The Government’s Childhood Obesity Strategy does not go far enough
The Government has finally published its long-delayed Childhood Obesity Strategy – and it’s disappointing to say the least.
We see a watered-down plan covering three areas – the already-announced Soft Drinks Industry Levy, a voluntary programme of sugar reduction and a focus on promoting physical activity.
The failure to take steps to reduce salt and fat in our diets undermines the success of this policy. It also remains voluntary. there is no action planned to close existing loopholes on marketing of junk food to children on TV or online.
We have to question if the measures announced will help reduce the rates of childhood obesity – and we fear not.
As part of the Obesity Health Alliance we will now take steps to hold the Government to account for failing to come up with an ambitious strategy which would protect our children’s health and weight (in England).
In better news we recently welcome the call by experts in diabetes for surgery to be recognised as a standard treatment option for Type 2 diabetes, based on a wide body of evidence, including 11 randomised trials. Economic studies also show that the treatment can be cost-effective. This supports the day-today experience of bariatric surgeons and nurses across the UK in recent years that surgery is cost-effective and gives people back their health.
Type 2 diabetes is a serious health condition so it is essential that all effective treatment options are available – and this includes surgery. Poorly controlled diabetes can lead to serious complications such as blindness, amputations and stroke, complications which rob people of their health and are very expensive to treat.
“The National Institute for Health and Care Excellence (NICE) must now make it explicit in its Type 2 diabetes guidelines that those with Type 2 diabetes who meet the recommended criteria for obesity surgery should be referred for early assessment for surgery. These recommendations are currently stated in the NICE obesity guidelines (2014) but are not fully incorporated in current NICE Type 2 diabetes guidelines (2015).”
The new guidelines state that surgery should be recommended to treat people with Type 2 diabetes who have a BMI of 40 or more, regardless of their blood glucose control, as well as people with a BMI of 30 and over whose blood glucose levels are inadequately controlled by lifestyle changes and blood glucose lowering medication. It is also recommended that the BMI thresholds in Asian people with Type 2 diabetes should be lower as they develop Type 2 diabetes at a lower BMI compared to other populations.
Mr Roger Ackroyd
Thank you Cardiff – a wonderful and informative Scientific Meeting
Cardiff proved to be a wonderful venue for the 7th BOMSS Annual Scientific Meeting.
BOMSS has grown in stature over recent years, with ever increasing membership numbers – and the annual congress has grown from our first venture in 2010 into a great annual event, which we all look forward to after the Christmas and New Year festivities. This year was no exception.
We were delighted to welcome our friends from SOBA and APSO to the meeting. We all work together in the field of obesity and bariatric surgery and their attendance will make for much more widespread and interesting debates.
A wide range of national and international speakers attended the meeting including guests from Europe, the USA and Australia. This gave us a fabulous scientific programme, with both trainee papers and well known experts speaking to us. Sessions included health economics, the autonomic nervous system, new obesity drugs, macrobiota and the metabolic syndrome, sleeve gastrectomy, single anastomosis gastric bypass, psychology, surgery in patients with type II diabetes, medicolegal matters and a new devices update.
Our gala was made extra-special thanks to the with pre-dinner entertainment from the Morriston Orpheus Male Voice Choir. Thanks must go once again to Mr Jon Barry and the organising committee for putting together a superb event.
Mr Roger Ackroyd
Looking forward to Cardiff 2016
The 2016 BOMSS meeting will be held in Cardiff from 28 – 29 January, with a training day on 27th –
We also look forward to IFSO 2017 – which will be held in London – and which promises to be superb meeting. We are also planning our first BOMSS Overseas meeting in the beautiful Dolomites in Italy next March.
The 6th Annual Scientific Congress in Newcastle was again a great success with record numbers of delegates. We had a great scientific programme with many eminent national and international speakers, together with a superb social programme.
The abstracts which were presented at the Meeting have been published online with the BJS.
To access the abstracts, click on the following link: http://onlinelibrary.wiley.com/doi/10.1002/bjs.2015.102.issue-s4/issuetoc
It is good that we are a strong and flourishing Society as British bariatric surgery is facing very challenging times, with issues relating to commissioning and tariffs among others. BOMSS is actively involved in negotiations in both areas and is working hard on behalf of all its members and for the benefit of our patients.
