A recently published study suggests that weight-loss surgery aftercare is inadequate.

Clinical guidelines recommend that patients receive nutritional and weight monitoring annually for life following procedures such as having a gastric bypass. However, new research from the University of East Anglia and the University of Birmingham suggests that, in the majority of cases, weight-loss surgery aftercare is inadequate

The study was funded by the National Institute for Health Research (NIHR) Clinical Research Network West Midlands.

If patients do not receive the follow-up care from their GPs as recommended in clinical guidelines, it can lead to patients putting weight back on or developing low levels of vitamins and other nutrients, which can have serious health consequences.

At Healthy Life Essex, we focus on natural wellbeing and would therefore question if weight-loss surgery is being offered unnecessarily. While we appreciate that in cases where people who are excessively obese and have failed to lose weight through a healthy diet and exercise are more vulnerable to serious health conditions such as type 2 diabetes or high blood pressure, weight loss surgery is a major operation. And yet in 2018/2019, there were over 5,000 NHS weight-loss (bariatric) surgeries

There are several types of weight-loss surgery, the most common being:

• gastric band – a band is placed around the stomach, so patients do not need to eat as much to feel full
• gastric bypass – the top part of the stomach is joined to the small intestine, so patients feel fuller sooner and do not absorb as many calories from food
• sleeve gastrectomy – some of the stomach is removed, so patients cannot eat as much as they could before, and they will feel full sooner

But the irony is, although the surgery can achieve dramatic weight loss, even the NHS stresses that unless people make dramatic lifestyle changes such as healthy eating and exercise, they will quickly put the weight back on. And if weight-loss surgery aftercare is inadequate, one can imagine that this will happen in a high percentage of case.

So, apart from a very few extreme cases, shouldn’t there be more support and insistence of lifestyle changes being embraced before surgery would even be considered?

Additionally, as with most major operations, weight loss surgery carries the risk of complications, some of which can be serious.

Stomach pain after gastric surgery is also very common.

But back to the study results:

Lead researcher Dr Helen Parretti, from UEA’s Norwich Medical School, said:

“Obesity is a healthcare priority and weight loss surgery, also known as bariatric surgery, is an effective treatment.

It can lead to significant weight loss and improve many obesity-related conditions such as type 2 diabetes or high blood pressure. It is the most cost-effective treatment for severe obesity, and it can achieve dramatic weight loss. But it’s not a cure for obesity on its own.

Patients are supported to make changes to their eating before surgery and these changes need to continue after surgery to help avoid putting weight back on and to keep well. In addition, it is important that patients take lifelong nutritional supplements after their surgery.

But patients need support to achieve this after their operations and current guidance recommends this is offered by GPs. Without this, weight loss surgery has long-term risks such as nutritional deficiencies and weight regain can occur.

There is international clinical consensus that long-term follow-up care following bariatric surgery is important to optimise patient outcomes and reduce the risk of preventable harms.

We wanted to find out whether the nutritional care and weight monitoring delivered by GPs following bariatric surgery meets current clinical guidance.”

The team studied data from 3,137 patients in the UK who had received bariatric surgery between 2000 and 2015.

Dr Parretti said:

“We found that in most cases, patients were not receiving the recommended long-term monitoring after they are discharged from bariatric services.

We found that only around half of the participants were having their weight measured annually. In addition, only around half were having blood tests for nutritional deficiencies commonly seen in general practice, such as anaemia. The percentage of participants having blood tests more specific to bariatric surgery was very low – around five percent or less each year.

The most common deficiency we found was anaemia – around 40-50 per cent of those patients who had had a blood test.

We also found that the proportion of patients with prescriptions for recommended nutritional supplements was low.

This shows that there is an urgent need to support GPs and patients to engage with post-bariatric surgery nutritional reviews and monitoring, for example through education and commissioning of services to provide this long-term care.”

But perhaps the ultimate goal is more effective interventions before people get to the point where bariatric surgery is even considered?