance (OHA) is a coalition of over 30 leading health charities, campaign groups and Royal Medical Colleges who have joined together to fight obesity.

http://obesityhealthalliance.org.uk/

 

  1. The membership of the OHA currently comprises: Academy of Medical Royal Colleges, Action on Sugar, Association for the Study of Obesity, Association of Directors of Public Health , British Association of Sport and Exercise Medicine , British Heart Foundation, British Medical Association, British Obesity and Metabolic Surgery Society, British Society of Gastroenterology, Cancer Research UK, Children’s Food Campaign, Children’s Food Trust, Diabetes UK, Faculty of Public Health, Faculty of Sport and Exercise Medicine, Health Equalities Group, Institute of Health Visiting, Jamie Oliver Food Foundation, National Obesity Forum, Men’s Health Forum, Royal College of Anaesthetists, Royal College of General Practitioners , Royal College of Nursing , Royal College of Physicians, Royal College of Paediatrics and Child Health , Royal College of Obstetricians and Gynaecologists, Royal College of Psychiatrists, Royal College of Surgeons of England, Royal College of Surgeons of Edinburgh, Royal Society of Public Health, Society for Endocrinology , UK Health Forum, World Cancer Research Fund UK

 

  1. The statement has been issued on the behalf of the Obesity Health Alliance steering group, which comprises of: British Heart Foundation, British Medical Association, Cancer Research UK, Children’s Food Campaign, Diabetes UK, Faculty of Public Health, Royal College of Physicians, Royal College of Paediatrics and Child Health and UK Health Forum

May 2016

More weight loss surgery needed to curb the obesity epidemic

Despite being the most successful treatment, the availability of bariatric surgery is limited

The NHS should significantly increase rates of weight loss surgery to 50,000 a year, closer to the European average, to bring major health benefits for patients, and help reduce healthcare costs in the long term, argue experts in The BMJ.

Weight loss surgery, also known as bariatric surgery, reduces the size of the stomach with a gastric band or through removal of a portion of the stomach.

Studies have shown surgery to be clinically effective and cost effective in helping patients to reduce weight, by as much as 25-25% within the first year, and managing obesity related conditions, such as type 2 diabetes.

Cost of surgery can be recoupled within three years by savings on prescriptions and daily blood glucose monitoring, and improved physical activity can help patients return to work, and reduce the need for disability benefits.

However, bariatric consultant surgeon Richard Welbourn and colleagues argue that as obesity levels are increasing, NHS bariatric procedures are falling.

Between 2011-12 and 2014-15, the number of operations fell by 31%, from 8,794 to 6,032. And less than 1% of those who could benefit get treatment. This is in stark contrast to provision in many European Union countries.

The UK has the second highest rate of obesity in Europe, and ranks sixth internationally. However, it ranks 13th out of 17 for countries and sixth in the G8 countries for rates of bariatric surgery.

Rates of surgery vary within the UK. NHS operations are not performed in Northern Ireland, and only a few in Wales and Scotland. “Given the severity of the problem, it seems urgent to consider the potential barriers to surgery,” they say, and recommend a number of solutions.

They explain that GPs are unable to refer patients directly to surgical services. Instead, patients enter a four tier system for diet and weight management treatment, before they can be treated by a specialist clinical team or assessed for surgery.

This is a prolonged service, and may put patients off accessing treatment. So they suggest “combining provision of secondary care medical and surgical management so that patients have access to surgical assessment earlier.”

Furthermore, “GPs and commissioners need to recognise the health benefits gained from bariatric surgery and the cost savings. This will facilitate better provision of secondary care services,” and help address concerns of upfront costs being another barrier.

Predjuice and stereotyping can also have an impact, they add, and those opposed to surgery argue that it diverts attention away from prevention.

“Adopting the phrase ‘metabolic surgery’ might enable society and patients to talk about it and begin to establish a culture change,” they suggest.

Development of obesity or metabolic care services for surgical follow-up in general practice could improve care for people not wanting surgery, and provision of more surgery requires better long term support and nutritional follow-up.

Around 2.6 million people in the UK meet NICE criteria for bariatric surgery, which is based on various factors, such as body mass index, obesity related conditions such as type 2 diabetes, and previous attempts to lose weight.

It’s not possible to operate on every patient, therefore the NHS should target those who have the greatest potential for improved health, they explain, such as those with high BMIs, related conditions such as type 2 diabetes, and sleep aponea.

http://www.bmj.com/cgi/doi/10.1136/bmj.i1472


 May 2016

BOMSS responds to HSCIC report into obesity-related hospital admissions

BOMSS has responded  to the recent HSCIC report into Obesity, Diet and Physical Activity which showed that rising numbers of people are obese and that there is an increase in the number of obesity-related hospital admissions
Roger Ackroyd, the President of BOMSS said in response to the HSCIC report: “Being overweight is linked to a host of health problems, all of which can reduce quality of life and a person’s ability to be economically active as well as increasing the general healthcare bill.
Bariatric surgery can be an effective treatment for many health complications which are linked to being overweight – diabetes and high blood pressure for example.

Bariatric surgery is not to blame for the obesity crisis – and surgery is not a ‘quick-fix’ – but it can be part of the solution. And surgical success comes despite the fact that our patients are becoming heavier and presenting with more health complications at the point of surgery.

Surgeons in the UK currently operate on only a tiny proportion of the people who would be eligible for surgery under NICE guidelines. As Professor Sir Bruce Keogh, Medical Director of the NHS, said at the launch of the National Bariatric Surgery Registry (NBSR): “As in all branches of medicine, prevention is better than cure but, when required, bariatric surgery is effective and safe.”

In many cases bariatric surgery is the right choice for many people who have severe and complex obesity. It improves their quality of life and often enables them to achieve things that had become impossible. For some people, bariatric surgery is one episode in the lifelong chronic disease of obesity. Bariatric surgeons in the NHS are pioneers and champions of the multidisciplinary team (MDT) approach to patient care, ensuring that we get the best possible results in both short and long term.

Members of the British Obesity and Metabolic Surgery Society (BOMSS) and their colleagues do important work. Audits and official figures only confirm what we see day to day in our surgeries – bariatric surgery plays a vital role in helping people who suffer ill-health because of their weight and saves the NHS money at the same time.”

The full report can be seen here: http://www.hscic.gov.uk/catalogue/PUB20562/obes-phys-acti-diet-eng-2016-app.pdf


February 2016

BOMSS echoes concerns of Obesity Alliance over delay to Government Obesity Strategy

Members of the Obesity Health Alliance, a campaign group which formed last November to tackle obesity – and which includes BOMSS – has expressed concern about the increased risks to children’s health caused by the delay of the Government’s Childhood Obesity Strategy.

The Government’s strategy has already been delayed for months but the Department of Health has now confirmed that it will not be published until the summer, after the European referendum. With almost two thirds of adults and almost a third of children in the UK overweight or obese, members of the Alliance have warned that every day without an effective strategy in place means that the obesity time bomb is ticking, and that opportunities are being missed to protect the health and wellbeing of children and their families.

The group members say it is vital that the Prime Minister shows strong leadership, and calls on the Government to take urgent steps to address the obesity crisis. Being overweight or obese poses significant risk factors for serious health conditions such as Type 2 diabetes, cardiovascular disease, stroke, a range of cancers and poor mental health. These conditions have a devastating impact on our nation’s health and also place a huge financial burden on the NHS.

The Obesity Health Alliance has set out three key actions (see below) that it wants the Government to implement in its Childhood Obesity Strategy as a priority so that it is easier for people to make healthier choices and live healthier lives. This includes targets for food manufacturers to reduce the amount of saturated fat, salt and added sugar in their foods, meaningful restrictions to reduce children’s exposure to unhealthy food and drink marketing, and a 20 per cent tax on sugar sweetened beverages.

Jane Landon, Deputy Chief executive of the UK Health Forum said: “The Government has pledged its firm commitment to tackling child obesity, but we simply cannot afford a delay in taking action. As the clock ticks, the prevalence of obesity continues to rise, adding to already unsustainable demands on health and social care services.”

Professor John Ashton, President of the UK Faculty of Public Health, said: “We are disappointed that a strategy to tackle childhood obesity has been further delayed. A duty on sugary drinks would prevent over 300,000 cases of obesity among children and adults each month. Children only have one chance at a good start in life, and so we all need to each play our part in protecting their health.”

Obesity Health Alliance three key actions:

1)         The Government should introduce a ban on advertisements before the 9pm watershed for food and drink products that are high in saturated fat, salt and sugar. Alongside this, regulation governing on-demand services and online advertisements should be tightened to align with broadcast regulations.

2)         The Government should take action to reduce the consumption of sugar-sweetened beverages (SSBs) by introducing a 20 per cent tax on SSBs. The impact of this tax should be monitored and evaluated annually with revenue raised reinvested in public health promotion.

3)         The Government should develop an independent set of incremental reformulation targets for industry, backed by regulation and which are measured and time bound. These targets should address salt, sugar and saturated fat levels. Compliance with these targets should be monitored and non-compliance should be backed by meaningful sanctions.

– Ends –

 

Notes: 1              The Obesity Health Alliance (OHA) is a new coalition of 28  national organisations which have come together to represent the unified voice of the public health sector on issues relating to overweight and obesity in the UK. We seek to share expertise and to support government in tackling the complex issue of overweight and obesity.

2              The membership of the OHA currently comprises: Academy of Medical Royal Colleges, Action on Sugar, Association for the Study of Obesity, Association of Directors of Public Health, British Association of Sport and Exercise Medicine, British Heart Foundation, British Medical Association, British Obesity and Metabolic Surgery Society, British Society of Gastroenterology, Cancer Research UK, Children’s Food Campaign, Diabetes UK, Faculty of Public Health, Faculty of Sport and Exercise Medicine, Health Equalities Group, Institute for Health Visiting, Jamie Oliver Food Foundation, National Obesity Forum, Royal College of General Practitioners, Royal College of Nursing, Royal College of Anaesthetists, Royal College of Paediatrics and Child Health, Royal College of Physicians, Royal College of Psychiatrists, Royal College of Surgeons, Royal Society for Public Health, Society for Endocrinology, and UK Health Forum.

