Modelled Weight Loss in an English Population Eligible for Bariatric Surgery: A Retrospective Open Cohort Study

In this study, we aimed to quantify the economic consequences of limited access to obesity treatment and estimate the effect of modelled weight loss in a population who were eligible for bariatric surgery.

This was a retrospective open cohort study using data from the Discover database (1 January 2010-31 December 2019). Index was the first day that individuals were aged ≥ 18 years and eligible for bariatric surgery [body mass index (BMI) ≥ 40.0 kg/m² (obesity class III), or 35.0-39.9 kg/m² (obesity class II) and an obesity-related complication]. Time to surgery, healthcare costs and the impact of modelled weight loss over 2 years on estimated healthcare costs were assessed.

In total, 137,184 individuals were eligible for bariatric surgery, of whom 3241 (2.4%) ultimately received surgery during follow-up. Individuals who received surgery were slightly younger, and were more likely to be women and white, than the population eligible for surgery. Overall, 36.6% of individuals underwent surgery ≥ 4 years after they became eligible. Mean annual per-person healthcare costs increased 75% between year 1 and year 8 of the period before surgery in this group [from 1150 British pound sterling (GBP) to 2013 GBP]. Modelled weight loss of 10% would result in 58.3% of eligible individuals transitioning to obesity class I after 2 years, with only 12.2% remaining in obesity class III, resulting in a 14.3% reduction in healthcare costs. Greater degrees of weight loss were associated with greater estimated reductions in BMI and cost.

Delays to prompt weight management support appear to be associated with increasing healthcare costs, which could be mitigated by improving access to weight management.