Weight Loss Surgery On The NHS
Am I Eligible For Weight Loss Surgery On The NHS?
People with a BMI of 40 or more can be eligible for weight loss surgery through the NHS. People with a BMI of 35 or more who have serious health conditions, such as high blood pressure, may also be eligible.
If somebody has tried everything they can to lose weight through the regular channels, such as diet and exercise, but have failed to lose any weight for six months, they too may be eligible for weight loss surgery. Before agreeing to do the operation, the surgeon would also need to ascertain that the patient's body would be able to cope with the anaesthetic as well as the surgical procedure.
The operation is not recommended for children but teenagers are able to have a gastric band fitted if they are seriously obese.
Calculating Your BMI
In order to work out your BMI, take your weight in kilograms and divide it by the square of your height in meters. If you are unsure how to do this, there are many BMI calculators available on many websites such as NHS Direct. Alternatively, there are scales you can purchase which calculate your BMI for you, or quite simply, ask your GP.
Can I Get Weight Loss Surgery Through The NHS?
Done privately, a gastric band operation can cost anywhere between £5,000 and £8,000, depending on the clinic and the aftercare that they offer. The price will also depend on each patient and their circumstances. It is therefore no surprise that many people look towards the NHS to help them.
Providing you meet the above criteria, you should be eligible for treatment, but you must check with your GP to ensure it can take place on the NHS. Remember the demand for weight loss surgery through the NHS is very high and there is often a long waiting list.
It might also be worth bearing in mind that a patient having the operation on the NHS would need to attend an outpatient clinic after surgery, which would mean committing to long term follow up treatment at a specialist obesity service.
Watch Mr Chris Sutton, Consultant Specialist Bariatric Surgeon at Tonic Weight Loss Surgery Ltd, explain who could qualify for weight loss surgery on the NHS:
"You can get weight loss surgery on the NHS, it would depend on a patient’s Body Mass Index and whether they have a co-morbidity or condition related to being overweight. If they have these things and fulfill the criteria then in theory patients can be referred through. They need to be referred through what’s called a Tier-3 Weight Loss Program so they work with dieticians. And once they’ve completed this program they then would be referred on to the surgical clinic."
Mr Chris Sutton, Consultant Specialist Bariatric Surgeon at Tonic Weight Loss Surgery Ltd
Getting Ready For Surgery
Ahead of surgery, an individual will need to meet with their multidisciplinary team, known as an MDT, to discuss preparation.
The MDT normally consists of a doctor specializing in the digestive tract, known as a gastroenterologist, the surgeon who will carry out the weight loss surgery, the anaesthetist, a nurse specializing in weight loss, and a psychologist. The MDT will carry out assessments to ensure candidates are suitable for weight loss surgery. This process will include undergoing a physical assessment, psychological assessment, and a nutritional assessment.
During a physical assessment, the MDT will look for underlying issues or health problems that could potentially pose a risk to your surgery. Blood tests, x-rays, ultrasounds and an ECG may be carried out to ensure you are physically well enough to withstand the anaesthesia and surgery. The psychological assessment will determine the mental state of a patient, and isolate any conditions that could prevent the patient from being able to follow their post-surgery plan to prevent gaining the weight back. The psychologist may ask a number of questions to learn about your emotions, daily activities, mental health and expectations of the surgery. Finally, a nutritional analysis will be carried out to determine the current eating habits of the patient, and how these will need to be altered after surgery.
There are three main types of bariatric surgery – a gastric bypass, the fitting of a gastric band, and a sleeve gastrectomy. Which of the three your surgeon decides to use will depend on a number of factors, which will be determined during the pre-operative assessments mentioned above.
Where possible, these surgeries will be performed laparoscopically using a camera so as to be non-invasive. This is referred to as keyhole surgery. All three procedures are carried out under a general anaesthetic, with patients normally requiring a short stay in hospital afterwards.
During a gastric bypass, the surgeon uses sutures to create a small banana-shaped pouch at the top of the stomach, and then rearranges the small intestine to connect to this. This means only a small amount of the stomach is able to hold food, and so patients feel fuller for longer and consequently eat less. During a sleeve gastrectomy, the surgeon will remove a portion of the stomach to achieve the same effect. A gastric band can also be placed, creating a small pouch at the top of the stomach to also reduce its capacity for food. This band is flexible, and filled with saline to create the right size. This procedure can also be reversed and repeated if necessary.