3              The OHA is the first coalition of its size to support the long term goal of tackling obesity across the life course, and we are growing. Our organisations are diverse and bring a wealth of expertise, spanning the medical, nursing, charity, and public health fields. United, we represent the views of hundreds of thousands of health professionals and public health experts across the UK.

4                     The OHA has produced a joint position statement which outlines ten urgent population-level policy interventions for government, retailers and health professionals. We believe these measures, implemented in conjunction, will reduce rates of overweight and obesity and address the social inequality and cultural differences in overweight and obesity prevalence. This is accessible at: https://www.rcplondon.ac.uk/news/new-alliance-obesity-outlines-priorities-action


December 2015

BOMSS welcomes study which shows bariatric surgery can cut the risk of diabetes and heart attacks and help weight loss

Mr Roger Ackroyd, President of BOMSS, has welcomed the findings of a major study which shows that bariatric surgery can help curb the risk of diabetes, high blood pressure and heart attacks as well as aiding weight loss.

Research led by scientists from the London School of Hygiene & Tropical Medicine compared rates of obesity-associated illnesses in 3,882 weight-loss surgery patients with those who had not undergone the procedure.

They found that over three-and-a-half years, surgery significantly improved existing Type 2 diabetes and lowered high blood pressure.

Applying the findings to the 1.4million Britons believed to be morbidly obese, the study in the journal PLOS Medicine said surgery could prevent 80,000 cases of high blood pressure, 40,000 cases of type 2 diabetes and 5,000 heart attacks over four years.

Mr Ackroyd said: “We welcome the findings of this important study. It shows that bariatric surgery can be an effective treatment for diabetes and high blood pressure while also cutting the number of heart attacks, all of which have serious implications for people’s health and represent a heavy financial burden for the health service.”

It is the largest comprehensive investigation of bariatric surgery – spanning around four years in nearly 8,000 patients.

The researchers looked at 3,882 patients who underwent weight loss surgery and compared them with an identical number who did not have surgery.

Gastric bypass, sleeve gastrectomy and gastric banding were all included in the study – and all led to a significant and sustained weight loss of between 20kg and 48kg.

The weight stayed off which, in turn, significantly lowered people’s risk of developing Type 2 diabetes, high blood pressure, angina and heart attacks.

All surgery carries risks, however, and so people should only be offered surgery if attempts to lose weight through healthy eating and physical activity have already been tried and not worked, they add.

Lead researcher Dr Ian Douglas, from the London School of Hygiene and Tropical Medicine, said: “The results are really encouraging. Obviously we would love to help people lose weight in other ways, through exercise and healthy diets, but that’s difficult. Diets do not always work well for everyone.”

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001925


 

October 2015
Welcoming the RCOG Paper on pregnancy and weight

BOMSS president Mr Roger Ackroyd has responded to a Scientific Impact paper from the Royal College of Obstetricians and Gynaecologists (RCOG).

Mr Ackroyd said: “We welcome the RCOG report which has valuable insights and we agree entirely that bariatric surgery is indeed often beneficial to overweight women wishing to become pregnant. Not only does it increase fertility in women who are often less fertile due to their weight and/or polycystic ovaries, but it can decrease problems and complications of pregnancy and in the newborn.

“NICE Guidelines now recommend surgery down to a BMI of 30 in patients with Type 2 diabetes which may include many women of child-bearing age.”

The text of the RCOG press release is as follows –

RCOG release: Weight loss surgery improves female fertility and reduces pregnancy complications

RCOG recommends that bariatric surgery should only be considered as a “last resort”

Weight loss surgery can improve fertility and reproductive outcomes in obese women according to a Scientific Impact Paper (SIP) published today (15 October) by the Royal College of Obstetricians and Gynaecologists (RCOG).

Obesity, classed as having a body mass index (BMI) of 30 or over, affects over a quarter of the female population. Being very overweight or obese impacts on natural conception, miscarriage, pregnancy and the long term health of women and their children, due to an increased risk of congenital anomalies, pregnancy complications and illnesses associated with obesity, such as diabetes, high blood pressure and certain cancers.

This opinion paper reviews the latest evidence around the safety and effectiveness of different types of bariatric or weight loss surgery as an intervention to improve fertility and reproductive outcomes in obese women. The authors agree that the only effective ways of inducing long-term weight reduction in women with severe obesity, and thereby improving reproductive health, are either significant sustained lifestyle changes or bariatric surgery. However, they stress that it would be impractical to recommend surgery to all obese women of reproductive age.

Professor Adam Balen, lead author of the paper and spokesperson for the RCOG said:

“Our review of all the literature on this subject confirms that weight loss surgery can improve fertility and reproductive outcomes in obese women, but we believe it should only be considered as a last resort when other treatments, such as lifestyle changes, haven’t worked.

“As with any major operation, bariatric surgery carries a risk of complications but also requires a significant change in lifestyle afterwards. As well as the time needed to recover from the surgery, it can delay conception by up to 12 to 18 months during the initial weight loss phase, because the fetus may be at risk of nutritional deficiencies. Additionally, there is very limited access to these types of interventions on the NHS and the demand is currently higher than supply in many areas of the country.

“Being a healthy bodyweight increases the chances of conceiving naturally and reduces the risk of the problems associated with being overweight or obese in pregnancy. Before considering weight loss surgery, women planning a family who are overweight or obese should lose weight through a healthy, calorie-controlled diet and increased amounts of exercise. The free NHS weight-loss plan and a referral to a weight loss support group are proven effective ways of achieving weight loss goals”.

Bariatric surgery results in a 15 to 25 per cent long-term loss of body weight, as well as significant reductions in healthcare costs and illnesses associated with obesity, such as diabetes, high blood pressure and certain cancers.

Additionally, this review looked at evidence, which shows that bariatric surgery improves signs and symptoms associated with polycystic ovary syndrome (PCOS) which influences fertility, including anovulation (the ovary failing to release eggs), hormonal changes and libido. Bariatric surgery is also associated with higher success rates of assisted conception, including IVF. In pregnancy, most research has shown improved maternal and infant outcomes in women who have had bariatric surgery compared with similarly obese women or previous pregnancies in the same women. This includes a reduced risk of miscarriage, gestational diabetes, hypertension, macrosomia (large baby) and congenital abnormalities. There is however an associated increased risk of preterm birth and small for gestational age (SGA) babies.

Current NICE guidelines recommend bariatric surgery only in cases where a patient has a BMI of 40 or above or a BMI of 35 or above and another serious health condition that could be improved with weight loss. In both cases, surgery is only available on the NHS when other treatments, such as lifestyle changes, have not worked.

The authors advise that pregnant women who undergo bariatric surgery receive specialist care throughout their pregnancy, including dietetic support, weight monitoring, close observation of fetal growth and monitoring for gestational diabetes. During neonatal care, careful monitoring for SGA and preterm birth is essential.

Dr Sadaf Ghaem-Maghami, Chair of the RCOG’s Scientific Advisory Committee, added:

“As with any operation, bariatric surgery is associated with some risks and complications can include infection, protein malnutrition, deep vein thrombosis and hernia. An increased rate of small for gestational age babies and preterm birth has also been documented in some research.

“It is therefore vital that when bariatric surgery is considered an option and is available for women who wish to improve their chance of conceiving naturally or through assisted means, they speak to their obstetrician and surgeon to balance the risks of surgery against the benefits of improved long-term health and wellbeing for themselves and their future children.”


 

July 2015
The role of bariatric surgery

Roger AckroydOur President, Mr Roger Ackroyd, was recently asked to contribute a blog for use on the website of the Royal College of Surgeons. Here is the blog:

“Health Secretary Jeremy Hunt has warned that obesity will overtake smoking to become the biggest public health challenge over the next five years.

There are concerns that the health service will be overwhelmed unless urgent action is taken to stop people piling on the pounds. And there has been criticism in the media that more money is spent on bariatric surgery than efforts to stop people becoming obese in the first place.

We agree that the government must urgently get to grips with this health challenge. But we dispute claims that bariatric surgery is somehow to blame for the obesity crisis – that the health service simply waits for people to become obese and then offers them surgery as a ‘quick-fix.’

Bariatric surgery is not a quick-fix and surgeons in the UK operate on only a tiny proportion of the people who would be eligible for surgery under NICE guidelines.

As Professor Sir Bruce Keogh, Medical Director of the NHS, said at the launch of the National Bariatric Surgery Registry (NBSR): “As in all branches of medicine, prevention is better than cure but, when required, bariatric surgery is effective and safe.”

Surgical success comes despite the fact that our patients are becoming heavier and presenting with more health complications at the point of surgery.

The NBSR – www.nbsr.org.uk –  is the source of information on the effectiveness of weight loss surgery in the UK. The latest report includes figures on 16,956 primary operations and more than 1,327 planned follow-up procedures.

NBSR figures show that the average BMI of bariatric patients has increased from 48.5 to 48.8 in four years and the average number of co-morbidities has increased from 3.2 to 3.4. However, the average post-operative stay has fallen from 3.1 to 2.7 days. So patients are sicker at the point of surgery, but their post-op stay is decreasing.

Two-thirds of patients with Type 2 diabetes at the point of surgery were free of the condition two years later and therefore able to stop taking medications for it. This is how the NHS saves money through surgery.

Surgery also gives people back their health. Before treatment, 73.2 per cent of men and 71.5 per cent of women suffered functional impairment – they were unable, for example, to climb three flights of stairs without resting. After surgery more than half – 56 per cent – could carry out such tasks.

In many cases bariatric surgery is the right choice for many people who have severe and complex obesity. It improves their quality of life and often enables them to achieve things that had become impossible.