Second NBSR Report shows how bariatric gives patients their health back and saves healthcare costs
I am delighted to announce publication of the second report by the National Bariatric Surgery Registry – and equally pleased that it highlights our increasing success in helping people control their weight and improving their health.
The evidence is becoming clearer all the time: 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.
It is also clear that surgery saves the NHS precious resources. This report provides clear evidence that real savings can be made very quickly.
The NSBR is the major 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.
In his foreword, Professor Sir Bruce Keogh, Medical Director of the NHS, gives his seal of approval to our work. He points out that obesity and bariatric surgery are rapidly rising up the NHS agenda as a consequence of social and lifestyle choices, and adds: “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.”
The figures show that more than 99.9 per cent of patients survive their operations – better than the average – and that the time they spend in hospital is decreasing.
It reveals that our continuing success comes despite the fact that our patients are becoming heavier and presenting with more health complications at the point of surgery.
Since the first NBSR register in 2010, the average BMI of bariatric patients has increased from 48.5 to 48.8 and the average number of co-morbidities has increased from 3.2 to 3.4, while the average obesity surgery mortality risk score (OSMRS) rose from 1.6 to 1.8.
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.
Before treatment, 73.2 per cent of men and 71.5 per cent of women suffered functional impairment – they were unable to, for example climb three flights of stairs without resting.
After surgery more than half – 56 per cent – could carry out such tasks.
Perhaps most impressive are the figures on diabetes. These show that 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 – creating huge savings for our hard-pressed NHS.
I would like to thank all those who helped compile this report including our colleagues in the Association of Laparoscopic Surgeons (ALSGBI) and the Association of Upper Gastrointestinal Surgeons (AUGIS) who together with BOMSS form the NBSR consortium with database specialists Dendrite Clinical Systems.
In particular, I would like to thank all BOMSS members who carry out our important work day to day. This latest report from NBSR confirms what our experience tells us: bariatric surgery has a vital role to play for many who suffer with their weight and it saves resources which can be deployed usefully elsewhere in the NHS.
Click here to view an extract from the NBSR 2014: Extract_from_the_NBSR_2014_Report
BOMSS President and Chair of the NBSR Database Committee
Second round of data publication shows continued success for bariatric surgery
I am pleased to announce 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.
It remains important for BOMSS to emphasise to patients that bariatric surgery is one episode in the lifelong chronic disease of obesity. As we know, 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.
We hope 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
Mr Richard Welbourn
A busy few months lie ahead for BOMSS
BOMSS is heading into a busy autumn season.
Thursday October 9 is the date set for the second round of surgeon data release when we will again report on in-hospital mortality data for primary and revision or planned second stage for the years 2012/13 and 2013/14. Look out for the data which I am confident will put the work of bariatric surgeons in England in good light.
Although this remains a contested area – bariatrics more than many other specialities relies and thrives on the MDT, we are confident that our data will once again reflect the success of bariatric surgery.
Thanks must go to the NBSR committee and the administrators Sarvjit Wünsch and Nichola Coates for their enormous help in delivering this for NHS England. We are also acutely aware of the support of Dendrite Clinical Systems Ltd, our software provider, and especially Dr Peter Walton, managing director, and Dr Robin Kinsman, senior data analyst, for their help in getting the report ready for publication.
This will be followed by the much anticipated second NBSR report. As many of you will know the report includes a foreword by Sir Bruce Keogh, and covers up to three-year follow-up for 18,000 patients operated on for the three years 2010-2013. For us, the NBSR is the major source of data on the effectiveness of bariatric surgery in the UK. Information in the report will include average BMI at the point of operation, the average number of co-morbidities, the length of post-operative stay, the level of functional impairment in patients and the effect on diabetes of surgery, plus details of surgery numbers on adolescents.
Again special thanks go to Dendrite and Dr Kinsman in particular for help with this project, in generating excellent data on the patient outcomes after surgery in the UK.
November 22 will see new National Institute of Health and Care Excellence (NICE) guidance on access to bariatric surgery. While current guidance says surgery is an option for people with a BMI above 35 who have other health conditions, the update is likely to strengthen the focus on those with Type 2 diabetes, saying that people who have been diagnosed in the past decade and have a BMI over 35 should be assessed for surgery. The guidelines are also likely to suggest that doctors should consider referring people with a BMI of 30 or more on a case-by-case basis.
Looking further ahead – all the way to IFSO 2017 – we are anticipating formal agreement with AUGIS in the next few weeks and will then set up a limited company to run the event.
