Bariatric surgery risks 'not being assessed'
18 October, 2012 By The Press Association
Bariatric surgery is too often being seen as a "quick fix" to solve obesity problems, research suggests.
A new report found that many patients undergo operations without a proper assessment of the risks the procedure poses to them.
More attention should be paid to pre-surgery counselling, the authors said.
The report, conducted by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD), examined the care given to 381 patients who were treated both privately and on the NHS.
The authors said that just a third of patients had received psychological counselling prior to referral for surgery, 24% of consent forms did not contain appropriate information and 32% of patients did not receive adequate follow-up after surgery.
And nearly a fifth of patients had to be readmitted to hospital, with some people needing further surgery, the researchers said.
The number of bariatric weight loss procedures - such as a gastric bypass or the fitting of gastric bands or balloons - rose by 70% between 2008 and 2010, the NCEPOD report said.
Between 2008 and 2009 there were 4,200 surgery cases in England, this soared to 7,200 between 2009 and 2010.
"Bariatric surgery is a radical procedure with considerable risks, as well as benefits," said the report co-author and NCEPOD clinical co-ordinator in surgery Ian Martin.
"It shouldn't be undertaken without providing full information and support to patients. But, when we reviewed cases we found examples of inadequate processes from start to finish - even the basics, such as giving patients dietary advice and education before decisions to operate are taken, were sometimes lacking."
Mr Martin also raised concerns about poor consent procedures and lack of psychological counselling prior to treatment, adding: "Consent often happens on the day the patient is admitted for surgery.
"This means there is no time for patients to reflect on their choices and have the opportunity to ask further questions about the risks and benefits of surgery before committing themselves to an operation."
The report authors said there should be a greater emphasis on psychological assessment before surgery.
They also said there should be a two-stage consent process - so patients have time to weigh up the benefits and the risks.
But separate research published today said that if obese patients undergo bariatric surgery they could quickly reduce risk factors for heart disease and stroke.
The research, published in the journal Heart, said the impact of such surgery is greater and faster than drug treatments for weight management or diabetes and in some cases, could be life-saving.
NCEPOD chair Bertie Leigh said that obesity had reached epidemic levels in the UK costing around £5bn a year, but that surgery could only ever be a part of the solution.
He said: "Surgery is not a panacea, yet both the private sector and the NHS offer a surgical solution to people suffering from an extreme disorder of diet without involving the dietician," he said, adding: "A clinician treating the problems of a patient needs to understand them at an individual level."
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I agree this surgery is not a quick fix to obesity although a significant number of patients see it as such and don't research it enough before applying so have unrealistic weight loss expectations and as such think they will become thin and model like in a matter of weeks/months.
While I agree psychology assessment is necessary for a number of patients pre op who have "comfort food issues" it would also be useful to have a pre op combined psychology/dietetic assessment to ensure patients are adequately counselled for the post op period to ensure they understand the lifetime dietry changes that need to be followed for sucessful weight loss to be achieved/maintained.
Another useful element would be to ensure people have free/reduced cost access to learn decent cooking skills as many younger people lack even basic skills to prepare healthy food and so rely heavily on fast food/takeaways etc which appears to contribute significantly toward obesity epidemic we now face.
As a recipient of bariatric surgery I can only speak for myself in that it has made a vast difference to my life.
Struggling for 20+yrs (with minimal success) to reduce my weight with diets/medication I was lucky that despite being over 20 stone with a family history of heart disease/diabetes etc I myself did not have any major health problems other than under active thyroid and significant joint/back pain which prevented me doing my job effectively or getting adequate exercise.
As a nurse working for several years with bariatric patients and researching the options and outcomes I finally opted to apply for surgery which I had 2 years ago which was done after 2 years of waiting from referral to surgery which gave me adequate time to consider my decision and and potential consequences and have to say I have no regrets as my health has now vastly improved (8st weight loss) and as I am mostly pain free I exercise more now.
However on reflection although I had relatively healthy choices (low fat/low sugar) in my diet its only since my enforced dietry restrictions (due to actual stomach size) I can now look back and see where I was going wrong over the years namely poor portion control combined with lack of proper breaks at work to eat properly meant I ate more calories at end of the day.
A typical day for me would be cereal or porridge and slice toast at 6am then a light lunch (due to break time restriction of 30mins around 12.30pm) which meant I was often so hungry on returning home at night for my main meal (7.30pm) it was often an excessive portion which was then eaten too fast for my body to sense full feeling, hence too many calories being consumed for my body's needs.
Now 2 years post op I still eat pretty much same foods but now with sensible portion control which more than satisfies my needs although I am still working to break the bad habit of eating too quickly or I feel very uncomfortable afterwards.
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