Wales has a disproportionate number of young people with severe morbid obesity who are beyond the point of surgical help, one of Wales' leading doctors has warned. Professor Jon Barry, a consultant laparoscopic bariatric surgeon at Morriston Hospital in Swansea, described these adolescents as a "ticking time bomb" who are at high risk of 240 different obesity-related conditions.
Prof Barry said some of the young people he sees have a body mass index of 75 – three times what their weight should be. He added that areas of social deprivation are "carrying the burden" of ill-health in Wales due to the lack of access to green space, poor education, and the availability of high-calorie fast food.
However he warned that Wales is "far behind the curve" in terms of delivering on the obesity issue including the fact the country has no adolescent bariatric unit in Wales which results in young people being sent to London for treatment. He said the Welsh Institute of Metabolic and Obesity Surgery based in Morriston Hospital is the only unit of its kind offering bariatric surgery to adults in Wales.
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"We have got a huge problem with morbid obesity and it's all linked with social deprivation – and that's not going away," said Prof Barry, the new director in Wales for the Royal College of Surgeons of England. "There are vast areas in Wales where we have people – particularly children and adolescents – where we have nothing on the table to help them.
"We are far behind the curve in terms of delivering on the obesity issue full stop. It's not just the operations. The Senedd has set up an obesity pathway made up of four levels, the first two being primary care, the third being specialist weight management clinics based in secondary care, and then we only have the one level four and that's us in Swansea.
"The main block to delivering this care is the [lack of] level three units. We have a very good one in University Hospital Llandough and one in Aneurin Bevan University Health Board but the rest of it is just all over the shop."
Prof Barry said among the 240 conditions he has seen in young morbidly obese people include cardiovascular disease, hypertension, diabetes, osteoarthritis, depression, sleep apnoea, and obesity-related cancers. "We have seen a quadrupling of morbid obesity in the last 30 years. When I was a medical student there were one million diabetes patients in the UK and now there are four-and-a-half million," he added.
"Our gene pool is exactly the same. Your genetic footprint is the same as your great-grandparents but if you look back to photographs from, say, the early 20th century – for instance, there's one of my grandfather standing on a boat he was a seaman on with all his mates smoking – none of them were overweight. These days if you took a photograph of 30 men aged 30 two-thirds of them would be overweight or obese."
Prof Barry said the obesity epidemic in Wales and the rest of the UK is multi-factorial. "Your grandparents would have expended more calories years ago – of course everyone has cars these days. Nowadays if you were travelling home you can nip into McDonald's or have a pizza.
"The food industry is an extremely powerful body. These foods are programmed to make you want more and more and more. We have far more accessible, high-calorific nutritionally poor food types around these days."
His comments come just days after Dr Rowena Christmas, Wales chair of the Royal College of GPs, said some people in Wales are lacking in vital vitamins because they cannot afford to eat properly. She added that an increasing number of her consultations are centred around the cost of living crisis and the physical and mental problems that come with it. You can read that story in full here.
In a bid to address the growing backlog of planned surgery in the Welsh NHS generally, Prof Barry and the Royal College of Surgeons of England are calling on the Welsh Government to create "scheduled surgical hubs" remote and separate from those needing emergency or unscheduled care. The Welsh Orthopaedic Board National Clinical Strategy for Orthopaedics, in its blueprint for surgical delivery in Wales, believes three orthopaedic hubs must be developed "at pace" in north Wales, southwest Wales, and southeast Wales. This, in reality, would likely be the repurposing of existing facilities rather than creating three new hospitals.
"Orthopaedic surgeons are quite clear that they want to focus first on major arthroplasty – so people needing new hips and knees. These patients are in excruciating pain, they can't exercise, and it affects their mental health and employment," Prof Barry said.
But he admitted one of the biggest issues facing the health and social care system at the moment was getting patients out of acute wards following surgery when they're fit and ready to do so. The pejorative term coined for this issue is "bed blockers".
"I am completely opposed to the phrase 'bed blockers' because these patients need some form of care," Prof Barry added. "If somebody, for example, is recovering from their colon being taken out due to cancer you don't want these patients remaining on an acute surgical ward where they could develop a chest infection or gastroenteritis. These patients need to go somewhere.
"Historically when I was training we had step-down facilities but as we don't have them anymore the patient flow is completely disrupted. The knock-on effect is that we have a finite number of beds in our hospitals. So where we can uncouple the elective and emergency care we can keep on top of our backlog and continue to do elective procedures."
However Prof Barry admitted that a barrier to setting up these scheduled surgical hubs was staffing. According to the Royal College of Nursing there are 2,900.41 registered nurse vacancies in the Welsh NHS – an increase from 1,719 in 2021. There are also around 12,000-13,000 doctors too few UK-wide. He added: "We've seen a 20% reduction in real terms of nursing wages, a 20% reduction in junior doctors, and a 35% reduction of consultants.
"Junior colleagues who have been to work in places like Australia tell me that while they will certainly work a little bit harder abroad they will take home twice as much as we do the United Kingdom. So there are lots of issues here.
"We're in an ageing population so it stands to reason that we're going to need far more doctors, nurses, physios, OTs, porters, and whatnot. So it's a difficult time ahead."
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