For some of these people, bariatric surgery is one episode in the lifelong chronic disease of obesity. Bariatric surgeons in the NHS are pioneers and champions of the multidisciplinary team (MDT) approach to patient care, ensuring that we get the best possible results in both short and long term.

Members of the British Obesity and Metabolic Surgery Society (BOMSS) and their colleagues do important work. Audits and official figures only confirm what we see day to day in our surgeries – bariatric surgery plays a vital role in helping people who suffer ill-health because of their weight and saves the NHS money at the same time.”


 

January 2015
BOMSS hails delay in transfer of obesity services to CCGs

Leading surgeons who treat people with morbid obesity have expressed relief that plans to transfer control of commissioning weight loss surgery to Clinical Commissioning Groups (CCGs) have been delayed.

The British Obesity and Metabolic Surgery Society (BOMSS) was concerned that the proposed transfer was being pushed through too quickly and would have impacted negatively on both patient care and access to cost-effective treatment.

The objections from BOMSS echoed those of the NHS Clinical Commissioners – the independent membership organisation of CCGs.

And this week NHS England announced that the transfer of services would be halted and instead it launched a consultation into how it will prioritise which specialised services and treatments to invest in. It directly commissions around 145 specialised services and will consult on which of these it will continue to fund.

Mr Roger Ackroyd, the new president of BOMSS, says: “We were concerned about the transfer of commissioning to CCGs so quickly and without any clear evidence that the change would result in improved patient care.”

“Surgery referrals are likely to have fallen and access to effective treatment made even more difficult for severely obese patients.”

BOMSS will now work to ensure that statutory safeguards to protect morbidly obese patients from inequality of access to NHS treatment are put in place before any new transfer plans are announced.

Ends

Notes to editors:

  • BOMSS is the UK’s professional society of bariatric (weight loss) surgeons and allied health professionals, including dietitians, specialist nurses and psychologists. bomss.org.uk

For more information contact Helen Riley at Helenriley@headlinemedia.co.uk, Tel: 020 8348 3103 / 07931 300 425


 

January 2015
BOMSS calls for transfer of obesity services to CCGs to be delayed until 2016

Leading surgeons who treat people with obesity have expressed concern over plans to transfer control of commissioning weight loss surgery to Clinical Commissioning Groups (CCGs) by April.

The British Obesity and Metabolic Surgery Society (BOMSS) says the plans are being pushed through too quickly and could impact on both patient care and access to cost-effective treatment.

The objections from BOMSS echo those of the NHS Clinical Commissioners – the independent membership organisation of CCGs – which has complained to NHS England about the proposals to transfer responsibility for morbid obesity services (and renal dialysis) to CCGs by April, saying they do not give CCGs time to plan effective services for patients.

Mr Richard Welbourn, president of BOMSS says: “We share these concerns about the transfer of commissioning to CCGs so quickly and without any clear evidence that the change would result in improved patient care.”

“If the transfer of services is handed over in haste in just a few months we are worried that in the inevitable chaos that will result, surgery referrals will fall which will make access to effective treatment even more difficult for severely obese patients and may even threaten the viability of some NHS bariatric units”.

“We recognise that many have little sympathy for obese individuals getting bariatric surgery on the NHS and that prejudice against people who are severely overweight is widespread, but we have shown that bariatric surgery very quickly gives people their health back and actually reduces the national healthcare bill.

“Any reduction in the NHS weight-loss surgery service would end up costing the taxpayer much more in other health costs as untreated patients consume huge amounts of NHS resource treating conditions such as diabetes and other serious disabilities caused by obesity.”

BOMSS is calling for the transfer of commissioning responsibility to be delayed for a year until April 2016 to allow enough time to introduce statutory safeguards which will protect morbidly obese patients from inequality of access to NHS treatment.

It wants NHS England to retain overall responsibility in a co-commissioning arrangement with CCGs from April 2015 to April 2016 and that commissioning practice during this transition period adheres strictly to current practice and the national service specification.

 

Ends
For more information contact Helen Riley at: Helenriley@headlinemedia.co.uk Tel: 020 8348 3103 / 07931 300 425

 

November 2014
BOMSS welcomes updated NICE guidance on obesity management

The British Obesity and Metabolic Surgery Society (BOMSS) has welcomed the updated guidance from the National Institute for Health and Care Excellence (NICE) on eligibility for bariatric surgery which has been issued today (November 27).

The new guidance strengthens the focus on people with Type 2 diabetes. It states that those who have been diagnosed in the past decade and have a BMI over 35 should be assessed for surgery. The guidelines also suggest doctors should consider those with a BMI of 30 or more on a case-by-case basis.

BOMSS strongly endorses access to surgery for people with diabetes with appropriate follow-up, the involvement of physicians and the use of a shared care model of chronic disease management.

Mr Richard Welbourn, president of BOMSS and one of the experts who advised NICE on the updated guidance, says: “Surgery can be a powerful treatment for diabetes. There are published data on 26,000 surgical patients with impressive recovery from diabetes and functional status with those who have had diabetes for the shortest period recovering quickest.” (UK data from the NBSR – www.nbsr.co.uk ).

The 2014 NBSR report, which was released on November 10 showed that 65.1% of patients with Type 2 diabetes at the point of surgery showed no indication of diabetes two years after surgery and were able to stop their diabetic medications – a cost saving to the health service.

Mr Welbourn added: “Bariatric surgery improves people’s health and also saves on healthcare costs.”

BOMSS also supports lifestyle interventions such as dieting to improve diabetes control and possibly reduce medications for some patients. But data shows that 70% of bariatric patients cannot climb three flights of stairs so are not physically able to exercise their weight away. However, one year after surgery half of those who couldn’t manage three flights previously of stairs then could manage them.

BOMSS Commissioning guidance can be viewed here:

http://www.bomss.org.uk/commissioning-guide-weight-assessment-and-management-clinics-tier-3/ .

Notes to editors:

 

  • Mr Richard Welbourn, Mr Ken Clare and Ms Mary O’Kane, BOMSS Council members, were part of the NICE Guidance Development Group.

 

  • BOMSS is the UK’s professional society of bariatric (weight loss) surgeons and allied health professionals, including dietitians, specialist nurses and psychologists. bomss.org.uk

 

 

November 2014
Weight loss surgery helps people regain health – and reduces healthcare bill

National Bariatric Surgery Registry offers fascinating insights into complexities of obesity

Figures released today show that bariatric surgeons in the UK are increasingly successful at helping people control their weight – even though they are operating on people who are getting heavier and have more health complications at the point of surgery.

The National Bariatric Surgery Registry is the major source of data on the effectiveness of weight-loss surgery in the UK and the newly-published 2014 registry report has data on 18,283 operations operated between 2010 and 2013.

Of the people treated, the average body mass index (BMI) was 48.8, meaning that patients were almost twice the weight they should be for their height. 73.2% of men and 71.5% of women had what is known as functional impairment – eg, they couldn’t climb three flights of stairs without resting. After surgery more than half of those patients (56.0%) could manage three flights without resting.

An increasing proportion of men are seeking surgery. In 2006, 16% of patients were male while by 2013 this figure had risen to almost 26%.

Turning to diabetes, 65.1% of patients with Type 2 diabetes at the point of surgery showed no indication of diabetes two years after surgery and were able to stop their diabetic medications – a cost saving to the health service.

For the first time, the NBSR has a section on adolescent bariatric surgery with data on more than 550 patients aged under 25 years old. In this group 57.2% couldn’t climb three flights of stairs and almost 40% had a BMI of 50 or higher.

Mr Richard Welbourn, Consultant Surgeon, Chair of the NBSR and the President of BOMSS, says: “Severe and complex obesity is a life-long condition associated with many major medical conditions, the cost of which threatens to bankrupt the NHS. For severely obese people, medical therapy, lifestyle changes and attempts at dieting rarely succeed in maintaining long-term, clinically beneficial weight loss due to the hormonal effects of being obese.

“Our data shows that there is great benefit from bariatric surgery for all the diseases studied, in particular, the effect on diabetes has important implications for the NHS. Bariatric surgery cost-effectively improves the health of obese patients.

“Surgery is one aspect of a multi-disciplinary approach to care that involves many healthcare and allied healthcare professionals. These include dietitians, specialist nurses, psychologists, bariatric physicians, anaesthetists, theatre teams and recovery staff, ward nurses, outpatient staff, radiographers, radiologists and exercise therapists. The close working and performance of the MDT is integral to the overall outcome.

“The NBSR is the major source of data on the effectiveness of UK bariatric surgery. I am very happy to say that results from the NBSR shows that patients with severe and complex obesity can continue to have confidence in bariatric procedures.”

In the foreword to the NBSR Professor Sir Bruce Keogh, Medical Director of the NHS says: “Obesity and bariatric surgery are rapidly rising up the NHS agenda as a consequence of social and lifestyle choices. As in all branches of medicine, prevention is better than cure, but this report clearly demonstrates that when required, bariatric surgery is effective and safe. This is based on detailed data on over 18,000 patients. The survival rate of over 99.9% and the decreasing length of time spent in hospital is all the more impressive given the increasing illness of patients being sent for surgery.”

The NBSR data, showing the effectiveness of bariatric surgery, comes at a time when lower NHS surgery tariffs which could restrict the number of bariatric operations are being proposed for 2015 – 16 and BOMSS members have expressed concern over the new arrangements.

The NBSR data has been compiled from 161 surgeons from 137 hospitals and it reveals that between the years 2010 and 2013, the average BMI of bariatric patients increased from 48.5 to 48.8; the average number of obesity-related diseases such as type 2 diabetes increased from 3.2 to 3.4 and the average obesity surgery mortality risk score (OSMRS) increased from 1.6 to 1.8, meaning that patients were becoming increasingly sick at the point of surgery.

However, the Registry also shows that the average post-operative stay has fallen from 3.1 days to 2.7 days. These figures show that the patients are sicker at the point of surgery but their post-op stay in hospital is decreasing, even taking into account an increase in more complex sleeve gastrectomy operations and a fall in gastric band surgery.

