Top surgeon warns patients who have ‘died waiting’ or gone abroad for weight-loss surgery during the pandemic

Obese patients have “died” waiting for weight-loss surgeries during the pandemic, according to one of Scotland’s leading bariatric surgeons.

Professor Majid Ali said the few surgeries that have taken place over the past two years are mainly the result of patients who required emergency surgery due to complications suffered after paying for private treatment abroad.

He said: “Patients have suffered and are no longer eligible for anesthesia due to long waiting lists.

“Some of them had their diseases progressing – complications from diabetes were increasing, becoming uncontrolled, some of them had progressed heart disease in the last two years and some of them died while waiting for surgery.

“These things have happened across Scotland and will have happened across the UK and probably Europe as well.”

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Ali, who spoke personally to the Herald on Sunday, heads the surgical specialties and endoscopy unit at Ayrshire University Hospital – one of the NHS’s four main bariatric centers in Scotland.

Weight loss procedures such as gastric bands, gastric balloons, and gastric sleeves reduce the size of the stomach so less food is eaten and digested. In other surgeries, the intestines can be bypassed to reduce food intake.

The number of procedures performed on the NHS had been increasing before the pandemic, but was still limited to those with a BMI of 35 or more who also have type 2 diabetes or sleep apnea, or who are occasionally on a hip or hip surgery waiting list Knee prostheses that cannot go any further unless they lose weight.

Ali said his own unit has gone from averaging 40 to 50 bariatric surgeries a year before Covid to “maybe one or two throughout the pandemic” as elective surgeries have been scaled back.

Most patients undergoing bariatric surgery in Scotland over the past two years have paid for private surgeries that went wrong, Ali added.

He said: “Because of NHS regulations, they went to Turkey or Poland or other places where it’s cheaper.

“It’s not a small number, it’s become a trend. Many of them have gone to Turkey and had surgery there but the package is not right, some of them are developing complications and we have to operate on them to try to fix these complications. You’re desperate, that’s why.

“Our criteria are very restrictive and the majority of patients are refused treatment by the NHS.

“The price in Turkey is about a third of what it is in the UK, but you go into a ‘shop’ – you don’t get a full package of medical services, so there are serious complications.”

Ali said patients awaiting bariatric surgery in the NHS have been “pushed to the back of the queue” as a result of the pandemic and are unlikely to be prioritized in the future despite evidence the surgeries are reducing healthcare costs in the long term.

“Obesity is a complex disease that is a huge cost to the NHS and taxpayers if left untreated, but unfortunately bariatric patients are still viewed by some clinicians as ‘cosmetic’ surgery – quality of life interventions rather than life-saving surgeries.

“Unfortunately, the managers and budget officers do not see bariatric surgery as a priority at all.”

READ MORE: One in 20 patients waits over two years for surgeries at NHS Scotland

The pre-obesity surgery crisis has coincided with a spiraling obesity crisis.

In 2018 the Scottish Government set a target of halving childhood obesity by 2030, but figures released in December show 15.5 per cent of primary school children were at risk of obesity in 2020/21 – up from 10 per cent the year before the pandemic .

Overall, overweight and obesity rates among P1 children are increasing faster than at any time since monitoring began in 2001, and the gap between the poorest and the wealthiest students is wider than ever, at 21% and 8%, respectively.

HeraldScotland: Source: Public Health ScotlandSource: Public Health Scotland

The rate of maternal obesity in 2021 was the highest on record, with 54% of mothers-to-be being overweight or obese and 35% of all adults reporting gaining weight during the first lockdown.

However, in the wake of the pandemic, legislation to transform Scotland’s food environment was also suspended by the Scottish Government in June 2020 due to concerns about the impact on businesses and retailers already impacted by the Covid restrictions.

The plans — hailed as groundbreaking when they were first discussed in 2017 — would have bans on junk food promotions in supermarkets, mandatory calorie labeling on menus, portion size caps for takeaways, and restrictions on “upselling” (where consumers pay more for get their food) provided money if they upgrade to a larger size).

