Reshape guidelines on body contouring surgery to best treat obese patients

As a nation we are getting heavier. The number of people classified as obese has nearly doubled and continues to rise.

‘Bariatric surgery has been shown to be the best way to treat most patients with severe obesity’

It is therefore encouraging to hear that the National Institute for Health and Care Excellence has lowered the threshold at which patients should be considered for a weight loss operation so that all people classified as obese who have serious weight related illnesses can be considered for the surgery.

Bariatric surgery has been shown to be the best way to treat most patients with severe obesity. It decreases the cost of ongoing medicines to control diabetes and hypertension, and also the complications of these diseases: stroke and heart attacks.

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Skin surfeit

What is less positive, however – and rarely talked about – is the number of people who, after bariatric surgery or through natural weight loss, are left with unwanted folds of hanging tissue, and the physical and psychological problems that come with this change.

The reality is dramatic weight loss and excess skin can have deeply distressing side effects, ranging from infections, embarrassing body odour and back pain, to stress, depression and low self-esteem.

However, there is light at the end of the tunnel: research shows that those who undergo reconstructive body contouring plastic surgery following massive weight loss experience significant improvements in their physical function, emotional and physical wellbeing, body image satisfaction, and quality of life.

Indeed, as a plastic surgeon who specialises in this procedure, I see first hand the extraordinary physical and psychological benefits to patients as a result of body contouring after massive weight loss.

Patchy picture

Yet there are significant inconsistencies in the provision of body contouring surgery across the country. A study of 67 former primary care trusts in England showed that 23 excluded any reference to body contouring procedures.

Even where guidance is in place, recommendations can vary dramatically. It has been shown that 38 per cent of patients who were approved in Scotland for body contouring surgery would not have fulfilled the criteria used in Leeds.

To tackle these inconsistencies, earlier this year the British Association of Plastic, Reconstructive and Aesthetic Surgeons and the Royal College of Surgeons launched the first national guide around body contouring surgery, following a rigorous NICE accredited process.

The guide addresses variation in provision and quality of care while also helping to make the most appropriate use of resources by providing clear criteria for commissioning body contouring surgery and best practice information for healthcare professionals.

‘It’s about restoring a quality of life to patients where previously there was little or none’

This process not only shone a light on the struggles of patients up and down the country unfairly denied this life changing treatment, but also challenged misconceptions about the NHS providing “free cosmetic surgery” to people who are “too lazy to lose weight naturally”. 

In fact, to qualify for this reconstructive surgery procedure patients need to demonstrate incredible weight loss and show they have kept the weight off for a considerable period.

Up to 70 per cent of massive weight loss patients are desperate for body contouring surgery to restore them to normality, working hard to lose enough weight to meet the criteria for surgery.

This isn’t about getting a super-toned body – it’s about restoring a quality of life to patients where previously there was little or none.

Cosmetic misnomer

However, this surgery is unhelpfully termed “cosmetic”, which makes it difficult for society to get behind this need for provision and for patients to access care on the NHS.

Many are stuck in their “molten” body with depression, social isolation and poor life quality.

This needs to change. Not only will equality in body contouring surgery provision mean that more patients will be happier and healthier, research has shown that it makes financial sense too.

‘Body contouring surgery gives these people another chance at a fulfilled life, return to work and make a contribution to society’

Without this procedure, post-massive weight loss patients are likely to regain weight, which can lead to a range of health problems and a knock-on financial strain on the NHS.

Body contouring surgery also gives these people another chance at a fulfilled life, allowing them to return to work and make a contribution to society.

We are calling on commissioners and GPs to use this carefully researched, NICE accredited guidance to put an end to these “postcode lotteries” and to people living in limbo, enabling them to live healthy, happy lives.

Mark Soldin is a consultant plastic and reconstructive surgeon and member of the British Association of Plastic, Reconstructive and Aesthetic Surgeons