Eligibility for bariatric surgery among adults in England: analysis of a national cross-sectional survey

Abstract

Objectives: This study aimed to determine the number eligible for bariatric surgery and their sociodemographic characteristics. Design: We used Health Survey for England 2006 data, representative of the non-institutionalized English population. Setting: The number of people eligible for bariatric surgery in England based on national guidance is unknown. The UK National Institute for Health and Clinical Excellence criteria for eligibility are those with body mass index (BMI) 35– 40 kg/m2 with at least one comorbidity potentially improved by losing weight or a BMI>40 kg/m2. Participants: Of 13,742 adult respondents (≥18 years), we excluded participants with invalid BMI (n=2103), comorbidities (n=2187) or sociodemographic variables (n=27) data, for a final study sample of 9425 participants. Main outcome measures: The comorbidities examined were hypertension, type 2 diabetes, stroke, coronary heart disease and osteoarthritis. Sociodemographic variables assessed included age, sex, employment status, highest educational qualification, social class and smoking status. Results: 5.4% (95% CI 5.0–5.9) of the non-institutionalized adult population in England could meet criteria for having bariatric surgery after accounting for survey weights. Those eligible were more likely than the general population to be women (60.1% vs. 39.9%, p<0.01), retired (22.4% vs. 12.8% p<0.01), and have no formal educational qualifications (35.7% vs. 21.3%, p<0.01). Conclusions: The number of adults potentially eligible for bariatric surgery in England (2,147,683 people based on these results and 2006 population estimates) far exceeds previous estimates of eligibility. In view of the sociodemographic characteristics of this group, careful resource allocation is required to ensure equitable access on the basis of need.