The National Bariatric Surgery Registry is part of the British Obesity and Metabolic Surgery Society (BOMSS), plus database specialists Dendrite Clinical Systems.

 

Notes to editors

For more information – including case studies – please contact Helen Riley 020 8348 3103 / 07931 300 425, helenriley@headlinemedia.co.uk or Sarah Ghabina, RCS press office 020 7869 6047, sghabina@rcseng.ac.uk

An extract from the NBSR Report can be viewed here: http://www.bomss.org.uk/nbsr/


 

 

November 2014
BOMSS response to diabetes and surgery research (Lancet Diabetes & Endocrinology)

BOMSS welcomes findings from the research funded by the National Institute for Health Research and published in The Lancet Diabetes & Endocrinology  which show that bariatric surgery reduces the risk of developing Type 2 Diabetes by around 80% in obese people.

Mr Richard Welbourn, president of BOMSS said: “We have long noted that many patients who have diabetes are able to reduce or stop taking medicines related to their diabetes post-surgery. This new research shows that surgery is also very effective in curbing new onset diabetes in obese people who have had bariatric surgery by 80%.

 “We echo the call of the researchers for more work to help us understand how weight loss surgery can be used – along with other interventions – as part of a diabetes prevention strategy.”

 For the full report go to http://www.thelancet.com/journals/landia/article/PIIS2213-8587(14)70214-1/fulltext


October 2014
Second round of data publication shows continued success of bariatric surgery

The British Obesity and Metabolic Surgery Society welcomes the second annual publication of data on the performance of individual consultant surgeons who perform bariatric surgery across NHS England for the financial years 2012/13 and 2013/14.

Figures released by the National Bariatric Surgical Registry (NBSR) on behalf of BOMSS show 144 consultant surgeons contributing to the NBSR from 49 hospitals. There was 100% consent for publication from surgeons on the NBSR and the results revealed no potential statistical outliers for mortality or length of stay.

The total number of primary operations recorded was 5,419 for the financial year 2013/14. The average length of hospital stay for all operations was 2.6 days.

Overall for the two years, the average patient body mass index (BMI) of patients was 50.2 kg/m2 and the average weight was 139.7kg, indicating that they were twice the ideal weight for their height.

Again over two years there were 11 recorded deaths – giving an in-hospital mortality rate of 0.07% equivalent to a survival rate of 99.93%.

73.5% patients were female and the average number of obesity-related diseases for each patient, for example Type 2 diabetes, hypertension, sleep apnoea, functional impairment and arthritis was 3.71.

Mr Richard Welbourn, the president of BOMSS, said: “It remains important to emphasise to patients that bariatric surgery is one episode in the lifelong chronic disease of obesity. All NHS surgeons work in well-developed multidisciplinary teams (MDTs) dedicated to the care of patients with severe and complex obesity. Our preference was to present outcomes data from units, since it is units that are commissioned to deliver services to patients, not individual surgeons.”

This year, patients will be able to search for hospitals by geography using an added map function and postcode. Again, for this year the dedicated website shows overall operation volumes for each hospital as well as for each surgeon, making the data a more accurate reflection of the whole process of care.

An additional outcome has been published this year – that of revision surgery. Surgeons with higher volumes of revision surgery may be referred these patients from other centres due to their expertise. Revision operations can be major surgery, for example where the first procedure failed and it is revised to another bariatric operation. As this type of revision surgery carries higher risk due to scarring of the tissues, which occurs after the first operation, it is important to be able to characterise these patients separately from patients having primary procedures. Revision operations can also be relatively minor, such as a replacement of a gastric band port.

Mr Welbourn added: “We expect that patients will be able to use the data presented in the surgeon graphs to facilitate their consultations with the local bariatric team and help them make informed decisions about surgery.”

The data can be viewed here: http://nbsr.e-dendrite.com


 

 

September 2014
BOMSS statement on mini-gastric bypass option

A position statement on mini gastric bypass operations (MGBs) has been released by the British Obesity and Metabolic Surgery Society (BOMSS).

In an MGB, the stomach is divided to form a long gastric pouch with subsequent anastomosis of that pouch to the jejunal loop. The narrow tube of gastric pouch affords a restrictive component and the bypassed small bowel contributes the malabsorptive element.

BOMSS has published a position statement on the use of MGBs which describes its benefits as including the requirement for a single anastomosis – making it a more technically simple operation than other options and one which has fewer potential sites for leaks and internal hernias – normally a worrisome complication associated with gastric bypass procedures.

A shorter learning curve and a shorter operative time is also highlighted. Furthermore, ease of reversal and revision have also been described in published reports on MGBs.

Professor Duff Bruce, BOMSS member and consultant surgeon at Aberdeen Royal Infirmary, said; “There is published experience with this procedure of more than 6,000 patients, performed over a period of 16 years by surgeons around the world. Results to date suggest non-inferiority of MGB compared to the gold standard Roux-en-Gastric bypass in terms of mortality, weight loss, comorbidity resolution and quality of life.

“If the MGB is introduced into routine bariatric surgical practice it is recommended that it is within the confines of careful prospective data collection by surgeons working within the framework described in BOMSS Professional Standards guidelines. Follow-up data should be submitted to the National Bariatric Surgery Registry.”

Some potential disadvantages of MGBs have been noted and include the possible risk of reflux, a theoretical association between biliary reflux and oesophageal carcinoma and a lack of long-term outcome data.

BOMSS recommends patients undergoing MGB receive careful long-term follow up that observes nutritional parameters. It also suggests that patients should be counselled regarding symptomatic biliary reflux (which may require further surgical treatment), the controversy surrounding the risk of gastric or oesophageal carcinoma and the lack of long-term data.

BOMSS will review its MGB position statement after two years in line with its usual policies.

NOTES TO EDITOR

The position statement in MGBs can be viewed here – http://www.bomss.org.uk/statement-on-mini-gastric-bypass/

BOMSS Professional Standards can be viewed here – http://www.bomss.org.uk/bomss-professional-standards/

BOMSS is the UK’s professional society of bariatric (weight loss) surgeons and allied health professionals, including specialist nurses, dieticians, psychologists and dieticians.

http://www.bomss.org.uk

For more information / high res images contact Helen Riley Helenriley@headlinemedia.co.uk , 020 8348 3103 / 07931 300 425.


 

September 2014
BOMSS expert publishes ‘traffic lights’ poster for GPs on post-op symptoms

BOMSS has issued a traffic lights-style poster to help GPs care for patients who have had bariatric surgery.

Mr Sean Woodcock, a Council member of the British Obesity & Metabolic Surgery Society, (BOMSS), designed the at-a-glance poster displaying a range of possible symptoms which require referral back to bariatric specialists.

Symptoms are categorised in traffic light colours to show whether they warrant emergency, urgent or routine attention. The poster – “Primary care management of post-operative bariatric patients” – also suggests how soon after an operation the symptoms are most likely to occur.

Emergency symptoms, most likely to occur within days or weeks of the operation, are shown as red. These include abdominal or chest pain, breathlessness, tachycardia (fast heart beat), pyrexia (fever) and continuous vomiting.

Urgent symptoms most commonly presented within weeks of months of the operation are coloured yellow and include intermittent vomiting or abdominal pain, nocturnal coughing and heartburn.

Symptoms requiring routine attention by bariatric specialists and most likely to occur months or years after an operation are shown in green. These include the patient experiencing poor weight loss or regaining weight.

A post-operative patient who becomes pregnant should also routinely be referred for further specialist attention.

Mr Woodcock, consultant surgeon at Northumbria NHS Foundation Trust, said: “The poster will help GPs decide how urgent the situation may be if a patient presents symptoms following an operation and how quickly they should be referred back to a specialist.

“Bariatric procedures are often extremely beneficial to people with serious weight problems but like all operations there can be complications. This traffic lights-style poster will help GPs decide how serious any complications may be and help make sure they refer patients to a specialist in good time.”

The poster – Primary care management of post-operative bariatric patients can be viewed at http://www.bomss.org.uk/primary-care-management-of-post-operative-patients/

BOMSS President Mr Richard Welbourn said: “The poster will be very useful to GPs in deciding whether and how quickly they should refer a patient back to the bariatric specialists for attention. GPs will use their own professional judgment in coming to a decision with their patients but this will provide some useful guidelines in a simple format.”

Notes to editors

BOMSS is the UK’s professional society of bariatric (weight loss) surgeons and allied health professionals, including specialist nurses, dieticians, psychologists and dieticians. bomss.org.uk

For more information contact Helen Riley at: Helenriley@headlinemedia.co.uk

Tel: 020 8348 3103 / 07931 300 425


August 2014
BOMSS statment on draft NICE guideance

The British Obesity and Metabolic Surgery Society (BOMSS) supports draft guidance from the National Institute of Health and Care Excellence (NICE) on eligibility for bariatric surgery. It is expected that full guidance will be issued on November 26.

The current guidance says that bariatric surgery is an option for people with a BMI above 35 who have other health conditions.

The draft update in guidance strengthens the focus on people with Type 2 diabetes. It states that those who have been diagnosed in the past decade and have a BMI over 35 should be assessed for surgery. The guidelines also suggest doctors should consider those with a BMI of 30 or more on a case-by-case basis.

BOMSS strongly endorses access to surgery for people with diabetes with appropriate follow-up, the involvement of physicians and the use of a shared care model of chronic disease management.

BOMSS believes that for diabetes, surgery is a very powerful treatment (and for all the obese) and would welcome a shift in thinking so GPs and physicians think BMI 35+ diabetes = referral for surgical assessment, in the same way that abdominal pain on the right side + gallstones = referral to a surgeon.

There are published data on 26,000 surgical patients with impressive recovery from diabetes, functional status, etc, with those with diabetes for the shortest period recovering quickest (UK data from the NBSR).

BOMSS additionally supports lifestyle interventions (eg short-term dieting) to improve diabetes control and possibly reduce medications for some patients. But data shows that 70% of bariatric patients cannot climb three flights of stairs so are not physically able to exercise weight off. However, one year after surgery half of those who couldn’t manage three flights of stairs then could manage them.