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Immediately following the surgery, you may feel groggy and tired from the anaesthetic, and experience some pain and tenderness. All of this is normal, and if you are struggling with pain, your nurses can give you paracetamol or prescription painkillers if necessary. If during your pre-operative physical assessment you were found to be at high risk of developing a blood clot, you may also be prescribed a blood-thinning medication.
You will be monitored in hospital for the first 24 hours, during which time you’ll only be allowed liquids. Gradually, you’ll be able to return to eating solid foods as you recover. You may be discharged after the first 24 hours, but you may be required to stay in for longer if there are any complications or concerns. Most people are able to resume normal activities and return to work within four to six weeks of undergoing bariatric surgery. Following the insertion of a gastric band, you will have to attend a follow-up appointment so that the band can be filled with saline and adjusted to finalise its placement. For gastric sleeves or a gastric bypass, patients can expect to spend one to four days in hospital and be back to normal within four to six weeks, after which follow up appointments may be required.
The types of results an individual can expect following bariatric surgery will depend on the type of procedure they’ve had, along with their ability to stick to a calorie-controlled diet and introduce exercise into daily life following surgery.
Following the insertion of a gastric band, you should expect to lose 50% of your excess body weight within two years of the surgery. It is expected that 35% of this weight will be lost within the first six months, with patients experiencing 40% weight loss within 12 months and the remaining 10% in the 12 months after that. Patients who have had a gastric sleeve created can expect to see similar results. When an individual undergoes a gastric bypass procedure, they should expect to lose 70% of their excess body weight within 24 months of the surgery. The majority of this weight loss (60%) occurs within the first year, with the remaining weight loss occurring during the second year.
Weight loss surgery has also been shown to treat weight-related health conditions, such as high cholesterol levels, type 2 diabetes, and gastro-oesophageal reflux disease (GORD). Sticking to a post-surgery lifestyle plan as created by your MDT will help you see success and enjoy long-lasting results.
As is the case with any surgery, there are risks associated with undergoing a bariatric weight loss procedure.
These risks include physical and psychological repercussions. Immediately following surgery, there is the chance of infection developing (which occurs in roughly 1 out of 20 patients), internal bleeding, and blood clotting. One common side effect of rapid weight loss is excess skin; as the fat is removed but the skin remains, this skin can become loose and fold around the breasts, tummy and hips especially. It can be unsightly and also prone to infection, and so many patients will undergo cosmetic surgery through a private clinic to remove this skin.
Gallstones are also common after weight loss surgery. As many as 1 in 12 patients will develop gallstones, and normally do so around 10 months after surgery. With gastric band surgery, there is the risk that the band will slip out of position. This occurs in roughly 1 in 50 patients, and will require reparative surgery. For those who have had a gastric bypass, there’s a risk that the hole connecting the stomach to the small intestine (known as a stoma) becomes blocked. This is called stomal stenosis, and occurs in one-fifth of gastric bypass patients. Endoscopic surgery can repair this condition.
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Following weight loss surgery, your MDT will provide you with a lifestyle guide. This guide will consist of a diet plan, to contribute to ongoing weight loss, along with an exercise plan.
Your diet will need to be changed after surgery, and this is done in stages. Four weeks after surgery, you will be on a liquid-only diet, with pureed foods being introduced towards the end. Soft foods can be introduced in weeks four to six, after which you can begin eating healthy foods in small portions. It is important to stick to the eating guidelines as provided by your medical team, as failing to do so can increase the risk of vomiting, which can cause damage to the stomach. During the first four weeks, it’s important to drink plenty of water, and have small portions of pureed food four to five times a day. In weeks four to six, soft foods such as porridge, yoghurt and rice can be added into your diet. Once you are able to resume eating solids after six weeks, it’s important to have three meals a day and to avoid snacking.
Regular exercise should also become part of your life following weight loss surgery. Integrate this exercise slowly and under the advisement of your medical team. You may wish to opt for low-impact activities such as walking, gardening or cycling, and increase your levels of activity when you are able.
If you, or someone you know, is thinking about undergoing weight loss surgery, it is very important to first seek the advice of your GP.
Your GP or surgery nurse should be able to give you any information that you need and be able to advise you on the best course of action to take. They should discuss both the benefits and the risks with you.
If you choose to have the operation done privately, it is advisable to take advantage of any free consultations that clinics might offer to get a better understanding of the procedure and to gain a balanced view of the type of surgery and aftercare on offer. Make sure you ask lots of questions and, if possible, speak to others who have had the surgery.
You can also get advice from NICE (The National Institute for Health and Clinical Excellence) who have an excellent document available called 'Treatment for People who are Overweight or Obese'.