As a leading cause of morbidity and mortality worldwide, obesity poses a significant threat to population health and places substantial burden on health services. It is clear that the treatment of morbid obesity needs to be recognised as a fundamental aspect in tackling the obesity epidemic. The increasing evidence on the clinical and cost-effectiveness of bariatric surgery make it an attractive treatment option (1,2). Bariatric surgical procedures are not commonly performed in Ireland. Only two public bariatric centres exist nationally and between them fewer than 50 procedures are done per annum, equivalent to fewer than 1/100,000 population publicly funded surgeries taking place annually. However, there is currently no national registry of bariatric surgical patients and so robust information about how many procedures are done is limited.
To inform health policy and resource allocation it is necessary to quantify the pool of eligible people who would potentially benefit from bariatric surgery. Using data from The Irish LongiTuDinal Study on Ageing (TILDA), our research sought to inform health service planning by estimating the number of people who would potentially benefit from bariatric surgery. We applied two separate sets of criteria to identify those potentially eligible for surgery. The first set of criteria, based on UK guidelines (3), included a BMI ≥40 kg/m2 or a BMI ≥35kg/m² and one or more of the following conditions; type 2 diabetes, hypertension, previous myocardial infarction (MI) and sleep apnea. Under these criteria, 7.97% of older Irish adults, representing 92,573 people, are eligible for bariatric surgery. The second set of criteria was used to identify the cohort of patients in whom the largest benefits and cost-savings from bariatric surgery are observed (4,5). These are patients with type 2 diabetes and BMI ≥35kg/m², who had one or more of the following; previous MI, elevated urine albumin-creatinine ratio, retinopathy, neuropathy or peripheral vascular disease. Under these criteria, 0.97% of older Irish adults are eligible for surgery, representing 11,231 adults. With fewer than 1/100,000 population publicly funded surgeries taking place annually, our findings indicate that current public service provision of bariatric surgery in Ireland meets much less than 0.1% of the need.
Implementing a strategy that will address this need and have an acceptable budget impact initially is a considerable challenge. One possible strategy is to focus on the provision of bariatric surgery to the patients that would benefit most from surgery who simultaneously have the highest direct healthcare cost. Patients eligible under criteria two have established complications of diabetes and use expensive drugs to treat their diabetes. Focusing on this cohort of patients has the potential to improve both patient outcomes and reduce direct healthcare expenditure quickly. Our findings demonstrate that increasing the rates of surgery in Ireland in line with other European countries would make the intervention more accessible, at least, to this population subgroup.
While many adults who fulfil the eligibility criteria for bariatric surgery may not want or require it, the current level of need for bariatric surgical services is not being met. A strategy to develop and expand the provision of bariatric care is urgently needed.
Ms. Kate O’Neill,
PhD Student ,
Department of Epidemiology and Public Health,
University College Cork
- Papasavas P, El Chaar M, Kothari SN. American Society for Metabolic and Bariatric Surgery position statement on vagal blocking therapy for obesity. Surg Obes Relat Dis [Internet]. Elsevier; 2016;12(3):460–1. Available from: http://dx.doi.org/10.1016/j.soard.2015.11.021
- Rubino F, Nathan DM, Eckel RH, Schauer PR, Alberti KGMM, Zimmet PZ, et al. Metabolic surgery in the treatment algorithm for type 2 diabetes: A joint statement by international diabetes organizations. Diabetes Care. 2016;39(7):861–77.
- Welbourn R, le Roux CW, Owen-Smith A, Wordsworth S, Blazeby JM. Why the NHS should do more bariatric surgery; how much should we do?: BMJ [Internet]. 2016;1472(May):i1472. Available from: http://www.bmj.com/lookup/doi/10.1136/bmj.i1472
- Picot J, Jones J, Colquitt JL, Gospodarevskaya E, Loveman E, Baxter L, et al. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess. 2009;13(41).
- Keating CL, Dixon JB, Moodie ML, Peeters A, Buflone L, Maglianno DJ, et al. Cost-Effectiveness of Surgically Induced Weight Loss for the Management of Type 2 Diabetes : Modeled Lifetime Analysis. Diabetes Care. 2009;32(4):567–74.
- Klein S, Ghosh A, Cremieux PY, Eapen S, McGavock TJ. Economic impact of the clinical benefits of bariatric surgery in diabetes patients with BMI ≥35 kg/m2. Obesity [Internet]. Nature Publishing Group; 2011;19(3):581–7. Available from: http://dx.doi.org/10.1038/oby.2010.199/nature06264
If you have any queries or comments please contact Martin on email@example.com