Date of Award

January 2012

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Howard Pearson

Second Advisor

Sonia Caprio

Subject Area(s)

Medical ethics, Surgery, Endocrinology

Abstract

Obesity is an epidemic of global proportions and contributes significantly to the burden of chronic disease and disability. Bariatric surgery is the only effective treatment for morbid obesity. Patients not only lose weight but see vast improvement in obesity related comorbidities. Childhood obesity is one of the most serious public health challenges of the 21st century. England, Scotland and the US have some of the highest rates of childhood obesity, with increasing rates of obesity related comborbidities seen in this population. In adolescents, bariatric surgery has been shown to be safe and effective. England and Scotland have significantly lower rates of surgery provision compared to the US. This is particularly true in adolescents. This appears due to barriers that effectively ration surgery amongst those who are eligible. This mismatch between eligibility and receipt of surgical care is related to multiple factors, including the ways in which the health care system considers patients for surgery and delivers surgical care. These barriers include inconsistent application of guidelines, lack of resources, and prejudice toward the obese for the "self inflicted" nature of their disease. As a result, access to surgery is highly variable. The concept of personal responsibility has been central to social, legal, and political approaches to obesity. Policy in the UK places heavy emphasis on obesity prevention and lifestyle choices but this neglects those who are currently in need of surgical treatment.

England and Scotland need to acknowledge the under-provision of bariatric surgery and its potential consequences. Increasing surgery for obese adolescents may prevent them from becoming obese adults and may also be cost effective for the NHS. Increasing physician training in this procedure, enforcing evidence-based guidelines, and initializing specialized bariatric surgery programs for adolescents would help to address the under provision of surgery. Also, discrimination toward the obese should be acknowledged and governments must ensure that policy reflects medical evidence, not attitudes.

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