28 May 2009
***EMBARGO: NOT FOR BROADCAST OR PUBLICATION BEFORE 00:01HRS 28 MAY 2009***
RCPE Press Release
EXPERTS’ CONCERN OVER OBESITY BIAS & LIMITED SCOTS’ ACCESS TO WEIGHT-LOSS SURGERY
A leading international medical expert will tell a conference today (28 May 2009) that obese patients in Scotland may avoid or delay seeking potentially life-saving medical treatment due to fears that they will be adversely judged and stigmatised by medical staff or other health professionals. Doctors will also be told that almost 24,000 severely obese Scots patients would benefit from surgery which could significantly improve their health and deliver major savings to the NHS in Scotland, but that such treatment can currently only be offered to 1% of suitable patients due to limited resources.
Obesity presents a significant health challenge in its own right, but is also associated with a higher risk of secondary and serious ill-health in a variety of disease areas including Type 2 diabetes, heart disease and cancer. Obesity levels in Scotland have now reached epidemic levels and are the second highest in the developed world, trailing only the US. Against this background, the Royal College of Physicians of Edinburgh, the Royal College of Surgeons of Edinburgh and the Royal College of Anaesthetists have organised a major conference on obesity which will be held in Edinburgh today [1]. During this conference speakers will present information on different aspects of obesity in Scotland, including the potential danger of obesity bias amongst health professionals and limited access to surgery for obesity.
‘OBESITY BIAS’
Research has shown that obese people can be highly stigmatised and may face multiple forms of prejudice in employment, educational and healthcare settings. While obesity bias can be distressing, it can have potentially life-threatening consequences in healthcare settings if obese patients avoid or delay accessing medical advice and treatment for fear of being judged by doctors, nurses and other health professionals. Perhaps surprisingly, research has shown that ‘obesity bias’ is common amongst health professionals including those who specialise in obesity. In studies, some doctors and health professionals have clearly associated the stereotypes of ‘lazy’, ‘stupid’ and ‘worthless’ with, and displayed an ‘anti-fat’ bias towards, obese people. Further studies have also shown that obese people avoid or delay accessing potentially life-threatening treatment, such as routine screening examinations for cervical cancer, for fear of being judged about their size by health professionals.
Dr Pat Croskerry, Professor of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada, said,
“Obesity bias is prevalent in society, including within medicine. While doctors and other health professionals are human and are subject to a range of emotions and prejudices, it is vital that such prejudices are not allowed to influence clinical decision-making, as obese patients can be placed in double jeopardy. Obesity itself carries the risk of serious ill-health in a variety of disease areas and obesity bias can further result in compromised care for patients. If we wish to ensure that obese patients receive the best quality of care, be it for a chronic obesity-related condition or in an emergency situation, and do not experience inequalities of treatment due to their size, medical staff need to avoid blaming or judging obese patients and concentrate on how to best treat them.”
LIMITED ACCESS TO OBESITY SURGERY IN SCOTLAND
While bariatric (or weight-loss) surgery for obesity, involving the fitting of a gastric band, is generally considered to be a last resort for severely obese patients, there is increasing evidence to demonstrate that this surgery can be both clinically and cost-effective. Most significantly, this form of surgery has been shown to cure and cause Type 2 diabetes to go into full remission in 90% of severely obese patients with Type 2 diabetes. Similarly, it has reduced obesity-related cases of hypertension (high blood pressure) by 68%, coronary artery disease by 57% and deaths from obesity-related cancer by 60%. Bariatric surgery has also been shown to be more cost-effective than treating the range of chronic diseases (such as Type 2 diabetes) associated with obesity.
In Scotland, around 24,000 severely obese patients are both eligible and willing to undergo this surgery, but only 300 procedures a year are available, with only half of those on the NHS. In addition, it has been estimated that almost 100,000 Scottish obese patients are currently being under-treated. Against this background, a multi-disciplinary group of surgical and medical experts from across Scotland has recently been established to seek to improve understanding about and the provision of weight-loss surgery in Scotland.
Mr Duff Bruce, a bariatric surgeon and Chair of the Severe and Complex Obesity Treatment Service (SCOTS), said,
“Bariatric surgery has largely been seen as an endpoint or last resort for severe obesity, without accompanying recognition that this form of surgery has been shown to be extremely clinically effective and that it can cure a number of obesity-related conditions including Type 2 diabetes. Bariatric surgery is very cost-effective and, if made more widely available, could significantly reduce the cost to NHS Scotland of treating a range of obesity-related chronic diseases. There are currently 24,000 severely obese patients in Scotland who are eligible and would be willing to undergo bariatric surgery, but capacity for performing only 300 such procedures a year. We believe it is now time to significantly expand the provision of bariatric surgery throughout Scotland and to ensure that severely obese patients throughout Scotland can obtain equitable access to this treatment regardless of where they live.”
Doctors attending the conference will also hear presentations on obesity in pregnancy and labour, and a presentation from Ms Shona Robison MSP, Minister for Public Health, Scottish Government.
Dr Graham Nimmo, Consultant in Intensive Care Medicine, and speaking for the Royal College of Physicians of Edinburgh, said,
“Obesity presents one of the greatest public health challenges of our time. Scotland has an unenviable level of obesity and it will require concerted and, indeed, radical action to improve the quality and range of treatments available. This will present challenges for policymakers when prioritising limited resources, for obese patients when managing their health and, as Dr Pat Croskerry has highlighted, for medical staff and other health professionals to ensure that any form of obesity bias does not creep in to clinical interactions with obese patients. By highlighting some of these challenges, the RCPE hopes to move discussion on and to, ultimately, ensure that the most effective care is provided for obese patients in Scotland”
ENDS
Contact: Graeme McAlister on 07808-939395 or 0131-247-3693
Notes to Editors
‘Obesity Now: what you need to know’ will be held at the Royal College of Physicians of Edinburgh, 9 Queen Street, Edinburgh on 28 May 2009, 9.00am – 5.00pm.
Journalists wishing to attend this event or to interview the speakers should contact Graeme McAlister on 07808-939395 or 0131-247-3693
Issued: 27 May 2009
