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Feature Obesity

Slimmed down surgery

BMJ 2010; 341 doi: (Published 26 October 2010) Cite this as: BMJ 2010;341:c5499
  1. Margaret McCartney, general practitioner
  1. 1 Glasgow, UK
  1. margaret{at}

Despite NICE recommending bariatric surgery for specific groups of patients, Margaret McCartney finds many people are unable to get access to NHS treatment

Approaches to weight loss are subject to fad and fashion, but one measure looks set to stay. Thirty years ago bariatric surgery was treated as an oddity imported from the United States; now the procedures are recommended for certain patients by the UK’s National Institute for Health and Clinical Excellence (NICE).1

As the publicity surrounding the alleged obesity epidemic has taken hold, medical methods to try to combat it have drawn increased attention. Drug treatment for weight loss has not been very successful: ribonamant was withdrawn because of an increased risk of suicide and sibutramine, another centrally acting appetite suppressant, was banned early this year because of concerns about cardiac side effects. Orlistat, which prevents fat absorption, has unpleasant gastric side effects and compliance can be problematic. Patients who do manage to take it over six months are likely to lose an average of 2.3 kg in addition to 2.1 kg lost with lifestyle changes alone.2 Diet and exercise alone, although universally recommended in guidelines on the management of obesity, seem to have been unsuccessful in reducing the number of very obese patients presenting with complications.


NICE guidelines recommend bariatric surgery for people with a body mass index (BMI) ≥40 and those with a BMI of 35-40 who have obesity related disease, such as hypertension or diabetes, after other interventions have failed. A Cochrane review found that “surgery is more effective than conventional management,”3 and a health technology assessment published last year concluded that “bariatric surgery appears to be a clinically effective and cost effective intervention for moderately to severely obese people compared with non surgical interventions.”4

Several procedures fall under the bariatric …

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