MORE THAN SKIN DEEP: POST-OBESITY PATIENTS LEFT IN LIMBO
Official Guidelines Ignored by 90% of Clinical Commissioning Groups – Surgeons Prove Cost-Effectiveness of Body Contouring Treatment
London–5 January 2016 –A huge proportion of Clinical Commissioning Groups (CCGs) are ignoring official guidance by not funding potentially life-saving surgery, a new study has revealed.
Following obesity treatment such as gastric bands, bypasses or sleeves, post-bariatric patients can be left with almost two people’s worth of skin (think of a deflated balloon) which result in functional problems – such as reduced mobility, hygiene issues and infections– a heavy impact on their psychological wellbeing as well as impede their ability to work. In some cases, being left in these ‘molten bodies’ has even lead to depression and suicide.
The British Association of Aesthetic Plastic Surgeons (www.baaps.org.uk); the only organisation based at the Royal College of Surgeons solely dedicated to the advancement of aesthetic (‘cosmetic’) surgery; says that removing the overhanging skin would help these patients to rejoin society and restore their lives to normality – and today proves that in fact this treatment is a cost-effective exercise for the economy as a whole.
A study by a leading plastic surgeon specialising in post-bariatric contouring and ‘body lifts’ has revealed that NICE-accredited national commissioning guidelines specific to the removal of overhanging, excess skin is being ignored by over 92% (100 out of 108) of CCGs across the country; and that 2/5 (42 out of 108) do not fund the surgery at all. One CCG admitted funding just 3 out of 66 cases referred, and two CCGs had only funded seven between them.
"We are only half-treating these patients, who have previously been severely obese,” says author of the study Mark Soldin, a consultant plastic surgeon at St George's Hospital and BAAPS member; "They have successfully shed, in many cases, half their body weight or more, and we know around 70% of them will require body contouring due to the excess skin folds. Yet under a short-sighted (and rather convenient) misunderstanding of the term ‘cosmetic’, they are left in a cruel limbo where they can’t yet quite feel whole. Many of the patients I see tell me that they feel 'disabled’ and incomplete. Almost like a mythical zombie: neither dead or alive, but stuck in a gruesome transitional state – slim now, yet dragging two people’s worth of skin which impede their movement or they’re forced to roll up and ‘tuck’ into their clothes. The removal of these folds cannot be classified as simply aesthetic – it is life changing and in some cases life saving.”
The overhanging, excess skin folds left after massive weight loss (MWL) are not just a burden on patient – their ‘transitional’ state is actively hurting the economy. In many cases patients’ self-consciousness and despair lead them to become isolated, unable to form romantic or sexual relationships and many sufferers end up so depressed they even put the weight back on, with its ensuing risks such as diabetes.
It is known that every unemployed person in the UK costs the taxpayer £10,000 per year, the cost of treating depression is over £9billion per year and the economic cost of stress and anxiety is over £10billion/year – moreover, it is known the unemployed become ill and have to visit the GP more often than those in employment. With obesity continuing to grow (twenty fold increase in case load from 2000 to 2010), this problem is set to become increasingly worse. The obesity crisis in fact is escalating so dramatically that Chief Medical Officer Prof Dame Sally Davies warns it should be included in national risk plans alongside threats such as terrorism and climate change.
According to consultant plastic surgeon and BAAPS President Michael Cadier;
“Not only can this type of procedure help these patients who feel ‘incomplete’ – but by eliminating their functional problems, increasing their self-esteem and removing the cost of treating co-morbidities (such as poor mobility, skin infections, anxiety and depression) it can in fact be an active contributor to the growth of the economy and the overall wellness – or ‘happiness’- indices of our country. According to the Office of National Statistics these metrics should be at the centre of many social and political measures, and we know Britain lags considerably behind other countries. This is not about making people ‘beautiful’ but restoring normality and function, so they can lead healthy and productive lives. Moreover, studies have shown that the higher your self-esteem, the higher your earnings – therefore, more tax injected straight back into the economy!”
