Guidelines issued to prevent stigmatisation of obesity patients awaiting surgery – Irish Medical Times


Posted: May 12, 2020 at 9:44 am

Along with elective surgeries, bariatric and metabolic procedures have been postponed during ongoing pandemic

New guidelines to prevent patients with obesity and diabetes being stigmatised when non-Covid treatments restart have been published.

Along with elective surgeries, bariatric and metabolic procedures have been postponed during the pandemic.

The Irish Society for Clinical Nutrition and Metabolism (IrSPEN), however, said patients with obesity were at higher risk of complications from the Covid-19 virus and required equal access to treatments when the health service begins to address backlogs and schedule new appointments.

New guidance published this week in The Lancet Diabetes and Endocrinology journal (Bariatric and metabolic surgery during and after the Covid-19 pandemic: DSS recommendations for management of surgical candidates and postoperative patients and prioritisation of access to surgery) stated patients awaiting such procedures should be prioritised into three categories: surgery within 30 days for those who have complications of previous metabolic surgery; surgery within 90 days for patients with substantial risk of complications of diabetes or who have poor control of their diabetes, despite complex medical regimens or using insulin; and standard access to surgery for patients who were unlikely to deteriorate within six months, but these patients need to be optimised using intensive medical treatment.

IrSPEN spokesperson Prof Carel le Roux, a co-author of the new guidelines, said overcoming the stigma associated with diabetes was an essential first step to implementing the new measures.

Obesity is at epidemic scale in Ireland, as over a million people live with or are at risk of the complications of the disease, added Prof Le Roux, who is also Head of Pathology at University College Dublin.

Irelands public health system has the lowest funding per capita for obesity treatment in Europe. Type 2 diabetes is a major complication of obesity and affects 200,000 people. This single obesity complication accounts for more than 10 per cent of the overall healthcare budget.

Prof Suzanne Norris, Consultant Hepatologist at St Jamess Hospital in Dublin, said the new framework maximised fairness of access for a vulnerable group in this pandemic.

The concern during and post this Covid-19 pandemic is rationing medical care with backlogs in the system and limited resources, she added.

Dr Conor Woods, Consultant Endocrinologist at Tallaght University Hospital in Dublin, also welcomed the new guidelines, saying that due to the progressive nature of diabetes, delaying surgery can increase future health complications and even earlier death.

The traditional weight-centric criteria for patient prioritisation needs to change, he said.

For the period ahead, a new triaging approach for obesity and diabetes surgeries and treatments has been agreed internationally.

IrSPEN member and metabolic surgeon Prof Helen Heneghan added: Although we will be particularly focused on how we should restart activity in the immediate post-Covid-19 period, the new guidelines also provide a framework for clinical prioritisation long into the future.

peter.doyle@imt.ie

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Guidelines issued to prevent stigmatisation of obesity patients awaiting surgery - Irish Medical Times

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