BOMSS notes that the IFSO Global Registry report acknowledges that UK surgeons currently operate on the highest risk patients in the world.

BOMSS Commissioning guidance can be viewed here:

 http://www.bomss.org.uk/commissioning-guide-weight-assessment-and-management-clinics-tier-3/ .

 


 

March 2014
Royal Medical Colleges and weight loss experts announce launch of guide for commissioning weight-loss programmes (Tier 3)

The launch of a clinical commissioning guide on weight loss services (today Thursday, 20 March), developed following a NICE accredited process has been welcomed by experts across several disciplines.

The guide is intended to assist clinical commissioning groups in commissioning these services and reduce variation in access to weight-loss clinics across the country.  It has the backing of five Royal Colleges, the British Obesity and Metabolic Surgery Society (BOMSS), the Faculty of Public Health, the National Obesity Forum (NOF), the British Dietetic Association (BDA) and the British Psychological Society.

Mr Richard Welbourn, Consultant Surgeon and President of the British Obesity and Metabolic Surgery Society (BOMSS) and Professor John Wass, academic vice-president at the Royal College of Physicians (RCP) led the project, joining forces with other experts to compile the guide – and to press for better joined-up clinical pathways for obesity services.

Along with surgeons, physicians and other health professionals they have been concerned that access to Tier 3 weight management clinics is restricted in some parts of the country.

Tier 3 obesity services offer support from clinicians, specialist dietician, psychologist and exercise specialists and are a prerequisite for patients seeking Tier 4 services such as bariatric surgery.

A lack of provision of Tier 3 obesity services in some parts of the country was highlighted by the Royal College of Surgeons in January pointing out that it risked leaving obese patients unable to access vital services they need to help control their weight.

Last week Public Health England and NHS England published a report which sought to clarify responsibility for providing Tier 3 obesity services and recommended that they should be commissioned by Clinical Commissioning Groups (CCGs). The new guide sets out how those services should be commissioned.

In a joint statement, Mr Welbourn and Prof Wass say: “The Royal College of Surgeons and BOMMS have developed a commissioning guide for Tier 3 services which covers weight assessment and management which takes into account the views of 10 sponsoring organisations.

“The guide includes input from patients, pathologists, bariatric physicians, general practitioners, public health experts, dieticians, psychologists and healthcare commissioners.

“It deals with the roles of the weight management clinic, the multidisciplinary team, the role of general practitioners, the role of the clinic itself, referral to bariatric surgery and pre- and post-operative care.

“We hope that this guidance will clarify the role of Tier 3 services in helping patients with weight problems.

“We are aware that Tier 3 services need to be developed in a number of areas in the UK.  We believe that the service model set out in this guide should be adopted as quickly as possible across the country to ensure that a consistent service is provided to those who need it. ”

Hospital Episodes Statistics data shows there has been a fall of 10% in the number of bariatric surgical procedures being performed between April 2012 and March 2013, even though the most recently available statistics show obesity rates in England continuing to rise.

Ends

Notes to editors
The Commissioning Guide: Weight assessment and management clinics (Tier 3) can be viewed at http://www.bomss.org.uk/BOMSS_standards_for_clinical_services.htm

BOMSS is the sponsoring organisation and the guidance is supported by the Royal College of Surgeons, Royal College of Physicians, the Royal College of General Practitioners, the Royal College of Pathologists, the Royal College of Psychiatrists, The British Dietetic Association, the National Obesity Forum, The British Psychological Society and the Faculty of Public Health.

For more information, please contact Helen Riley helenriley@headlinemedia.co.uk tel 020 8348 3103 / 07931 300 425 (BOMSS)


 

January 2014
Bariatric surgery highlighted once again as the cameras roll for a second series of ITV’s ‘Weight Loss Ward.’

The work of the weight loss unit at Sunderland Royal Hospital – and featuring BOMSS council member and consultant surgeon Mr Peter Small – is getting a second outing on television.

The ITV programme ‘Weight Loss Ward,’ follows Mr Small and his team and focuses on the stories of some of the 600 patients who are operated on in the unit each year.

Mr Small says: “Bariatric surgery works. There are a host of medical conditions that improve as someone’s weight comes down. How do you put a price on a new life, getting back into work, enjoying your family, becoming useful? I see people getting their life back.”

Focusing on one of the busiest NHS obesity units in the UK, Weight Loss Ward follows the personal stories of the patients, their journeys to losing weight, possible reasons behind their weight gain, the reality of gastric surgery and its consequences.

The programme revisits 30-year-old Terry Gardner, who was featured in series one when he was 47 stone and unable to climb the stairs in his home. Terry, the heaviest patient on the ward, is determined to lose weight for the sake of his two children.

“I’m trapped in my own body. Feeling like my weight is eating me up. I want to be able to walk out the door, I want to be able to walk out of the door with my children.”

Weight Loss Ward, ITV, Tuesday, January 14, 8pm and the following Tuesdays.

Ends

NOTES TO EDITOR

BOMSS is the UK’s professional society of bariatric (weight loss) surgeons and allied health professionals, including specialist nurses, dieticians, psychologists and dieticians. www.bomss.org.uk

For more information contact Helen Riley helenriley@headlinemedia.co.uk
Tel: 020 8348 3103 / 07931 300 425


January 2014
Postcode lottery is denying obese patients access to vital treatment

Patients are being denied access to bariatric surgery because intensive weight loss programmes – which are a prerequisite to surgery – are not being commissioned in some areas, the Royal College of Surgeons warns.
A lack of provision in some parts of the country is leaving obese patients unable to access the vital services they need to control their weight which could potentially put their health at risk.
Earlier this year, NHS England, which is responsible for commissioning bariatric surgery, published a clinical commissioning policy on the specialised management of severe and complex obesity.

The published policy reflects NICE guidance that recommends that individuals try and exhaust all non-invasive treatment options prior to potentially higher-risk surgical approaches. As part of this, it requires patients to complete support from weight management services (called ‘tier 3’ support) which helps them to succeed in controlling their diet post-surgery.

Recent Hospital Episodes Statistics data shows there was a fall of 10% in the number of bariatric surgical procedures performed between April 2012 and March 2013, even though the most recently available statistics show obesity rates in England continue to rise.

The RCS is concerned that the current problems with commissioning weight management has led to a further fall in the number of bariatric procedures, as these programmes are a prerequisite for referral to bariatric surgery.
Richard Welbourn, President of the British Obesity and Metabolic Surgery Society (BOMSS), said: “It is concerning that patients are being denied access to treatment due to weight assessment and management clinics not being commissioned. The benefits of bariatric surgery are well-known. It leads to greater body weight loss and higher remission rates of type 2 diabetes than non-surgical treatment of obesity. Poor access to bariatric surgery therefore places some patients at continuing health risk. In the long run this will end up costing the NHS more.”
BOMSS, in conjunction with the College and other partners including the Royal College of Physicians, has produced NICE accredited commissioning guidance for weight assessment and management programmes. The guidance is intended to assist clinical commissioning groups in commissioning these services and reduce variation in access to these clinics across the country.
Professor Norman Williams, President of the Royal College of Surgeons, said: “To hear that a postcode lottery is emerging in UK weight management provision is deeply worrying. The fact that access to surgery is blocked because of this means the NHS is simply storing up problems for later and compromising patient care. The Royal College of Surgeons and Specialty Associations’ commissioning guides give commissioners a clear understanding of what cost- effective quality care should look like. We hope to work with CCGs to reduce this sort of variation and drive up standards of patient care across the UK.”


 

December 2013
BOMSS seeks further views on commissioning guidelines for body contouring surgery

BOMSS has announced its support for the current process of developing clear, practical and clinically sensible guidance for commissioning Body Contouring practice and has also called for further input from bariatric professionals.

BOMSS Council member Professor Duff Bruce says: “We promote the safe and effective use of surgical strategies as part of a co-ordinated pathway of care for severely obese people. As such, we recognise that Body Contouring surgery (BCS) is a crucial component of a continuum of care for post-bariatric surgery patients.

“Many successful bariatric surgery patients suffer from physical and psychological problems secondary to loose skin and we strongly concur with evidence which shows significant quality of life benefits following BCS.”

A consultation on BCS was recently carried out and included input from BOMSS {see link below} but the process is still ongoing.

Following weight-loss surgery (and all other forms of weight loss) there are predictable changes in weight and associated body mass index (BMI). BOMSS is concerned that the BMI cut-off of 27kg/m2 is set at a level that many successful patients may never 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 the threshold should be reviewed.

BOMSS recognises the resource implications of 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.

BOMSS recognises that it is likely that new guidance will need to stipulate a prioritisation group. It would strongly recommend that, in view of the evolving evidence in this area, there is a commitment 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, BOMSS would like to hear views from its members – info@british-obesity-surgery.org

Notes to editors

For more information, please contact Helen Riley helenriley@headlinemedia.co.uk  tel 020 8348 3103 / 07931 300 425.

With nearly 400 members, BOMSS is the UK professional society of surgeons involved in obesity management. Membership of the society includes medical professionals and allied health professionals including specialist nurses, dietitians and psychologists. http://www.bomss.org.uk

BAPRAS: http://www.bapras.org.uk – British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS).

Consultation document


 

September 2013
BOMSS unveils new Fellowship Curriculum to enhance metabolic surgery in the UK

The British Obesity and Metabolic Surgery Society (BOMSS) has issued an updated Fellowship Curriculum aimed at enhancing the delivery of metabolic surgery.

Bariatric Fellows work at centres in North Tyneside, Sunderland, Luton and Dunstable, Imperial, UCH and Taunton and are supported by an unconditional grant from an industrial partner for professional development of a metabolic surgery service and intended to be applicable to other RCS-Approved Fellowships as and when approved.

Six new Fellows will start work at the centres in October and will use the new curriculum. The fellowships are RCSEng approved in high volume centres providing specialist bariatric services.

