The number of obese people having weight loss surgery needs to double or triple in the UK so the soaring bill for treating type 2 diabetes can be cut, according to NHS advisory body Nice.
Up to two million people could be eligible for surgery, said Rachel Batterham, head of obesity and bariatric services at University College London Hospital NHS Trust who helped update guidance for the National Institute for Health and Care Excellence (Nice). Only 6,500 people a year had it in 2009/10.
Nice says bariatric surgery can greatly help type 2 diabetics. The most modern operations, the stomach bypass and the gastric sleeve, do more than reduce stomach capacity – “they alter how the body handles glucose”, said Batterham.
Of the 4,000 patients who had surgery because of type 2 diabetes, 65% were not on any diabetes medication within two years, she said. “If you look at the healthcare savings from drugs alone, the surgery pays for itself in two to three years.” That was without taking into account the savings from avoiding the severe side effects of the disease, which can include blindness, amputations, renal failure, heart attacks and stroke.
“The benefits are so great it really needs to be considered as part of their treatment pathway,” she said.
Nice does not back the routine use of very low calorie diets, often 400-800 calories. “The problem is that most people will lose weight but most people will also regain much of that weight that has been lost,” said Prof John Wilding, a diabetes consultant and obesity specialist from the University of Liverpool. We don’t see [diets] as a long-term solution for people with obesity. They could be used in people who need to lose weight quickly because they are going to have a knee replacement operation, for instance.”
One in 20 people have type 2 diabetes and the numbers are growing because of the obesity epidemic. The toll is high. “Every year 24,000 people die prematurely because of type 2 diabetes. There are 100 amputations every week in the NHS and these are all preventable,” said Batterham.
Wilding said the number of NHS operations could realistically rise to about 15,000 a year. There are currently serious delays in many parts of the UK, however, because obese patients need assessment and counselling over several months before embarking on surgery and many hospital trusts do not have the services in place.
The cost of each operation is about £6,000, which includes follow-up care. Nice says it is vital that people should be seen regularly because their diet and exercise habits need to change. But surgery will, over the long-term, reduce the annual £10m bill for care of diabetes and its complications, says Nice.
However Simon Stevens, the NHS England chief executive, has strongly backed efforts to prevent obesity and some experts agree with him.
But Prof Iain Broom, director of the centre for obesity research and education at Robert Gordon University in Aberdeen, said Nice had missed lots of evidence.
“The Nice guidance could send tens of thousands of Britons towards unnecessary surgery, with its known morbidity and mortality, and costing taxpayers many millions of pounds, when all that is required is a different dietary and lifestyle approach including the use of low carbohydrate diets and low calorie diets,” he said.
Nice says obese people (BMI of 35 or over) with recently diagnosed type 2 diabetes should be assessed for weight loss surgery. People of Asian family origin and those recently diagnosed with type 2 diabetes should be considered for an assessment even if their BMI is lower than 35.
• This article was amended on 27 November 2014. An earlier version lost a zero from a figure of 100 amputations mentioned in a quote.