Assessment for weight loss surgery – such as gastric bypass or gastric banding – has to ask whether patients are committed to a healthier way of life, insists David Ashton.

Some 60 per cent of the UK population is either overweight or obese and the epidemic shows no sign of abating.

Currently the only effective long term treatment for morbid obesity is surgery, primarily gastric bypass and gastric banding. After surgery patients typically lose 40-70 per cent of excess weight, with major improvements in obesity related conditions such as type 2 diabetes, hypertension and depression. Compared with non-surgically managed controls these benefits translate into significant reductions in long term mortality and healthcare costs.

In 2002, the National Institute for Health and Clinical Excellence estimated that at least 1.2 million people in England and Wales were eligible for obesity surgery. However, there are only something like 8,000 procedures carried out each year, many of these in the private sector. Even quadrupling the number of NHS surgical procedures would only cater for 1-2 per cent of those who could benefit. This is the dilemma many primary care trusts already face or will be forced to soon.

Obesity surgery should be offered to those at greatest risk from their disease and those most likely to benefit. These two groups are not the same.

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