“The term ‘contouring’ is probably misleading – this is not about liposuction for a ‘muffin-top’ or getting a bikini body. This is excision of aprons of skin which are impeding freedom of movement and resulting in painful and embarrassing conditions. Much is being done to stem the tide of obesity itself; but those who have been able to be pulled back from the abyss be it through exercise, diet or surgery should not be abandoned in what is effectively disfigurement.”
Using epidemiological, economic and outcomes data, the BAAPS has calculated that the economic burden of not treating these patients correctly (according to guidelines) is over £53 million per year (based on the costs of treating stress, depression and unemployment) HOWEVER, should these patients have access to this important surgical intervention, the potential net benefit (as in savings) to the economy could be as high as £73million EVERY YEAR; this benefit is a combination of removing the healthcare costs and increasing the tax paying ability and productivity of this 'lost' workforce. The payback is larger than the cost, because the intervention is a one-off, but the returns ongoing.
According to Michael Cadier;
“At it most simplistic, one must calculate the cost of illness plus the cost of treatment; which tends to be a one-off; minus the overall economic burden which remains year after year. Similar studies have undisputedly proven the need for obesity surgery in the first place (because of the reduction in having to treat costly problems such as Diabetes). They can also be used for other conditions often misperceived as purely ‘aesthetic’, such as breast reduction which also result in ongoing issues such as musculoskeletal conditions, persistent infections, back and neck pain, and stress. This is not just costly to the Health Service – through, for example, GP consultations and hospital treatment – but to the economy as a whole, such as days off work.”
The short-sighted refusal to fund proven, cost saving interventions is a perfect example of what the Institute of Economic Affairs describes as structural flaws in the NHS. According to their report (Diagnosis: Overrated)[i], the NHS is falling well below its potential and demonstrates the lack of patient choice and lack of transparency in spending. Additionally, the authors state that the NHS still lags behind the health systems of most comparable countries in terms of health outcomes and healthcare quality measures.
As well as Osborne's financial targets, Cameron has set national targets for Happiness and Wellbeing, a measure becoming increasingly important and at the centre of economic and social policies across Europe. According to the Office of National Statistics, less than 60% of Britons feel satisfied with their health and in terms of overall wellbeing, scores for the UK lag well behind countries such as New Zealand, the USA and Israel.
Proof in cost-effectiveness was cited by 3/5 CCGs as a need for justifying funding in Mark Soldin’s study; and a similar proportion cited the importance of Patient-Reported Outcome Measures (PROMS), which evaluate the results of procedures in satisfaction and quality of life.
According to consultant plastic surgeon and BAAPS President-Elect Simon Withey;
“With target reduction in health spending of £12 billion, the onus is rightly on the surgical profession to prove that funding in this area will produce savings. Can we now afford to ignore evidence-based guidelines, which demonstrate that these procedures do result in both long-term savings and a more productive and happier group of patients?”
Mark Soldin concludes;
“If a post-obese person is off work with mobility, skin infections and hygiene problems, suffering with stress and isolation, on their way to putting the weight back on again and risking Diabetes costing the taxpayers tens of thousands, suddenly that one-off intervention which will get them back on their feet doesn’t seem so expensive after all.”
The BAAPS (www.baaps.org.uk), based at the Royal College of Surgeons, is a not-for-profit organisation, established for the advancement of education and practice of Aesthetic Plastic Surgery for public benefit. Members undergo thorough background screening before they can join. Information about specific procedures and surgeons’ contact details can be found on the web site, or by contacting their advice line at 020 7405 2234. Further materials can be posted to members of the public seeking specialised information. BAAPS is also on Twitter: www.twitter.com/BAAPSMedia and Facebook: www.facebook.com/BritishAssociationofAestheticPlasticSurgeons
 http://www.dailymail.co.uk/health/article-2831731/NHS-refuses-remove-saggy-skin-man-lost-19st-gastric-bypass-claims-making-suicidal-unable-relationship-job.html, http://www.dailymail.co.uk/health/article-2061579/Distressing-skin-problems-The-downside-losing-weight-tells-about.html, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4372842/