National Assembly for Wales

Health and Social Care Committee

Inquiry into the availability of bariatric service

Evidence from the Royal College of General Practitioners – ABS 01






ATTN:   Committee Clerk

            Health and Social Care Committee

            National Assembly for Wales


23rd December 2013



RE: Inquiry into the Availability of Bariatric Services


Please find attached comments from RCGP Wales on the National Assembly for Wales’s inquiry into the availability of bariatric services


Yours Sincerely




Dr Paul Myres


RCGP Wales

The Royal College of General Practitioners is the largest membership organisation in the United Kingdom solely for GPs. It aims to encourage and maintain the highest standards of general medical practice and to act as the ‘voice’ of GPs on issues concerned with education, training, research, and clinical standards. Founded in 1952, the RCGP has over 49,000 members, 1,931 in Wales, who are committed to improving patient care, developing their own skills and promoting general practice as a discipline.


RCGP Wales recognises the important role bariatric surgery can play in the management of obesity. The college would advocate a systematic approach to the prevention and management of obesity starting with advice on activity and nutrition plus eating and exercise habits in children and guidance to young parents. UK guidelines for physical activity in 5-18 year olds state that children should engage in at least 60 minutes of vigorous physical activity each day. We believe educational institutes at all levels should support and provide opportunities for young people to participate in sports but also encourage alternative methods of taking physical activity for those who are less competitive. We are concerned that some schools often sacrifice sports activities in order to meet other areas of the curriculum. The College would also emphasise the value of teaching children to cook healthy and nutritious meals in school, to reduce their reliance on ready-cooked processed foods later in life. The College is pleased to see that public awareness campaigns highlighting the value of healthy eating and diet in school, such as that of Honorary RCGP Fellow Jamie Oliver, have had an impact, with a fall in the UK numbers of schoolchildren deemed obese or overweight.


Thus we support the concept of prevention is better than cure. We recognise that losing weight in overweight or obese individuals is not easy. We do not endorse any particular dietary plan but note that the only way to lose weight is to reduce the number of calories consumed in relation to calories used. We also note that an active overweight individual is likely to be healthier than a thin inactive individual. We encourage GPs to identify obesity and promote activity as a means of keeping weight under control and reducing the morbidity associated with being overweight. However there are people who are morbidly overweight and are not able to lose weight for a variety of reasons. The psychological impact of obesity, and the failure to lose weight can be substantial, both for the individual and their family members, who often acquire ‘learnt behaviour’.


NICE guidance identifies the value of bariatric surgery in reducing morbidity and the risks of diabetes. RCGP Wales is not confident that the criteria currently used for the recommendation of Bariatric surgery in Wales fit that guidance and would hope that the committee would clarify this and understand the reasons for deviation (if there is such) from the NICE guidance. Anecdotally we have heard from colleagues that the rules for getting permission to refer an individual for bariatric surgery are too stringent and some individuals who would benefit from such surgery are being denied that opportunity. We are not able to provide figures on this but suspect this is sometimes a false economy as such individuals need subsequent long term therapy (and use of NHS resources) to manage the consequences of their obesity. We hope that the H&SC committee will seek further data in this regard.


The Royal College of General Practitioners is happy for this response to be made public.


RCGP Wales, Regus House, Falcon Drive, Cardiff Bay, Cardiff CF10 4RU. Email: