Britain performs far fewer bariatric surgeries than other Europeans nations do. Why is that?
Obesity is the “last remaining respectable prejudice,” according to a commenter in The Guardian, and it appears that British surgeons agree. While obesity rates continue to climb in the UK, creating a slew of health issues that threaten to bankrupt the National Health Service, many medical experts are saying that the country should perform more obesity operations in order to reverse the trend.
“Bariatric surgery is one of the most cost-effective interventions we have in modern medicine,” says Professor Francesco Rubino, the chair of metabolic and bariatric surgery at King’s College London. Indeed, it seems that other countries share his view, performing far more surgeries per capita than Britain. France does 37,000 surgeries a year, compared to Britain’s 5,000, despite being a nation of equivalent size. Belgium and Sweden, with far smaller populations, carry out 12,000 and 7,000 operations, respectively, and Italy does 8,000.
Obesity operations, also known as bariatric surgery, involve shrinking the size of the stomach to prevent an individual from being able to overeat. It is a “safe therapy for a deadly disease,” experts say, and costs around £6,000 to £7,000 (US $7,750 to $9,000), less than a third of what it costs to perform a knee replacement – a common operation that’s often caused by obesity.
So what is preventing the NHS from normalizing bariatric surgery? Rubino says he used to think it was about cost, but now believes it stems from prejudice. People are forgiven for many things, but they’re not viewed favorably for overeating and not exercising. The stigma against obese people remains solidly entrenched. Rubino argues that this is unfair:
“Looking at the science of obesity today, it is inconsistent with the evidence to conceive of obesity as a lifestyle choice. It is not true that all patients who are obese are basically overeating. I would also submit that even if it were all about overeating – and I don’t believe it is the case – we don’t forgive obese patients for their poor lifestyle choices although we forgive those, such as smoking, that lead to cancer and transplant surgery.
“If we start taking the approach that disease associated with lifestyle choice should not be treated by surgical intervention, where are we going to draw the line? Pretty much every disease would have to be associated with lifestyle. I don’t think we should be here to judge.”
But isn’t pretty much every disease associated with lifestyle? I am not a bariatric surgeon, but I don’t think it’s too much of a stretch to link diseases with problems or complications in an individual’s life.
Interestingly, the same commenter whom I quoted at the beginning and who self-identifies as obese agrees with Rubino that obesity is not a lifestyle problem – “Who in their right mind would choose to make their daily life uncomfortable and embarrassing? Obesity is self-denying misery, not joyful self-indulgence” – but disagrees that surgery should be a default response, since it fails to address the complex mental issues at play:
“In many cases severe obesity is the visible result of trauma, anxiety, depression and sadness that may not have found expression and resolution in other realms of life. It also in itself worsens underlying negative feeling. In other words, it is a mental health issue. Surgery can help and in some cases it may be the only answer. But for the majority of us surgery isn't available and may not be the right answer anyway.”
Nevertheless, there’s a heated debate going on the UK right now, and if bariatric surgery can be a gateway to educating and improving individuals’ health, while reducing the NHS’ beleaguered budget, then perhaps it does deserve closer examination.