Controversial surgery for treating obesity that involves reducing the patient's stomach to the size of a thumb should be made more widely available on the NHS, according to obesity researchers. They say a lack of resources and prejudice from some doctors is preventing many morbidly obese patients from receiving life-saving surgery.
Dr Carel Le Roux at Imperial College London and his colleague Dr Rachel Batterham are calling for 10 times the number of operations currently performed. At present around 6,000 people receive the surgery each year but guidelines from the National Institute of Clinical Excellence say the number should be 60,000.
Currently, only patients with a body mass index of 35 or over are eligible, but the scientists say more research is needed to work out whether this criterion should be extended. A BMI of 25 or higher is considered overweight. Thirty or more is considered obese. "We are shooting way low at the moment," Le Roux said. "We actually don't have the infrastructure to look after these patients."
"What we need to know is which patients would benefit from this operation and I think that evidence is lacking," Le Roux told the British Association's Festival of Science in Liverpool. Around two-thirds of the UK population is overweight or obese and the World Health Organisation predicts that by 2015 2.3 billion adults worldwide will be overweight and 700 million will be obese.
Gastric bypass surgery involves closing off part of the stomach to dramatically reduce its size and replumbing the new smaller stomach into a point further down the small intestine. Traditionally, this was seen as a crude way to reduce the ability of the patient's gut to absorb energy from food. "Physicians had thought this was bad news for a long time," Le Roux said.
But he said more recent research has found that the surgery leads to subtle long-term changes in the levels of hormones that determine how hungry and full the patient feels. "Until that point, people actually thought these operations worked through mechanical means … and that's what patients have been told," Le Roux said. In many cases the surgery also cures type 2 diabetes.
In the long term Le Roux and Batterham hope to recreate these changes using drugs without surgery, but in the meantime they say the £9,000 operation can make a huge difference to patients. It typically leads to a 25% weight reduction in the long term.
"The holy grail of understanding how this works is that it will potentially lead to a cure for obesity and type 2 diabetes," said Batterham, who works at the centre for diabetes and endocrinology at University College London.
She said that there is a great deal of prejudice against obese people, and solving their condition is not as simple as merely eating less and exercising more.
"The systems that control our weight evolved in a totally different environment," Batterham said. "In the past, being able to store excess calories and being able to use that energy was actually a survival advantage."
She said some people are genetically predisposed to becoming obese and once they become overweight, changes in their hormone levels mean it becomes almost impossible for them to lose weight. "As soon as you start to diet the body thinks you are starving even though you have got lots of fat stored. What it does in response to that is it changes these gut hormones to make you feel even more hungry," she said.