Mr Richard Welbourn, President of BOMSS, says: “I’m delighted to announce that education and Training experts at BOMSS have worked hard to produce a comprehensive curriculum which offers world-class Fellowships at UK centres.”

The Fellowship curriculum covers a wide range of technical skills and professional attributes including:

  • Managing patients who are morbidly obese and understanding their surgical treatment, including early and late complications
  • Understanding different patterns of presentations of complications
  • Experience in Gastric Bypass and at least one other bariatric procedure
  • Producing work of scientific value in the field of bariatric and metabolic surgery
  • Teaching junior medical staff and allied healthcare professionals.

 

Notes to editors

For more information, please contact Helen Riley helenriley@headlinemedia.co.uk tel 020 8348 3103 / 07931 300 425

The updated curriculum can be viewed at http://www.bomss.org.uk/trainees.htm

With 385 members, BOMSS is the UK professional society of surgeons involved in obesity management. Membership of the society includes medical professionals and allied health professionals including specialist nurses, dietitians and psychologists. http://www.bomss.org.uk


 

July 2013
BOMSS welcomes surgeon data release – which highlights safety of bariatric surgery – but re-affirms the value of MDTs

The British Obesity and Metabolic Surgery Society (BOMSS) welcomes the publication of data on the performance of individual surgeons in several specialities across NHS England, including bariatric surgery. But the Society also stresses the importance of multi-disciplinary teams in ensuring that success rates for surgery remain high.

For the bariatric speciality, figures have been released by the National Bariatric Surgical Registry (NBSR) for 106 consultant surgeons contributing to the NBSR for the financial year 2013/14. There was 95% consent for publication from surgeons on the NBSR (101 surgeons) and the results revealed no potential statistical outliers for mortality or length of stay.

The total number of primary operations recorded was 4,389. There were three recorded deaths for an in-hospital mortality rate of 0.07%, equivalent to survival rate of 99.93%. The average length of hospital stay for all operations was 2.5 days.

The average body mass index (BMI) for the patients was 50.6 kg/m2 and the average weight was 141 kg, indicating that the patients were twice the ideal weight for their height. 72.8% of patients were female.

The average number of obesity-related diseases for each patient, for example type 2 diabetes, hypertension and sleep apnoea, was 3.6.

According to HES we estimate that the overall in-hospital mortality rate for bariatric surgery was 0.11% for the four financial years 09/10 to 12/13, equivalent to a survival rate of 99.89%, validating the very low mortality from bariatric surgery recorded by the consultant surgeons contributing to the NBSR.

The data is available on the NHS Choices website – www.nhs.uk – and a dedicated website – http://nbsr.e-dendrite.com/

Mr Richard Welbourn, Consultant Surgeon, Chair of the NBSR and the President of BOMSS, says: “The publication of surgeon-level data highlights the safety of bariatric surgery and gives patients and other members of the public the opportunity to review the work of individual surgeons. We want patients with severe and complex obesity to feel confidence in NHS care and, as surgeons, we want to deliver the best treatment for individuals in the context of team working as well as individual performance.”

“Bariatric surgery is just one aspect of an MDT process of care that involves a range of healthcare and allied healthcare professionals dedicated to the care of our patients. These include dietitians, specialist nurses, psychologists, bariatric physicians, anaesthetists, theatre teams and recovery staff, ward nurses, outpatient staff, radiographers, radiologists and exercise therapists. The close working and performance of the MDT is integral to the overall outcome.”

Mr Welbourn also called for more administrative assistance to support data validation to help ensure the accuracy of data in the public domain.

The National Bariatric Surgery Registry is a consortium of the British Obesity and Metabolic Surgery Society (BOMSS), the Association of Laparoscopic Surgeons (ALSGBI), the Association of Upper Gastrointestinal Surgeons (AUGIS) and database specialists Dendrite Clinical Systems and was set up in 2009.  Since then, approximately 30,000 patient records have been entered to date, and the first report of the outcomes of over 8,000 patients was published in April 2011.

Contribution of data to the NBSR was voluntary for surgeons until April 2013 and although the case ascertainment (the proportion of NHS operations recorded out of the total done) is not complete, it seems that the survival rates in the NBSR are an accurate reflection of overall practice.  In-hospital survival from bariatric surgery is at least as good if not better than many common gastrointestinal operations.

Mr Peter Small, consultant surgeon, member of the NBSR Committee and BOMSS Council member says: “The number of people receiving bariatric surgery has increased dramatically in England – and the developed world generally – in the past decade.  Bariatric surgery is a successful and rapidly developing speciality that helps people regain their health. Collecting information about patient treatment and care using the NBSR will help us further develop the service and improve best practice for our patients.”

 

Notes
Although the data presented revealed no potentially outlying surgeons, the NBSR committee was required by the Healthcare Quality Improvement Partnership (HQIP) to produce a policy on dealing with this eventuality and this can be found on the BOMSS website.

The Everyone Counts: Planning for Patients 2013/14 document of the NHS Commissioning Board published in December 2012 called for the publication of surgeon-level outcomes data for ten specialities by the end of June 2013. http://www.england.nhs.uk/everyonecounts/

Although the NBSR is well established, it remains a voluntary database with no NHS funding, supported instead by industry funding with administrative support from BOMSS, ALSGBI and AUGIS. Entry into the NBSR dataset became mandatory for all NHS patients by bariatric surgical providers from 1 April 2013.

Using Hospital Episode Statistics (HES) codes it is estimated that there were 138 NHS surgeons doing bariatric surgery in the 11 months April 2012 – February 2013, and 5,656 operations were recorded. Therefore most bariatric surgeons were entering data and the great majority of NHS patients were being recorded into the NBSR.


 

June 2013
BOMSS: Statement on Laparoscopic Gastric Plication for the treatment of severe obesity in response to NICE guidance IPG432

The British Obesity and Metabolic Surgical Society (BOMSS) has issued advice saying that laparoscopic gastric plication (LGP) is undertaken under careful scrutiny and with acknowledgment of the limitations of evidence for efficacy.

Bariatric surgery is a clinically and economically highly effective treatment for the illnesses associated with severe and complicated obesity. Several different procedures have been shown to be safe and to have excellent long-term outcomes. As novel procedures are developed it is essential that their safety and efficacy is critically assessed against existing options.

In accordance with current BOMSS Professional Standards guidance – which can be seen at http://www.bomss.org.uk/BOMSS_professional_standards.htm – this procedure should be delivered with due clinical governance by bariatric units offering a range of treatment options within an appropriate multi-disciplinary team.

The National Institute for Health and Care Excellence (NICE) published procedural guidance for LGP in November 2012 which highlights the reasonable short-term safety of the procedure and lack of long term safety evidence. Similarly, it indicates that whilst there is a limited body of evidence about the short and medium-term outcomes of LGP, there is as yet no long-term efficacy data.

Laparoscopic Gastric Plication is a restrictive procedure that reduces the size of the stomach and limits food intake. The procedure is undertaken using minimally invasive or ‘keyhole’ surgery.

NICE recommends that those wishing to employ the techniques should ensure support of their organisational governance leads, inform patients of uncertainties of procedure’s long-term efficacy and implications for further gastric surgery that may be needed and, lastly, provide patients with clear written information and access to NICE’s own public guidance.

BOMSS echoes the advice of NICE that clinicians should submit data on all patients undergoing LGP to the National Bariatric Surgery Registry under the “other procedure category”.

Richard Welbourn, the President of BOMSS says: “LPG seems to be a safe procedure but better long term data on outcomes and implications for subsequent gastric surgery are required before it can be fully endorsed. Clinicians should employ it within the structure described by BOMSS Professional Standards and reflect carefully on collected outcome data.”

The NICE guidance can be seen here: http://guidance.nice.org.uk/IPG432

Ends

NOTES TO EDITOR

BOMSS is the UK’s professional society of bariatric (weight loss) surgeons and allied health professionals, including specialist nurses, dieticians, psychologists and dieticians. www.bomss.org.uk

For more information contact Helen Riley helenriley@headlinemedia.co.uk
Tel: 020 8348 3103 / 07931 300 425


 

April 2013
Bariatric specialists at BOMSS unveil standards for professional care and ethics in bariatric surgery

New professionals standards aimed at helping surgeons achieve the highest possible level of conduct in bariatric practice have been produced by the British Obesity and Metabolic Surgery Society (BOMSS).

The BOMSS Code of Ethics and the BOMSS Professional Standards Document set new standards for bariatric specialists in this challenging area of surgery and health care.

The BOMSS Code of Ethics looks at the responsibility to patients – describing how surgeons must select appropriate candidates for bariatric surgical procedures, perform appropriate pre-operative evaluation, undertake procedures which have acceptable safety outcomes and ensure appropriate post-operative care and follow-up.

Another area covered by the new Code is Investigational Procedures, which are supported as long as accepted national and local guidelines for human research are followed and patients fully understand the procedure. Data collection, analysis and the reporting of results are all mandatory.

Continuity of care is emphasised in the Code and, with regard to advertising, surgeons should ensure that they – and organisations they work with – adhere to the BOMSS Statement on Current Advertising Practice for Bariatric Procedures.   (http://www.bomss.org.uk/BOMSS_statement_on_advertising.htm). Declaration of financial interests is also covered in the new Code.

The BOMSS Professional Standards Document sets practitioner standards and facility standards for bariatric surgeons, including training, patient advocacy, team-working, equipment, safety and staff education.

BOMSS is the UK professional society of bariatric (weight loss) surgeons and allied health professionals. Mr Richard Welbourn, the President of BOMSS, said: “I am delighted to announce the publication of the BOMSS Code of Ethics and the BOMSS Professional Standards Document.

“Bariatric surgery is challenging due to the large size of patients, restricted laparoscopic access and the unique physiology of the severely obese. Weight loss and metabolic surgery requires advanced skills and specific training and is already carried out to an extremely high standard in the UK. We are working to ensure the highest standards of care are carried forward.”

