A recent article in the Sheffield Star reported that despite 150 children requiring hospital treatment for obesity in Sheffield over the last three years, the number actually undergoing gastric surgery has plummeted (link).
The first thing to say on this story is how sad it is we’re even having discussions around bariatric surgery as a possible treatment pathway for children and young people. UK child obesity statistics support the view that UK child obesity is approaching epidemic levels. This year the National Child Measurement Programme (NCMP) measures have identified children with severe obesity or morbid obesity (>99.6 centile), where previously they only identified the differences between overweight and obese. That revision has revealed some shocking information for Sheffield –
21.2% of the city’s Reception year children are now obese. That’s an increase of 0.5% on last year’s figure and well above the national average of 20%.
35.6% of Year 6 pupils are either overweight or obese. Of those, 4.97% are severely obese – compared with a national average of 4.07 per cent.
Many of these young people with severe obesity would benefit from specialist Tier 3 services like ours but we can only see around 150-200 families with complex needs a year! That’s thanks to our Children in Need grant, of course. Providing services for these children via the NHS would be brilliant – but it would have a major impact on the health budget. Which is perhaps one of the reasons why these services are not currently funded by CCG’s.
So why are the figures for surgery dropping? The Clinical Commissioning Policy document ‘Obesity surgery for children with severe complex obesity’ (link here) identifies children eligible for bariatric surgery as those with BMI > 40 or BMI greater than 35 with a co-morbidity (ie type 2 diabetes, fatty liver, sleep apnoea). It advocates potential need for surgery and sets recommendations to be met before surgery is considered –
Children must have completed management treatment within Tier 3 services prior to assessment
Children must have undertaken assessments by a multi disciplinary team (including psychological assessments)
Surgery must not be offered until all non-surgical avenues have been explored and have been found to be unsuccessful
Patients must receive follow up care for five years
This feels like an impossible set of criteria to meet. How can this criteria be achieved when there is no national funding for Tier 3 services for children? And there’s no consistency for obesity treatment for children with severe obesity across the country – we desperately need the government to take this seriously and provide adequate guidelines and funding for children with severe obesity.
Is this lack of funding/services why the number of bariatric surgeries offered are reducing as number of children with severe obesity is increasing? If there were no bariatric surgery procedure undertaken for young people in the last two years is this because there is no statuary Tier 3 obesity service for children to access so the criteria for surgery cannot be met?
We’ve certainly noticed a change in the number and needs of children and young people we work with. When SHINE started in 2003 we saw 30 families a year with Body Mass Index (BMI) between 91st and 98th centile and managed to get most of the children into healthy weight ranges within 6 months – we now see around 200 families a year with complex needs requiring two or three years’ worth of support.
Our new term started January 2019 with 60 young people all with a BMI of higher than 99.6 centile, which means they were all severely obese when they came to us. Of these, more than half have a BMI of over 3.5 Standard Devisation Score (SDS) with co-morbidities or over 4 SDS who are working through our non invasive programmes. The latter fit the criteria for bariatric surgery according to the CCP’s report.
But the point here is that SHINE believe children shouldn’t be being offered surgery as a first line of treatment. SHINE provides demonstrably successful alternatives to the knife.