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Shocking Bariatric Surgery Figures For Sheffield: What’s Going On?

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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.

 

What the National Child Measurement Programme Missed

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The National Child Measurement Programme (NCMP) is a boring name for what is actually a huge and extremely useful annual survey. It contains measurements taken in schools for Reception and Year 6 children and is published by NHS Digital annually. This year is the first time they’ve identified children with severe obesity (>99.6 centile) and there are some shocking figures for Sheffield.

  • 21.2% of Reception year schoolchildren are now obese. That’s 0.5% higher than the previous year, and above the national average of 20%.
  • 35.6% of Year 6 pupils in the city are either overweight or obese and 4.97% of these children are severely obese – compared with a national average of 4.07 per cent.
  • At the time of the survey there were 40,724 children in Sheffield aged 6-11, which means that 2,023 children on this ratio are severely obese.
  • And there were 36,472 children in Sheffield aged 12-17 so 1,812 of children in this age bracket could be severely obese. What’s even more worrying is that these children are not included in NCMP measures.

Many of these young people would benefit from specialist Tier 3 services like ours but we can only see 200 families a year! Providing services for these children would have a major impact on the health budget, which is perhaps one of the reasons why these services are not currently funded. But that’s a lot of children and young people who are being left behind.

This survey proves there’s a substantial proportion of children who fit the criteria for interventions for ‘severe’ level of obesity. In fact the children we’re seeing at SHINE are above +3 and +4, which is even higher.

But what services will be available for children like those in this report whose weight poses significant health risks?

Alongside services provision, the main thing we’d like to see here is more information. There are no measures as yet for young people once they enter secondary school. NCMP measures stop at Year 6 so after that children are not measured at any other stage of their childhood life. We know obesity increases with age so measuring children again after this age is crucial. We agree with Tam Fry at the National Obesity Forum who is pushing for children to be measured every school year as they used to be in the past – early intervention is paramount to prevent children needing Tier 3 services.

Sign SHINE’s petition to fund obesity services for UK children and young people

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A third of children in the UK are overweight or obese; for those with severe weight problems this can greatly impact on their life.  Children with weight issues have high risk of type 2 diabetes, fatty liver and high blood pressure and are more likely to have low self esteem, depression and be vulnerable to bullying.

SHINE has been providing services for children and young people with severe levels of obesity for the past 14 years and have been dependant on Grant funding to enable us to provide a range of interventions including psychosocial intervention courses (PSIs) and a much needed counselling service, for children with emotional issues that leads to further weight gain. As funding becomes more difficult SHINE have been working closely with local MP Paul Blomfield to get Tier 3 services recognised at government level in order for them to provide clearer guidance on commissioning and appropriate funding to provide much needed services for these vulnerable young people not just locally but on a national basis.

At present specialist services for severely overweight children is only provided in 7% of Local Authorities throughout the UK.  We are urging the Government to provide adequate funding so that more specialist services can be offered for obese children with complex needs. We need them to invest in the treatment services that are urgently needed to improve quality of life.

Please support our e-petition:

We need 100,000 support signatures to get this issue debated in parliament – please give us your support.

Sign the petition here (link)!