Shedding the Pounds: Obesity Management, NICE Guidance and Bariatric Surgery in England

In December 2006, the National Institute for Health and Clinical Excellence (NICE) issued guidance for preventing and managing overweight and obesit. Recommendations are step-wise, starting with lifestyle changes and progressing through medicine to bariatric surgery. The guidance recommends that patients considered for bariatric surgery have either a BMI of 40 or more, or a BMI over 35 with an associated condition such as diabetes. Costing guidelines are included in the guidance. This study examines current provision of bariatric surgery in England and estimates the cost savings that would be produced if NICE guidance was followed closely. The project included surveying PCTs about current practice, a literature review of the indirect costs of obesity, and the development of a model that combines the NICE costing guidelines with other costs and benefits identified in the literature. OHE's economic model found that the contribution of additional paid work by patients following bariatric surgery offset the costs of surgery within one year after surgery. Further savings also accrue from reductions in welfare benefits paid and, although the evidence base is limited, savings for the health service.