National Bariatric Surgery Registry offers fascinating insights into complexities of obesity 

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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.

Further information can be seen in the NBSR Second Registry Report 2014 (PDF 3.5mb)