The BOMSS Code of Ethics is intended as a supplement to guidance contained in the General Medical Council’s publication, Good Medical Practice and the Royal College of Surgeons of England’s publication, Good Surgical Practice. It is adapted from the Code of Ethics of the American Society of Metabolic and Bariatric Surgery (ASMBS).

The guidelines can be seen at: (http://www.bomss.org.uk/BOMSS_Code_of_Ethics.htm and http://www.bomss.org.uk/BOMSS_professional_standards.htm
Both sets of guidance will be reviewed in 2015.

The BOMSS Professional Standards Documentisan Appendix to and should be read in conjunction with Providing Bariatric Surgery – BOMSS Standards for Clinical Services & Guidance on Commissioning (which can be seen on the BOMSS website at http://www.bomss.org.uk/BOMSS_standards_for_clinical_services.htm ). The GMC’s Good Medical Practice and the Royal College of Surgeons of England’s Good Surgical Practice set standards for UK surgeons. The BOMSS Professional Standards Documentaims to supplement these publications by defining Professional Standards relevant to the practice of Bariatric Surgery.

NOTES TO EDITOR
BOMSS is the UK’s professional society of bariatric (weight loss) surgeons and allied health professionals, including specialist nurses, dieticians, psychologists and dieticians.
http://www.bomss.org.uk

For more information contact Helen Riley Helenriley@headlinemedia.co.uk
Tel: 020 8348 3103 / 07931 300 425


January 2013
Health specialists gather in Scotland amid growing concerns over obesity

World-class surgeons and allied health professionals will gather in Glasgow next week for a two-day conference on obesity. The 4th Annual Meeting of the British Obesity and Metabolic Surgery Society (BOMSS) will be held on January 24-25.

National and international speakers will address the conference on a range of key topics around obesity and bariatric surgery. Subjects covered will include metabolic surgery for diabetes, weight-loss surgery training in the UK, multi-disciplinary working and the European experience.

Professor Duff Bruce, a Consultant Surgeon at Aberdeen Royal Infirmary, is lead organiser for the Scientific Meeting, which has been a year in the planning. He said: “I’m delighted to welcome so many experts to Scotland. Weight-loss surgery is the most clinically effective, safe and cost-effective treatment available for many patients with severe obesity-related diseases.

“BOMSS’ UK-wide National Registry (NBSR) outcomes have been congruent with international data, suggesting that 85% of surgically-treated type 2 diabetics had benefitted and had stopped medications by two years after their procedure.

“BOMSS guides commissioning and policy on the need for bariatric surgery in the UK, promotes national audit and the development of high quality centres for bariatric surgery and educates and trains future obesity surgery teams.”

More than a quarter of adults in Scotland are obese, according tostatistics from the Scottish Health Survey. Its figures showed that 27.7% of people between the ages of 16 and 64 were obese in 2011. It is predicted that obesity rates could reach 40% by 2030.

NOTES TO EDITOR
BOMSS is the UK’s professional society of bariatric (weight loss) surgeons and allied health professionals, including specialist nurses, dieticians, psychologists and dieticians.
http://www.bomss.org.uk

For more information / high res images contact Helen Riley Helenriley@headlinemedia.co.uk ,
020 8348 3103 / 07931 300 425


October 2012
BOMSS supports recommendations of
newly-released study into bariatric surgery

The British Obesity and Metabolic Surgery Society (BOMSS) warmly welcomes ‘Too Lean A Service,’ a report released by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD).

NCEPOD looked at the process of care for patients undergoing bariatric (weight-loss) surgery. Its recommendations include ensuring patients have access to multi-disciplinary teams, the use of a two-stage consent form, good post-operative care and a long-term follow-up plan.

Mr Alberic Fiennes, President of BOMSS, said: “BOMSS welcomes the main recommendations made in this report, which lend powerful and much needed support to our longstanding endeavours to raise quality and to define practice, a process supported by the Royal College of Surgeons.”

Recent work by BOMSS includes the rolling out of the National Bariatric Surgery Registry (NBSR) in 2009 (first report in April 2011) and the recent publication of ‘Providing Bariatric Surgery’ – BOMSS Standards for Clinical Services & Guidance on Commissioning.

Mr Peter Small, BOMSS Council member and an Assessor in NCEPOD’s analysis, added: “In the correct setting, bariatric surgery is a successful and cost-effective treatment for Severe and Complex Obesity, alleviating many serious conditions associated with excess weight. Surgery is just the central part of a treatment process that must include proper pre-operative preparation and long-term follow-up care. These need to be included in resourcing for the high standard of bariatric care patients should rightly expect.”

BOMSS echoes the call for better use of multi-disciplinary teams and improved pre- and post-operative support. There is now a large number of patients for whom primary prevention has failed and for whom surgery is fully appropriate. Solid clinical and scientific evidence demonstrates that, however it was acquired, their condition of Severe and Complex Obesity has become a fixed pathological state.

The following evidence for correctly delivered bariatric surgery is clear:

  • Its risks are lower than those of remaining severely obese.
  • Patients regain personal health and wellbeing, as defined by the WHO.
  • Correct surgery saves treatment costs for the adverse consequences of severe and complex obesity.
  • Bariatric surgery has been rigorously demonstrated to be an outstandingly cost-effective treatment.
  • Bariatric surgery can deliver societal as well as health-care cost savings.

The National Bariatric Surgery Registry is co-operated and promoted by BOMSS (http://www.bomss.org.uk/news.htm#nbsr). It supports NCEPOD’s call for improved audit, although this is another area with resource implications.

BOMSS also endorses a two-stage consent process in its recently issued guidelines – “Providing Bariatric Surgery – BOMSS Standards for Clinical Services and Guidance on Commissioning which is aimed at improving the safe and effective provision of weight-loss and metabolic surgery in the UK. View the guidelines at: http://www.bomss.org.uk/BOMSS_standards_for_clinical_services.htm

BOMSS agrees that continuity of service is vital for bariatric patients. Long-term care plans and good liaison with Primary Care contribute to successful outcomes for patients.

– Ends –
NOTES TO EDITOR
BOMSS is the UK’s professional society of bariatric (weight loss) surgeons and allied health professionals, including specialist nurses, dietitians, and psychologists. http://www.bomss.org.uk
For more information contact Helen Riley Helenriley@headlinemedia.co.uk , 020 8348 3103 / 07931 300 425
More than one million adults in the UK meet the basic criteria set out in NICE Clinical Guideline 43 for bariatric surgery. The proportion of these who, properly informed, would be willing as well as individually suitable remains unknown, but current NHS provision caters for much less than 1% of this growing pool.
The NCEPOD report was based on 400 bariatric cases surveyed from June – August 2010.


 

October 2012
Bariatric specialists unveil improved standards for patient care and safety

Two sets of guidelines aimed at improving the safe and effective provision of weight loss and metabolic surgery in the UK have been issued today.

Clinical Guidelines for the Establishment of a Bariatric Surgical Service has been updated by the Independent Healthcare Advisory Services (IHAS), and Providing Bariatric Surgery – BOMSS Standards for Clinical Services and Guidance on Commissioning comes from the British Obesity and Metabolic Surgery Society (BOMSS).

The updated IHAS Guidance was written with input from the Society for Bariatric and Obesity Anaesthesia (SOBA), BOMSS and other leading organisations with a major interest in bariatric surgery. The guidelines reflect a consensus reached after extensive debate between experienced UK bariatric surgeons and anaesthetists.

A number of different bariatric surgical procedures are in current routine practice, including gastric banding, gastric bypass, sleeve gastrectomy, duodenal switch and revisional (‘re-do’) surgery.

Experts agree that bariatric surgery is not a cosmetic procedure, but has been proven to be an incredibly successful and cost-effective treatment for morbid obesity and many serious conditions associated with it.

Key points in the updated Guidelines include:

  • Pre-operative risk assessment of patients listed for bariatric surgery must be by a rigorous multidisciplinary process involving surgeons, anaesthetists, dietitians, specialist nurses and psychologists all with specialist experience in the field.
  • All clinical areas must have equipment specifically designed to deal with the morbidly obese patient.
  • Level 2 critical care availability is mandatory for all units undertaking bariatric surgery.
  • The need for long-term follow-up care is highlighted and must be made explicitly clear to both the patient and those bodies involved with the commissioning of specialist bariatric services.
  • For the first time, a nationally accepted document clearly lays out detailed guidelines on the level of training necessary for surgeons and anaesthetists who wish to specialise in bariatric surgery.

Sally Taber, Director of IHAS, said: “Patients must have access to the full range of specialist professionals; in other words, a multi-disciplinary team.” She also highlighted the need for hospitals to ensure that they follow guidance on the number of procedures that surgeons should perform in order to optimise outcomes.

She went on to say: “IHAS has also instituted a Code of Conduct for advertising Cosmetic Surgery and Non-surgical Cosmetic Treatments and will be taking forward the work of producing a code for independent hospitals and operators for the advertising of bariatric surgery.”

Dr Nick Kennedy, Chairman of SOBA, said: “The standard of patient safety and care in bariatric surgery, anaesthesia and critical care is already very high in the UK. These clear guidelines will provide focus for hospitals to ensure they can maximise patient safety and outcome during bariatric surgery and anaesthesia. There is also much in the guidelines that is applicable to anaesthesia, critical care and theatre management of morbidly obese patients undergoing all types of surgery. Following them will improve patient safety and experience for such patients across the board.”

Mr Alberic Fiennes, President of BOMSS, said: “Weight loss and metabolic surgery is already carried out to an extremely high standard in the UK, but some complications are inevitable in any surgery – perhaps especially in higher risk groups of patients. We are working together to ensure the highest standards of care for bariatric patients.”

Professor David Kerrigan, a leading bariatric surgeon who advised the government on the NICE obesity guidelines in use today, said: “I’m delighted to help set clear and unambiguous guidance to help hospitals and patients identify the key components of a well-run bariatric service performed by properly trained doctors.”