The Scottish Government says it remains “firmly committed” to introducing legislation to restrict the advertising of foods high in fat, sugar or salt during this Parliament and “will consult again this spring”.

A spokesman added: “We want to make it easier for people to make healthier choices and reduce health damage from poor diet and obesity, which is why we will also advise on the introduction of mandatory calorie labelling.”

HeraldScotland: Plans to restrict junk food promotions by retailers have been put on hold due to the pandemic's impact on storesPlans to limit junk food promotions by retailers have been put on hold due to the pandemic’s impact on stores

Meanwhile, obese patients – especially those in their forties and fifties, regardless of other risk factors such as diabetes – are significantly more likely than their healthy peers to become seriously ill or die from the effects of Covid-19 for reasons that are not fully understood.

“Covid has made a bad situation worse,” said Dr. Andrew Fraser, Chair of the Obesity Action Scotland Steering Group.

“Before Covid we were drifting, we were flattening, we weren’t going in the right direction; Covid has thrown us off course.”

He said the coming years would require “transformative and radical” interventions to reverse the crisis.

READ MORE: Jamie Oliver lauds Scotland’s junk food plan as ‘a world leader’ in the fight against obesity

Prevention as early as possible — even before conception — is key, he added.

“The kids who will be in P1 by 2030 aren’t born yet,” Fraser said. “Their mothers are three years short of having them.

“We must take immediate action to get people – mothers and fathers – in shape to have babies who have a good chance of being a normal weight from day one. Not even from day one, from in utero.

“The health of people of childbearing age is extremely important to improve the health of people who go to school because when they get to school it’s quite late.”

HeraldScotland: Every additional unit of BMI over 28 was associated with a 4% increased risk of dying from Covid, according to a study from England published in the Lancet in NovemberAccording to a study from England published in the Lancet in November, every additional BMI unit over 28 was associated with a 4% increased risk of dying from Covid

Measures should also be “proportionately slanted,” Fraser said, to benefit those in the poorest neighborhoods, where takeaways, fast-food outlets and off-license tend to proliferate and access to fresh food is more expensive is.

He said: “In poorer areas and rural areas, food – fresh fruit and vegetables – costs three times what it costs in more affluent areas, it’s not available, it’s not attractive.

“We have a bigger obesity problem than other countries so we need to be more radical about it and that depends on what people are buying and whether they can afford nutritious food. That is a big problem.”

Tam Fry, chair of the National Obesity Forum, said the “only good news” for patients suffering from obesity was NICE’s recent decision to recommend an appetite suppressant for prescription to the NHS in England and Wales.

Recommendations for NHS Scotland are issued separately by the Scottish Medicines Consortium.

The drug has been dubbed a “game-changer” after studies showed patients taking semaglutide (brand name Wegovy) lost 12% more weight than those taking a placebo.

HeraldScotland: Tam Fry, Chair of the National Obesity Forum Tam Fry, Chair of the National Obesity Forum

As for the UK’s approach to bariatric surgery, Fry calls it “absolutely insane”.

He said: “Over the years, bariatric surgery has been shown to pay for itself. It might cost a bit of money – £5000 to £6000 – in the initial stages of the surgery, but by stopping people from getting fatter – which bariatric surgery is very successful at – you reduce the likelihood that you’ll pay more for the very expensive treatment of diabetes, cancer and heart problems.

“It is unfortunate that bariatric surgery has been scaled back in this way. France, which has about the same population as England, does about two to three times more bariatric surgery because they’ve seen the light.

“We don’t have that and we suffer from it. Anywhere you raise the issue of obesity, stupid decisions are made.”

A Scottish Government spokesman said: “We understand it has been difficult for those awaiting treatment, but as we see cases of Covid-19 falling, our focus is on remobilizing services managed by are affected by the challenges of the pandemic.”

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