"An expansion of weight loss surgery in England is being proposed to tackle an epidemic of type 2 diabetes," BBC News reports. The National Institute for Health and Care Excellence (NICE) has recommended obese people with type 2 diabetes should be offered weight loss (bariatric) surgery.
These draft guidelines include new recommendations about the treatment of obesity. In particular, NICE advises that those with recent-onset type 2 diabetes who fulfil certain body mass index (BMI) criteria should have surgery. The recommendations also provide guidance on the use of very low-calorie diets.
As is often the case, the proposed NICE recommendations have made a huge media splash, leading to front-page headlines such as the Daily Mail's claim that, "Thousands more to get obesity ops on the NHS".
These are draft guidelines, so it is far from certain whether they will become official advice. A consultation will be taking place between July 11 and August 8 2014.
Currently, bariatric surgery is offered to people with a BMI of 40 or more, or those with a BMI between 35 and 40 if they also have another significant and possibly life-threatening disease that could be improved if they lost weight, such as type 2 diabetes or high blood pressure.
Patients must have tried and failed to achieve clinically beneficial weight loss by all other appropriate non-surgical methods and be fit for surgery. This recommendation has not changed.
The updated draft guidelines include additional recommendations on bariatric surgery for people with recent-onset type 2 diabetes. These recommendations include:
Bariatric surgery includes gastric banding, gastric bypass, sleeve gastrectomy and duodenal switch.
A range of techniques are used, but they are usually all based on the principle of surgically altering the digestive system so it takes less food and makes the patient feel fuller quicker after eating.
The two most common types of weight loss surgery are:
These procedures are usually performed using keyhole surgery.
As with all types of surgery, weight loss surgery carries a risk of complications. These include:
It is estimated the risk of dying shortly after gastric band surgery is around 1 in 2,000. A gastric bypass carries a higher risk of around 1 in 100.
The surgery also carries the risk of other side effects, including:
The draft guideline also makes recommendations regarding very low-calorie diets (800kcal per day or less). These include:
The risks and benefits of surgery should also be discussed. Patients should be made aware that very low-calorie diets are not a long-term weight management strategy and that regaining weight is likely, but not because of a failure on their or their clinician's part.
There is concern about how many people will be eligible for treatment under the new guidelines and how much it will cost, with Diabetes UK estimating that 850,000 people could be eligible for surgery.
Simon O'Neill, from the charity Diabetes UK, has been quoted as saying that, "Bariatric surgery should only be considered as a last resort if serious attempts to lose weight have been unsuccessful and if the person is obese.
"It can lead to dramatic weight loss, which in turn may result in a reduction in people taking their type 2 diabetes medication, and even in some people needing no medication at all.
"This does not mean, however, that type 2 diabetes has been cured. These people will still need to eat a healthy balanced diet and be physically active."
Professor Mark Baker, director of the Centre for Clinical Practice, said that, "Updated evidence suggests people who are obese and have been recently diagnosed with type 2 diabetes may benefit from weight loss surgery.
"More than half of people who undergo surgery have more control over their diabetes following surgery and are less likely to have diabetes-related illness; in some cases, surgery can even reverse the diagnosis. The existing recommendations around weight loss surgery have not changed."
It could actually be the case that increasing access to bariatric surgery will save the NHS money in the long term if this helps combat the obesity epidemic.
If obesity levels continue to rise at their current rates, it is estimated that by 2050 the annual cost of treating obesity-related complications will be £50 billion, more than half the entire current NHS budget for England; 1 million operations at £5,000 each – £5 billion in total – could well seem a bargain in comparison.