RCP-SoPW 2019 – Call for access to bariatric surgery for T2 diabetic patients

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by Rachel Pugh

Bariatric surgery prevents Type 2 diabetes (T2D), strokes and heart disease and is recommended as part of the treatment pathway for people with T2D by NICE, but less than 1% of eligible people can access it.

Rachel Batterham, professor of obesity, diabetes and endocrinology at University College London Hospital, urged for bariatric surgery to be made more widely available and for people with obesity to be recognised as having a disease, rather than being stigmatised.

Delivering the Bradshaw Lecture at the at the joint conference in Cardiff of the Royal College of Physicians/Society of Physicians in Wales, Professor Batterham said: “Obesity is one of the biggest issues facing the NHS at the moment. To ensure that people with obesity get the care they need, we need to get away from the idea of it being a lifestyle choice. Nobody with severe obesity makes a choice to be that way.”

Speaking on World Diabetes Day, she pointed out that diabetes rates have doubled in the past 20 years. A quarter of the UK population is now obese, fuelling a rise in cases of type 2 diabetes alongside a range of other comorbidities ranging from cardiovascular diseases to asthma, cancer and infertility.

Batterham challenged her audience, saying: “If newspaper headlines were saying cancer rates had doubled in the past 20 years rather than diabetes rates, the attitudes of the medical profession would be very different.”

Growing evidence indicates that bariatric surgery is the most effective treatment for people with severe obesity. Dieting puts the body into ‘famine mode’ leading to increased ghrelin levels, decreased satiety, low energy and a desire for high energy foods, bariatric surgery alters a person’s biology, allowing them to maintain their weight loss.

A number of studies have indicated that T2D is completely resolved after bariatric surgery, such as that of Rubio-Almanza et al (1). They also demonstrated a weight loss after year five of 32.8%. She highlighted another study by Inge et al in which 228 adolescents with a mean BMI of 53, who had bypass and sleeve interventions, had a mean weight loss of 27% in three years and T2D remitted in 95%. (2)

Bariatric surgery reduces morbidity and mortality:

*  Marked weight reduction (25% of total weightless in five years)

*  Resolution of comorbidities (such as T2D, hypertension, liver disease, pulmonary function and musculoskeletal disorders) leads to a 40% reduction in mortality

*  Prevention of T2D, strokes and ischaemic heart disease

*  Longer term prevention of T2D leads to 30% reduction in microvascular complications in 10 years post-surgery 

She stressed the need for education on the complex causes of obesity - genetics, metabolic and social factors in order for people to get the right care: “It matters because it reduces their life expectancy.”

The RCP is making an urgent call for obesity to be recognised as a disease by government and the broader health sector and warns that unless this happens, its prevalence is unlikely to be reduced.

There is research interest in GLP-1 (Glucagon-like peptide-1) currently used in clinical blood glucose control drugs. It has been proposed that taking GLP-1 and GLP-1 analogs in obese patients can not only achieve weight loss but also prevent complications.

Batterham called for the government and the wider NHS to take obesity seriously (3), to use the same methods to address it as it would to any other complex, multifactorial chronic disease, and to address environmental factors that makes healthy food less accessible to the poorest populations. She also urged for the end of stigmatisation of people with obesity. (4)