Choosing a Surgeon for Weight Loss Surgery - Obesity Surgery Guide

If you decide to go ahead with surgery or would like to know more about it via a healthcare professional then the next step is to find a surgeon.  For weight loss surgery you will need to find a bariatric surgeon.  

He or she needs to be a highly skilled and experienced surgeon as many of these weight loss procedures are very technically demanding.  The question is: do you find a surgeon via the NHS or do you look for a surgeon in the private sector?

Either way, we recommend that you talk to your G.P first.  He/she will be able to discuss this with you and then refer you to a bariatric surgeon.  Your G.P can either refer you through the NHS or as a private patient.  Be aware that weight loss surgery is not as extensive in the UK as compared to other countries such as the US.  You G.P may not know a great deal about the various types of obesity surgery but he/she will do their best to advise you.

What some bariatric surgeons do in order to help matters is to provide GPs in their area with a referral questionnaire. This is designed to target those patients who would most benefit from this surgery. 

You can opt to contact a specialist obesity or cosmetic surgery clinic instead.  For example, Cosmetic Surgery Consultants (www.cosmeticsurgeryconsultants.co.uk) offer a wide range of cosmetic procedures (surgical and non-surgical) which includes obesity surgery.

We recommend that you choose a highly reputable surgeon who is also based within your local area.  You may decide to go abroad for this surgery as it appears to be cheaper and quicker; but you have to bear in mind that if you suffer any complications then it could end up being far more costly than if you had opted for the surgery in the UK.

And, you may have to find a surgeon in the UK to repair any ‘damage’ or complications caused by going abroad for surgery.

What is also useful is talking to other people who have had this type of surgery.  ‘Word of mouth’ recommendations are always useful and, talking to a patient support group or organisation such as BOSPA (British Obesity Surgery Patient Association) is equally useful.

Your bariatric surgeon needs to be highly skilled, competent and experienced in this type of surgery.  You need to like him/her – this may not seem that important but remember: you are placing your trust and literally, your life in this person’s hands so you need to be comfortable with him/her.

Another useful way of finding out more about a particular surgeon is to telephone the clinic or hospital where he/she works and speak with his/her secretary. 

In order to help with this decision, we have listed a few questions or ‘pointers’ for you to consider before making your decision:

• Is your surgeon an experienced bariatric surgeon?  Have they performed many of these operations and what number? Is he/she qualified to undertake this surgery? 
  
• Is your surgeon a member of the FRCS (Fellow of the Royal College of Surgeons)?  Is he/she a specialist/consultant in Gastro Intestinal surgery (GI surgery)?
• If you are looking for a cosmetic surgeon check that they are listed on the GMC’s (General Medical Council) specialist register of Plastic Surgery.  And, that they have held or are currently holding an NHS consultant post.  
  
• Are they close to hand?  In other words are they based within your area?  If something goes wrong then you need to be able to contact your surgeon instantly.  
  
• Check your surgeon’s results.  He/she should be able to refer a patient database which will contain weight loss results and information about any possible side effects.
  
• Does your surgeon have a multi-disciplinary team?  Surgery is just one part of the anti-obesity package and so he/she should have a support team which includes a dietician, psychologist etc.
  
• What type of technique does your surgeon use – ‘open’ or ‘keyhole’ surgery?
  
• Does he/she have details of any local support groups in your area?  A support group can make a big difference to your progress as they are very useful sources of advice and guidance.  They tend to be very friendly as well.
  
• What aftercare is there?  What type of support is available?
  
• What are the personal benefits and risks of this surgery?  This means what can I personally expect from this surgery and what could go wrong?
  

Choosing an NHS surgeon

If done privately this surgery can be very expensive.  If you cannot afford to ‘go private’ or would prefer to have this done on the NHS then you will need to check if there is funding available for you to do so.

Your PCT (Primary Care Trust) and local NHS trust will have a contractual agreement in regard to funding for surgical treatment.  Unfortunately, weight loss surgery is not usually covered by these standard contracts

NICE have a list of guidelines regarding the provision of obesity surgery for patients and it is worth visiting their site for further information.  And BOSPA has some very useful information regarding NHS (and private surgery).  They also contain information regarding NHS funding and obesity surgery. 

As far as we know the government has not allocated any funding for the NHS, specifically for obesity surgery or for establishing a national framework of multi-disciplinary obesity surgery teams.  This is starting to change but it will take some time even though obesity has been cited by the government as one of the biggest challenges faced by the UK.

One of the barriers to this is that there are still prejudices in society towards obesity.  There is a lack of education regarding this issue and many people still hold stereotypical attitudes.  Another factor and one that is very common to the NHS is lack of money: there are so many competing demands on the NHS and these new medical advances that we all want cost a great deal of money.  So, money is often allocated according to need and priority and due to a lack of awareness of the seriousness of obesity it will probably be lower down the list.

What we advise is that you check your local PCT’s criteria for funding for surgery (especially obesity surgery).  You may be lucky and find that your PCT does have funding.  If not, you may find that another PCT does have funding but you will have to check to see if you can be referred out of your area.  Your G.P would have to obtain permission to refer you to a hospital or bariatric surgeon outside of your PCT.  What you may find is that you are not able to choose a particular surgeon or hospital if you choose the NHS whereas this is an option if you opt for private treatment. 

If these fail then you could try contacting your MP or the local/national press but these do put a great deal of pressure on your PCT and are really a last resort.

Choosing a private surgeon

If you have sufficient finances then you can always arrange to have this surgery done privately.   This means no waiting lists and a private room in a modern hospital with all the niceties.  However, you need to bear in mind that the ‘easier’ procedures such as gastric banding and the gastric balloon can be performed in a private hospital or clinic: but, the more technically demanding ones such as a gastric bypass or biliopancreatic diversion (BPD/DS) are better undertaken in the NHS (you could still be treated as a private patient).  The reason for this is that a large NHS hospital will have the facilities and equipment to deal with this type of surgery and any potential complications.

Many private hospitals and clinics are not sufficiently geared up to deal with these types of procedures.

Obesity surgery is not cheap: gastric banding can cost around £4,000 to £8,000 and a gastric bypass can be as much as £15,000.  You also need to check to see what is included in this cost?  Does this figure include surgeon, anaesthetist and dietician fees?  Does it include pre-op tests such as blood and ECG?  Does it include all hospital costs?  Does it cover follow up treatment such as the aftercare/healthy lifestyle programme?  And, if something goes wrong are you covered for that or will it incur extra expense?

You may have private medical insurance and are thinking of using this to pay for obesity surgery.  However, be aware that many insurers view obesity as a chronic condition.  They do not provide cover for what they term ‘pre-existing and chronic conditions’ and so will reimburse you for the costs of obesity surgery.  They tend to have a less than enlightened view of obesity and until things change, are unlikely to pay out on any claim made. 

However, organisations such as BOSPA are campaigning to change this attitude amongst health insurers.  They argue that paying out for surgery now will reduce the need for repeated claims for obesity related illnesses.

Whether you have medical insurance or are looking to fund it yourself, going private is an option but research this option very carefully to ensure that you do get what you pay for.