The NHS can’t stretch to gastric band surgery for all

Baroness Young of Diabetes UK has just been speaking on BBC Radio 4’s Today programme in response to the draft advice from NICE that everyone who is obese and has type 2 diabetes (the former often causes the latter) should be offered bariatric (gastric band, weight-loss) surgery – that’s about 800,000 of us. It’s covered here by Telegraph Health Editor @lauradonnelly with a useful timeline and BMI calculator. Baroness Young’s main complaint is the fact that not enough is being done to prevent people becoming obese, or offered support to lose weight once they are, and that bariatric surgery which has been a last resort is now being proposed as a solution for all. Of course there is then the cost – at £5,000 a pop, where would the money come from? @SarahBoseley rightly points out in the Guardian too that there is already a queue of potential patients to see the psychologists who need to counsel them on the serious implications of surgery.

Note it is draft guidance and NICE will know that about 8,000 weight-loss operations were undertaken last year and that we can’t overnight increase capacity 100 fold. As with all surgery, it has its risks and many will decline the offer. Added to this it doesn’t tackle route causes and you can still overeat even after surgery.

The reason we keep coming back to this subject is that there is no effective national strategy for what is an epidemic. The government launched their obesity strategy back in October 2011, and it included:

  • Responsibility Deal – a voluntary set of pledges for business around alcoholfoodhealth at work and physical activity
  • Public education
  • Environment & physical activity
  • Councils – moving public health to Health and Wellbeing Boards in the hope that they would ‘do something’

There are lots of examples of organisations taking action, which is great, but it is a drop in the ocean. Whilst it accurately recognises that causes of obesity are multi-factorial, we have an obesity crisis and this good will approach only means the troops are ready for battle, the real action hasn’t begun. Where is the COBRA meeting for obesity?

Whilst Diabetes UK want more weight loss classes, the reality is that most causes of obesity lie outside the NHS and to win the fight of the flab we have to have a serious cross-departmental strategy that enables prevention and action at every front-line including:

  • Food industry – especially fast food outlets and misleading labelling
  • Drinks industry – remembering a bottle of wine average 700 calories
  • Town and country planning – that encourages walking and cycling
  • Public Health planning – tackling the determinants of health
  • Incentives / penalties – no stone should be left unturned
  • Education – our Well’s Family Challenge report with Sainsbury’s showed a woeful lack of understanding of what constitutes a balanced diet.

Just a word on exercise however. As anyone who wears a pedometer will know that you can’t combat fat with exercise. I walked 11235 steps (8.2km) the other day and that only used up 309 calories – less than a mars bar. Exercise is great for fitness, pointless for weight loss (it makes you more hungry!)

2020health are now compiling our report on Obesity which will be launched in the early autumn. My recent blog on the subject of sugar is here.

About Julia Manning

Julia is a social pioneer, writer and campaigner. She studied visual science at City University and became a member of the College of Optometrists in 1991, later specialising in visual impairment and diabetes. During her career in optometry, she lectured at City University, was a visiting clinician at the Royal Free Hospital and worked with Primary Care Trusts. She ran a domiciliary practice across south London and was a Director of the UK Institute of Optometry. Julia formed 20/20Health in 2006. Becoming an expert in digital health solutions, she led on the NHS–USA Veterans’ Health Digital Health Exchange Programme and was co-founder of the Health Tech and You Awards with Axa PPP and the Design Museum. Her research interests are now in harnessing digital to improve personal health, and she is a PhD candidate in Human Computer Interaction (HCI) at UCL. She is also dedicated to creating a sustainable Whole School Wellbeing Community model for schools that builds relationships, discovers assets and develops life skills. She is a member of the Royal Society of Medicine’s Digital Health Council. Julia has shared 2020health's research widely in the media (BBC News, ITV, Channel 5 News, BBC 1′s The Big Questions & Victoria Derbyshire, BBC Radio 4 Today, PM and Woman's Hour, LBC) and has taken part in debates and contributed to BBC’s Newsnight, Panorama, You and Yours and ITV’s The Week.
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