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Researchers, who examined the health of nearly 9,500 people, acknowledged the huge financial implications for the NHS if treatments were carried out in such greater numbers.
According to NHS guidelines, weight loss surgery may be offered to those whose morbid obesity could kill them, or to people who are morbidly obese and who have a serious condition such as type 2 diabetes or high blood pressure that could be improved if they lost weight.
The study found that those meeting the criteria for bariatric surgery were more likely to be women, retired with lower educational qualifications and of lower socio-economic status.
Several factors contributed to surgery rates being so low, the study found:
- Those with greatest need for surgery were more often in the lowest socio-economic groups, who are least likely to use healthcare services.
- Patients' awareness of the possibility of surgery and their commitment to make the necessary lifestyle changes prior to the treatments may also be barriers, researchers said.
- Doctors might not be correctly identifying or referring those eligible, and service provision may also be insufficient.
More than two million adults in England could be eligible for weight loss surgery, according to research.
Some 8,000 people receive bariatric surgery each year, but researchers from Imperial College London say more than 5% of adults would qualify, more than 2.1 million people.
Operations for weight loss such as the fitting of a gastric band or gastric bypass surgery, is currently available on the NHS to treat those with potentially life-threatening obesity.
The study, published in the Journal of the Royal Society of Medicine, found that despite evidence of the cost-effectiveness of weight loss surgery, surgery rates were estimated to be a third of the NHS's benchmark rate.
The number of people eligible for surgery "far exceeds" the estimated number of people having procedures.