Operation weight loss – the increase in bariatric surgery in one Welsh health board
Almost two people a week went under the knife in Swansea last year to treat what one of the surgeons described as a 21st Century disease – obesity.
Bariatric surgeons like Jonathan Barry operated on 103 patients in 2022-23 – removing part of their stomach so they could not eat as much as before, placing a band round it so they didn’t need to eat as much to feel full, or joining the top part of the stomach to the small intestine so they felt fuller sooner and didn’t absorb as many calories from food.
A very small proportion of the 103 procedures, which took place at Singleton and Morriston hospitals, were to deal with a post-surgical leak or inspect the work that had been carried out.
The cost of the treatments, including in-patient care, was just over £867,000.
In comparison 25 obese patients were operated on by Swansea Bay University Health Board the previous year, although Covid was causing significant disruption. In 2019-20, the year before the coronavirus struck, 59 obese patients underwent operations. The figures were in response to a Freedom of Information request by the Local Democracy Reporting Service.
Professor Barry said the operations worked and that the outcomes were generally very good, although he said he didn’t carry out gastric banding any more.
“The following morning patients feel fine, they’re up and around and blood sugar levels are normal,” he said.
After six weeks, he said, many were no longer on medication. “But these are not reversible operations – they’re not just done on a whim,” he said.
The NHS website lists a number of small risks associated with weight loss surgery, from needing vitamin and mineral supplements, being left with excess folds of skin, and developing a blood clot in the leg or lung.
Prof Barry said bariatric surgery was in his view safer than gallbladder surgery and that the main risk was an internal leak.
He said patients who underwent surgery had to commit to lifestyle changes. After a while many were referred back down a level to specialist weight management clinics. “My role as a surgeon is a very small part of the process,” he said.
Prof Barry conceded that around 10% of patients would put on weight again but said that in the main the results were good.
While the outward signs of being extremely overweight might be obvious, what’s goes on inside the body isn’t. Prof Barry said there were 240 conditions linked to morbid obesity, including cardiovascular disease, depression, Type 2 diabetes, hypertension, arthritis, obstructive sleep apnoea and high blood pressure.
“Type 2 diabetes is a cruel disease,” he said. “It restricts your small blood vessels and you can go blind, lose legs and develop renal disease.”
He added: “Some cancers are weaponised by being obese.”
Prof Barry qualified as a surgeon in 1996 and operated on cancer patients before switching to bariatric surgery. The 52-year-old’s career has dovetailed with a rise in the proportion of overweight and obese people in Wales and elsewhere. A Welsh Government survey last year found that 62% of the population in Wales was overweight, including a 25% obese cohort.
“The figures are quite staggering,” said Prof Barry, referring to obesity and Type 2 diabetes levels.
“I call it (obesity) a disease of the 21st Century,” he said. “Our genetic make-up has not changed for thousands of years, but we live in a society that lends itself to people becoming obese.”
He attributed this to convenience food which was “laced with things you want to eat” but was nutritionally poor – simply “empty calories”. He said there were then the larger portion sizes, the sedentary lifestyles, the reduction in sport played at school, and the fact that both parents in the average family tended to work nowadays, restricting the time available to shop for and cook a healthy meal.
Prof Barry said: “Your genetic make-up loads the gun but society pulls the trigger.”
He explained that some people’s genes impaired their sense of feeling full, and that it was extraordinary how much some obese patients ate. “They don’t have an ‘off button’, but nobody would want a BMI (body mass index) of 50,” he said. “That’s not a lifestyle choice.”
Prof Barry, who lives in Cardiff, said he was worried about high levels of adolescent obesity in Wales. “Bad eating habits don’t go away of their own volition once they’re established in childhood,” he said.
Now available on the NHS is a weight loss jab called Wegovy, which is based on a drug to treat Type 2 diabetes. It mimics the action of a gut hormone to help regulate food intake and appetite. Prof Barry said stomach ache and diarrhoea were side effects for some people who received it.
While the drug appears to be a useful tool to treat obesity, it doesn’t address the root causes. Prof Barry said this goes back to the “societal problem” – the prevalence of certain food types, the market share dominance of a small number of food companies, and so on.
Talk of taxes and regulation makes some people edgy, and Prof Barry’s view was that any regulation to disincentivise unhealthy food would need to be done robustly.
Healthy eating information is, though, available from multiple sources and Prof Barry’s experience of schools was that they were doing a good job in this regard.
The Welsh Government is introducing a new law next year which will restrict the promotion of foods high in fat, sugar or salt. It won’t ban any product and won’t apply to all high fat, sugar and salt products, but it will target food and drinks that contribute most to obesity.
Ministers said a survey by Public Health Wales showed strong public support for government action to make our food healthier.
Scan ahead and the implications of diseases like obesity and Type 2 diabetes for the NHS and wider society look stark.
In October this year Dr Rob Orford, Wales’s chief scientific adviser for health, published a 140-page report about the likely impact of long-term conditions and risk factors in the coming years. He said prevention, supporting people to change their lifestyle, and early diagnosis were all important.
Modelling cited by the report suggested that the number of people with diabetes in Wales would rise by 260,000 by 2035-36 – a 22% increase from today, based on current levels. Around 90% of cases diagnosed today are Type 2. Levels of obesity are also expected to increase but estimates vary depending on the study.
Prof Barry said: “A hundred years ago we didn’t have fast food. Basically we’re eating a load of rubbish.”
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