SCOTS: Patients have bariatric surgery too late
Patients from Scotland who are assessed for bariatric surgery are older and have a higher weight than the international average, according to the findings from the SurgiCal Obesity Treatment Study (SCOTS), funded by the National Institute for Health Research (NIHR). The study found that a higher body mass index (BMI), combined with older age, is associated with poor physical functioning and quality of life in people seeking bariatric surgery. Researchers, led by the Universities of Glasgow and Lancaster, also reported the quality of life scores for those living with severe obesity in Scotland are similar to those seen in the end stage of diseases such as cancer and heart failure.
"Our findings demonstrate that we need to act much earlier to ensure that people with severe obesity are not significantly disabled by the time they are receiving treatment,” explained Professor Jennifer Logue, professor of metabolic medicine at Lancaster University, formerly of the University of Glasgow. "We also need more research to understand the health effects, as well as the best treatment of very severe obesity. Most commonly, patients with a BMI of over 40 - or sometimes over 30 - are classed in a group together within research studies; but our study shows that health status is substantially lower as BMI increases, and as age increases. Policy makers must consider the health and care needs of these individuals and invest to provide increased access to effective weight management."
The SCOTS investigators believe that the study is the first national epidemiological study established to investigate long-term outcomes following bariatric surgery. The findings were featured in the paper, ‘Surgical Obesity Treatment Study (SCOTS): a prospective, observational cohort study on health and socio-economic burden in treatment-seeking individuals with severe obesity in Scotland, UK,’ was published in BMJ Open.
The paper sought to describe the health-related characteristics of 445 patients scheduled for bariatric surgery at an of the 14 centres in Scotland, recruited between 2013 and 2017, and examine relationships between age, preoperative BMI and other health-related factors. Participants completed questionnaires pre-operatively and at two years and three years, post-operatively. Baseline preoperative questionnaires collected health-related information and comorbidity was assessed by self-report using a questionnaire designed specifically for this study. In total, 249 patients provided data for analysis.
Self-reported medical comorbidities (physical, mental and functional measures) revealed that over 40% had at least one of hypertension, T2DM, back problems, anxiety/depression and gastro-oesophageal reflux. Over 60% reported more than three comorbidities. Mean depression scores reflected mild depression, although nearly half (44%) of participants had scores indicating moderate to severe depression. More than 80% of participants exercised for at least 10 minutes in the last week however, almost one-third (29%) used aids or specialist equipment to assist with their daily activities in the home.
Higher BMI values and higher ages were negatively associated with physical, but not mental, HRQoL scores. The authors reported that for each 10 kg/m2 higher BMI, there was a change of −5.2 (p<0.0001) in SF-12 PCS, −0.1 (p<0.0001) in EQ-5D-5L score and 14.2 (p<0.0001) in IWQOL-Lite Physical Function score (where an increase in score indicates a worsening). They also reported a 3.1 times higher use of specialist aids and equipment in the home (p<0.0001), adjusting for age, sex, smoking and socioeconomic deprivation.
For each 10-year higher age, there was a change of −2.1 (p<0.01) in SF-12 PCS score, −0.1 (p<0.01) in EQ-5D-5L score and 5.01 (p<0.01) in IWQOL-Lite Physical Function score, and a 3.1 (p<0.0001) times higher use of specialist aids or equipment in the home, adjusting for BMI, sex, smoking and socioeconomic status. Higher BMI had a significant association with higher prevalence of asthma in the SCOTS population, while older age was associated with higher prevalence of hypertension, arthritis and sleep apnoea.
“Policy-makers should consider the health and care needs of the growing numbers of individuals living with obesity. There will be a considerable future demand for healthcare and services must be designed to accommodate the physical needs of the individuals,” the authors concluded. “While primary prevention of obesity is clearly paramount to avoid more people developing such a debilitating, chronic condition, investment is urgently needed, both in the UK and globally, to provide increased access to bariatric surgery and other forms of effective weight management, directly targeting patient groups who will benefit from surgical intervention as early in the disease course as possible.”
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