Opinion remains divided on whether bariatric surgery is cosmetic in nature

Posted: 10/10/2014

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Bariatric surgery, or weight loss surgery as it is probably more commonly known, is used to normalise intestinal hormones and metabolism function. It is one of the ways to tackle diseases caused by obesity which can lead to other medical conditions such as diabetes, high blood pressure and thyroid problems, to name but a few.

Why then, is there such a stigma attached to weight loss surgery, and why are many insurers not covering it? Many people view this type of surgery as a lifestyle choice, considering it to be cosmetic in nature rather than surgery to help a medical condition.

Bariatric surgery is on the increase in the UK as well as internationally. A recent study by the Metabolic Surgery Foundation of India has shown that the number of bariatric surgeries has seen a steady rise from about 3,500 in 2011 to 10,000 in 2013.  While more and more people are opting for bariatric surgery in India, insurance to cover the costs seems to be a grey area.

There are a number of reasons for this. Firstly, the conflict in opinion on whether to view bariatric surgery as a cosmetic or non-cosmetic procedure. Dr Ramen Goel, a bariatric surgeon in Mumbai, has commented: “The Government has said that obesity is a disease and bariatric surgery is a non-cosmetic surgery.” However, insurers seem to have a different opinion and consider it as a cosmetic procedure. For this reason it is very unlikely that insurance will cover the costs of surgery. A second factor is whether or not obesity is considered a medical condition, with many insurers stating that obesity will only be covered if the condition is life threatening. It is however clear that obesity can lead to serious medical conditions. Why should people have to develop these conditions before treatment/surgery is offered?

Weight loss surgery is only recommended for people with a BMI of 40 or more, or a BMI of 35-40 and a serious health condition that could be improved following weight loss, such as type 2 diabetes or high blood pressure. The National Institute for Health and Care Excellence (NICE) recommends that weight loss surgery should only be offered by the NHS if all the following conditions apply:

• patients have tried all the appropriate non-surgical methods, such as diet and exercise, but have failed to achieve or maintain a beneficial level of weight loss for at least six months;
• they agree to commit to long-term follow-up treatment after surgery at a specialised obesity service;
• they are fit and healthy enough to withstand the anaesthetic and surgery.

NICE is currently considering lowering the threshold for weight loss surgery to a BMI of over 30 for people who have recently been diagnosed with type 2 diabetes. A final decision is expected by the end of 2014.

Amy Milner, an associate in the clinical negligence team at Penningtons Manches, says: “Where we are seeing an increase in patients developing medical conditions secondary to obesity, it is concerning that there is still a stigma related to those undergoing bariatric surgery, particularly under the NHS. Even more worrying is the fact that some insurers are refusing to cover the cost of surgery as it is deemed cosmetic in nature. While NICE is in the process of considering lowering the threshold for weight loss surgery, it will only apply to those who have been diagnosed with type 2 diabetes, which is weight related. Those who do not fit the criteria, cannot afford the cost of surgery privately, or do not receive assistance with their weight loss by more conventional means, such as dieting or exercise, remain vulnerable. It is clear that in the majority of cases bariatric surgery should not be treated as cosmetic in nature, and it is frustrating that so many people who require surgery for medical reasons may lose out.”

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