Obesity and type 2 diabetes are in the national headlines almost every week. The burden to the individual, health service and society are clear. Although in the long term, prevention is the cure currently many individuals are already struggling with the fallout from these two common and linked conditions. Obesity is also closely associated with infertility, obstructive sleep apnoea, high blood pressure, heart disease, joint and back pain and even liver disease. These combined with type 2 diabetes results in medical complications that significantly reduce quality of life and life expectancy. So much so that recently, NICE (National Institute for Care Excellence) reduced the BMI (body mass index) criteria for bariatric surgery for obesity with type 2 diabetes to a BMI of 30 and above (from BMI 35 and above). There is now evidence to suggest that bariatric type surgery will benefit type 2 diabetes patients who are not morbidly obese. In fact studies have shown resolution of diabetes in patients with a BMI of 20-25 in certain countries.
My patients will tell you that although this kind of surgery is life changing for the better and often described as miraculous, it is not an easy choice or an easy option. For the surgery to work well requires a multidisciplinary approach and careful lifelong compliance to the changes brought on by surgery and once able to exercise more that this should be continued along with the balanced diets, vitamin supplementation for life and avoidance of smoking, excess alcohol and fatty, sugar rich and carbohydrate foods.
The approach to bariatric surgery has been well entwined with patient safety issues in major centres in the UK. The National Bariatric Surgery Registry (NBSR) to which all my patient and surgical outcomes data is entered prospectively allows monitoring of outlying surgeons and units. Indeed bariatric surgeons are only the second subspecialty in surgery to have a publically accessible database for surgeons’ results. Bariatric surgery is about making people healthier with a better quality of life, a longer lease of life and even to help some to conceive and start families. Our outcomes have been demonstrated to be safer than having a gallbladder operation in many hospitals due to most surgeons working in dedicated bariatric units. To get the best of this sort of surgery patients usually see a bariatric surgeon, dietician, anaesthetist, psychologist and a diabetologist prior to surgery and the patient journey, surgery and over all pathway is should be tailored for each individual patient.
The potential for bariatric surgery to improve the health of the nation and reduce the burden of obesity and type 2 diabetes in the UK and internationally is huge. It can improve the following sleep, lifestyle, insulin need, metabolism, mobility, energy levels and reproductive potential (SLIMMER effects). Safe surgery and even safer aftercare and follow up are the key to the best long term results, but this life changing surgical approach is available to everyone who chooses to access it.
Mr. Sanjay Purkayastha BSc MBBS MD FRCS
Consultant Bariatric Surgeon, Imperial Weight Centre & Wellington Hospital
Senior Lecturer in Bariatric Surgery, Imperial College London.