Surgery should be available to the obese

Thousands of chronically obese people whose weight endangers their health should be allowed to have stomach stapling and other surgery on the NHS, the Government's medical advisory body ruled yesterday.

The National Institute of Clinical Excellence (NICE) said the "last resort" treatment, which is only available to about 200 people a year, should be available to up to 4,000 people annually.

About 600,000 people in England and Wales are classed as morbidly obese and another 600,000 have obesity combined with diabetes, high blood pressure or another significant disease. Obesity is a growing problem in the UK, and NICE estimates the number of people with extreme obesity will increase by 5 per cent a year.

The condition, which increases the risk of heart disease, cancer, respiratory disorders and diabetes, results in 30,000 premature deaths a year. Surgery, costing an average of £5,500 per operation, has been shown to be highly effective for some patients, who might shed between 50 and 75 per cent of their excess weight.

Professor John Baxter, a surgeon at Morriston Hospital in Swansea, said: "It is not just a quality of life issue, it is not a cosmetic issue. People who are morbidly obese have a one in seven chance of reaching their normal life expectancy. The reason we operate is to save their lives.

"The fact that they look better and feel better afterward is a helpful side effect. Many of them already have problems such as diabetes which we can literally cure when we do this sort of surgery."

Two main types of surgery for weight loss are now available. Malabsorptive surgery shortens the length of the gut so the amount of food absorbed is reduced. Restrictive surgery limits the size of the stomach using staples or a tight band so that the patient quickly feels full. Both procedures can cause side effects, including nausea, vomiting, diarrhoea, infections in the wound, and the possibility of the staples bursting or ulcers forming around the band.

The NICE ruling says patients must be over 18, they must have been attending a specialist hospital obesity clinic, and have tried "all other appropriate non-surgical treatments" to lose weight.

Surgical treatment for obesity has been seriously lacking in Britain. Only about 12 surgeons perform the techniques on anything like a regular basis and less than 10 NHS trusts perform between seven and 25 operations a year.

The shortage of surgeons and suitably-equipped clinics means the new guidance cannot be implemented immediately. It is expected to cost an extra £1.7m in the first year, rising to an additional £21m after eight years.

Professor Alan Johnson, the president of the British Obesity Surgery Society (BOSS) said: "Patient safety is our first consideration and we would want to implement the appraisal over a sensible period to allow for surgeons to be appropriately trained and all of the support services to be in place."

Professor Baxter, who is secretary of BOSS, said the patients who might benefit were likely to have a genetic disposition for obesity which usually meant they weighed more than 20 stone.