Cost regulators for the National Health Service in England and Wales are proposing a new approach to the clinical assessment and management of obesity that could see nearly a million more people in England and Wales undergo bariatric surgery.

Draft guidelines from the National Institute for Health and Care Excellence (NICE) plan to lower the threshold for obese patients to have procedures such as stomach stapling or gastric banding from a body mass index of 40 to 35 if they are recently diagnosed with Type 2 diabetes. 

Can we afford it?

The move is designed to help reign in the snowballing epidemic of the disease, but critics are concerned over the affordability of the move, given that these procedures are expensive (more than £5,000 for stomach stapling and £2,500 for gastric banding) but are considered by experts to be a last resort, and the NHS is facing a deficit of £30 billion by 2021.

"We could end up with a situation where clinical commissioning groups say we can’t get the extra midwives we need for the local hospital, we can’t pay for life-saving drugs for people with cancer – because other people have been given the right to have expensive bariatric surgery," the National Obesity Forum's Tam Fry told the media.

Simon O'Neill, from Diabetes UK, also stressed that “although studies have shown that bariatric surgery can help with weight loss and have a positive effect on blood glucose levels, it must be remembered that any surgery carries serious risks".

Staving off future problems

Nevertheless, NICE insists that the move is cost effective given that it would help patients avoid long-term problems linked with obesity and diabetes that are costly to manage.

"More than half of people who undergo surgery have more control over their diabetes following surgery and are less likely to have diabetes related illness; in some cases surgery can even reverse the diagnosis," said Professor Mark Baker, Centre for Clinical Practice director.