Plans are well-advanced for our own conference in January 2015 to be held in the Gosforth Marriott Hotel, Newcastle. The Scientific Committee is working hard to ensure that the contents of the training day and conference appeal to all. Registration will open soon and BOMSS members should already be thinking about Abstracts.
Mr Richard Welbourn
Co-operation leads to new commissioning guidance for weight management clinics
I’m happy to say that a clinical commissioning guide on weight loss services has been developed and welcomed by experts across several disciplines.
The guide will help clinical commissioning groups in commissioning vital weight loss services and reduce variation in access to weight-loss clinics across the country and offer improved clinical pathways for obesity services.
BOMSS was the lead sponsoring organisation and we worked with the backing of no fewer than five Royal Colleges, plus four other organisations – the Faculty of Public Health, the National Obesity Forum (NOF), the British Dietetic Association (BDA) and the British Psychological Society.
As members will know, 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.
Public Health England and NHS England have recommended that Tier 3 services should be commissioned by Clinical Commissioning Groups (CCGs). The new guide sets out how those services should be commissioned.
It includes input from patients, pathologists, bariatric physicians, general practitioners, public health experts, dieticians, psychologists and healthcare commissioners.
The guide deals with the roles of the weight management clinic, the multidisciplinary team, the role of general practitioners, the role of the clinic itself, referrals for bariatric surgery and pre- and post-operative care.
The Commissioning Guide: Weight assessment and management clinics (Tier 3) can be seen here https://www.bomss.org.uk/BOMSS_standards_for_clinical_services.htm
Finally, a date for your diaries – BOMSS 2015 will take place in Newcastle on January 22-23, at the Marriot Hotel in the Gosforth Park area. The meeting will be preceded by a Training Day on January 21.
Mr Richard Welbourn
Data publication reveals safety of bariatric surgery
I welcome the publication of data on the performance of individual surgeons who perform bariatric surgery – along with data from surgeons in several other specialities – across NHS England.
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 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.
The publication of surgeon-level data gives members of the public the opportunity to review the work of individual surgeons and BOMSS supports this. However, I also want to take the opportunity to stress the importance of the MDT in ensuring that success rates for surgery remain high.
Bariatric surgery is just one aspect of an MDT process of care that involves many healthcare and allied healthcare professionals dedicated to looking after patients with severe and complex obesity. The close working relationships and performance of the MDT are integral to the overall outcome.
I would also like to see increased administrative assistance to support data validation to help ensure the accuracy of data in the public domain.
Mr Richard Welbourn
Looking ahead to Glasgow 2013
I’m pleased to say that work is well underway to ensure the success of our 2013 meeting which will be held in Glasgow from January 23 – 25. Make a note of the date in your diaries and please look out for the conference microsite in the near future.
Our 2012 Annual Scientific Meeting in Bristol was a great success and was preceded by an excellent Training Day. A full report on the meeting can be seen here.
Many BOMSS members also attended the recent successful DDF in Liverpool which included a very informative and useful BOMSS session, including the Hunterian Oration given by Professor Alan Osborne on Gut Hormones in Bariatric Surgery.
The NBSR First Registry Report (April 2011) continues to be a vital resource. Again, I should like to thank all who contributed data for your share in this success and I very much hope you will continue to encourage your colleagues to join in the enterprise! I was delighted to hear that several large groups who were not contributing now do so. Thanks are also due to Richard Welbourn and to the team at Dendrite Clinical Systems for their huge commitment to making it happen.
When I took office I made a commitment to improving participation and transparency including a revision of our Constitution to include some important byelaws and the setting out of the responsibilities and rights of the Membership, Council and the Executive group.
We have also activated a sub-committee process. The dual purpose is to encourage participation and share the workload arising from the tasks ahead, previously borne by Council alone. I know many of the groups are already quite active – please join in!
I hope that you find our renewed and upgraded website easy to use. The Communications sub-committee, led by Sally Norton and Mike Rhodes, did a huge amount of work with our web team of Helen Riley and Emmanuel Amadiegwu, to completely revise the format and content of the site – very successfully I feel. Please pass any suggestions and comments to Sally or Mike via firstname.lastname@example.org
A big “thank you” to everyone for your past and present efforts to enhance the practice of our specialty. The ultimate beneficiaries are our patients.
Very best wishes,