Impact of commissioning weight-loss surgery for bariatric patients.

Obesity is a major UK public health issue that is increasingly costly to an individual's personal health, the NHS and society. It requires an immediate intervention, as well as a long-term strategy to decrease the rising rates of obesity. NHS England (2013) has published a policy to commission bariatric surgery for carefully selected individuals according to National Institute for Health and Care Excellence (NICE) guidelines (NICE, 2006). This has been shown to be a clinically and cost effective weight-loss treatment option (Picot et al, 2009), but is invasive and expensive compared with non-surgical weight-loss programmes. In addition, there remains inequality in access to bariatric care services across England, thereby preventing potentially eligible patients from getting the treatment they need. Further clarity is required regarding the commissioning responsibilities across the four tiers of the obesity care services. This clarity would help to achieve a more 'joined-up' clinical pathway that is focused at a local level to improve access. However, there is criticism that too much funding is currently being invested in the provision of bariatric surgery when it could be better spent on national roll-out programmes for intensive lifestyle interventions that promote more sustainable weight loss across England.