The new guidelines can be seen at:

NOTES TO EDITOR

The Independent Healthcare Advisory Services (IHAS) is the representative trade body for the majority of independent healthcare providers across the United Kingdom.
http://www.independenthealthcare.org.uk
For more information contact Sally Taber, 0207 379 7721 or 07885 740500

BOMSS is the UK’s professional society of bariatric (weight loss) surgeons and allied health professionals, including specialist nurses, dieticians, psychologists and dieticians.
http://www.bomss.org.uk
For more information contact Helen Riley Helenriley@headlinemedia.co.uk , 020 8348 3103 / 07931 300 425
SOBA is Europe’s leading professional society for anaesthetists specialising in the management of the obese patient undergoing surgery.
http://sobauk.com
For more information contact SOBA via the Association of Anaesthetists of Great Britain and Ireland at soba@aagbi.org

The following people made a significant contribution to the Clinical Guidelines for the Establishment of a Bariatric Surgical Service:

Dr Nick Kennedy, Chairman, Society for Obesity and Bariatric Anaesthesia (SOBA, www.sobauk.com )
Professor David Kerrigan, MD with Distinction, FRCS, FRCSEd, MBChB. Visiting Professor in Surgery at the University of Chester and a pioneer of laparoscopic (keyhole) bariatricsurgery in the UK.
Mr Alberic Fiennes, President, British Obesity & Metabolic Surgery Society (BOMSS), in collaboration with Council members.
Representatives of Independent Healthcare Advisory Services (IHAS) member organisations, in particular, Nuffield Health (http://www.nuffieldhealth.com).

Providing Bariatric Surgery – BOMSS Standards for Clinical Services and Guidance on Commissioning – was drawn up by a BOMSS peer working party with valuable input from Council members.
There is close unity between both sets of guidelines. BOMSS Guidelines make additional reference to NHS services.


 

August 2012
Statement on gastric bypass surgery in response to Health and Social Care Information Centre data on rising numbers of morbidly obese people

Council members from The British Obesity and Metabolic Surgery Society (BOMSS) say gastric bypass operations have proven to be effective in ensuring long-term weight loss.

New figures show that the number of gastric bypass operations carried out in England has risen five-fold during the past five years. Some 5,407 procedures took place in 2011/12 to help obese patients lose weight, compared with 858 in 2006/07.

Figures from the Health and Social Care Information Centre show a further 1,316 gastric band operations were completed between April 2011 and March 2012 – nearly double the 715 procedures over the same period five years earlier.

BOMSS calls on the Department of Health to guarantee that all patients have equal access to the treatment.

BOMSS president Alberic Fiennes said: “There is compelling evidence that weight-loss surgery to treat the most severely affected is one of the most clinically effective, safe and cost effective treatments available.

“There are about 1.5 million such adults in the UK. They face premature death, disease and disability brought on as a direct result of their condition.

“These can be prevented, improved or eliminated by surgery. While the increase in bariatric surgery is welcomed by the BOMSS and the Royal College of Surgeons, we remain concerned that there is unequal access to treatment across the UK.

“We therefore call on the Department of Health to invest in a long term strategy to ensure that all patients have equal access to this life-saving treatment.”

BOMSS Council member Sally Norton added: “We’re not just talking about people weighing 50st. A 5ft 10in man weighing 18st – 6st overweight – may be morbidly obese and more than six times more likely to get diabetes and four times more likely to need a knee replacement.

“Preventing obesity is essential. And tackling childhood obesity is a major health priority if we are to prevent huge medical and financial problems in the future.”

Mr Fiennes said: “Evidence suggests that gastric bypass operations may be more effective in the long-term. They have also been shown to bring about a direct and immediate improvement in patients with type 2 diabetes in addition to the benefits of weight loss.”


July 2012
British surgeon Alberic Fiennes is named as President-elect of leading obesity surgery society

A leading British surgeon has been named as the next President of the European Chapter of IFSO – the International Federation for the Surgery of Obesity and Metabolic Disorders.

Mr Alberic Fiennes, who is currently President of BOMSS – The British Obesity and Metabolic Surgery Society – and who practices as a bariatric surgeon in London and at St Anthony’s Hospital in Surrey, will lead IFSO-EC from 2014.
He was formerly Director of Bariatric Surgery at University College London Hospital. Prior to this, he had been associated with pioneers of British obesity surgery in the 1980s at St George’s Hospital and Medical School in south-west London. Later, as Consultant Surgeon and Senior Lecturer, he went on to build up the current multi-disciplinary service there.

The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) brings together national societies for surgeons and allied health professionals who treat patients with Severe and Complex Obesity. Worldwide, the Federation is divided into four Chapters, embracing both 40 official member associations and individual members from countries currently without a national society.

Mr Fiennes said: “I am honored to be following Professor Yuri Yashkov as the next President of IFSO-EC. Tackling obesity is complex and challenging. Patients who are severely overweight have a disease that may spoil every aspect of their lives. They need safe and correct professional care plus understanding, kindness and support – to be helped, not judged. IFSO is playing a key role in improving that care and I look forward to contributing to its development.”
BOMSS Council member and consultant bariatric surgeon Sally Norton said: “We are very proud that our current president will soon be leading the development and regulation of metabolic and weight loss surgery across Europe.”
Obesity is one of today’s most visible public health problems. An escalating pandemic of obesity is affecting many parts of the world, so that globally more people are now obese or overweight than are undernourished. Without action, many, many millions will suffer from an array of serious health disorders, including diabetes.

Around 30% of the UK population is classed as obese. The most severely affected have a disease that can only be treated effectively by surgery. BOMSS is the UK’s leading society of surgeons and health professionals who offer bariatric (weight-loss) surgery.

BOMSS aims to guide commissioning and policy on the need for bariatric surgery in the UK, promote national audit and the development of high quality centres for bariatric surgery, educate and train future obesity surgery teams.

NOTES TO EDITOR
For more information contact Helen Riley Helenriley@headlinemedia.co.uk  020 8348 3103 / 07931 300 425

BOMSS is the leading UK professional society of surgeons involved in obesity management.

Membership of the society includes medical professionals and allied health professionals including specialist nurses, dieticians, psychologists and dieticians.


June 2012
Access to surgery – a statement from BOMSS

BOMSS welcomes the report in GP magazine1 on restricted access to surgery and the positive reflection this report received in the national media.

There is ample evidence that weight-loss surgery (bariatric surgery) is one of the most cost-effective treatments in acute health care. It recovers lives and significantly reduces overall medium and long-term healthcare costs2. It also saves societal costs of disability and unemployment3.

Severe obesity is a new disease of epidemic proportions which deserves intensive long-term prevention. However, once established in an individual, it is a permanent disease state. For the approximately 1.3 million eligible adults4 in the United Kingdom there is no other proven effective treatment for this disease except surgery. This view was supported in 2002 and 2006 by NICE, which has established valid criteria for surgical treatment.

At present surgery is available to much less than 1% of those eligible under the NICE criteria.

We well recognise the resource constraints faced by NHS commissioners. We are available and willing to give support in the difficult task of targeting these means appropriately.

However, it is the Society’s view that simply raising the threshold on Body Mass Index (weight for height) over and above NICE recommendations is neither a rational nor an appropriate way to allocate treatment:

  • It requires sufferers of a known disease to suffer further health loss before they can receive treatment.
  • When these patients do get access to treatment they will, on average, require more complex and thus, more costly, care.
  • On average, the longer the treatment of any disease is delayed, the less likely is eventual full rehabilitation.
  • There is no evidence in clinical science or professional ethics to support this simplistic strategy.

Other accepted approaches are available and we seek constructive dialogue in this regard. Resources can also be released by discontinuing ineffective or cost-ineffective treatments for other conditions. Commissioners would benefit from professional support and expertise in this difficult task.

Alberic Fiennes, FRCS
President, British Obesity & Metabolic Surgery Society on behalf of the BOMSS Council

Notes:

  1. www.gponline.com/News/login/1136671/
  2. Picot J et al, The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation, Health Technology Assessment 2009; Vol. 13: No. 41
  3. Shedding the Pounds: Obesity Management, NICE Guidance and Bariatric Surgery in England. Office of Health Economics, London 2011
  4. www.noo.org.uk

May 2012
Bariatric surgeons join call for better management of diabetes with obesity a major risk factor

The British Obesity and Metabolic Surgery Society (BOMSS) has added its voice to the call for better targeting of resources to halt rising levels of diabetes which threaten to overwhelm the NHS.

BOMSS- the UK’s leading society of surgeons and health professionals who offer bariatric (weight-loss) surgery- is reacting to a  new report published in the journal Diabetic Medicine which predicts that the NHS’s annual spending on diabetes will increase from £9.8 billion to £16.9 billion over the next 25 years, 17% of its entire budget.

The Impact Diabetes report also suggests that the cost of treating complications arising from diabetes is expected to almost double from £7.7 billion to £13.5 billion by 2035/6.

Obesity is a major risk factor for developing diabetes and currently 30% of the UK population is classed as obese.

Bristol-based consultant surgeon Sally Norton, BOMSS Council member, says: “Weight loss surgery can improve diabetes and reduce costs to the health service – but prevention of obesity in the first place is vital.  We must increase the resources available to implement preventative measures – but alongside these measures, surgery can help treat those with diabetes as a result of obesity and is a cost-effective resource.”

BOMSS aims to guide commissioning and policy for the use of obesity surgery in the UK, promote the development of high quality centres for obesity surgery, educate and train future obesity surgeons.

BOMSS aims to guide commissioning and policy for the use of obesity surgery in the UK, promote the development of high quality centres for obesity surgery, educate and train future obesity surgeons.

NOTES TO EDITOR
For more information contact Helen Riley Helenriley@headlinemedia.co.uk  020 8348 3103 / 07931 300 425

BOMSS is the leading UK professional society of surgeons involved in obesity management.

Membership of the society includes medical professionals and allied health professionals including specialist nurses, dieticians, psychologists and dieticians.