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It is now becoming accepted that the COVID-19 pandemic is not an intermezzo. Individuals and societies are learning to live with the SARS-CoV-2 virus. Indeed populations who are adjusting effectively to the constant change of circumstances and the emerging challenges achieve better outcomes.
At times of crisis, health inequalities become magnified. What has become clear at the most challenging time points in the pandemic, different in various parts of the world, is that the underlying health of the population influences the outcome of the individual. Perhaps nobody experienced this more acutely than the front-line clinicians facing the decisions for the allocation of intensive care unit beds when the discrepancy between need and demand was wide.
A group of individuals who have been disproportionally affected by COVID-19 is people living with obesity. Access to appropriate obesity care was challenging before the pandemic. Revisiting burning scientific questions in the context of the pandemic is imperative in evolving areas of research, particularly when there is an interaction between the pandemic and the condition studied, on this occasion obesity.
Using the model of bariatric surgery as the currently most effective treatment modality for control of obesity and sustained weight loss maintenance, the effect of effective obesity care during the pandemic was explored. It is now established that bariatric surgery is safe during the pandemic as demonstrated by the GENEVA study. Using a Markov model comparing outcomes of bariatric surgery and scenario analyses as part of which individuals experienced COVID-19 infection, the key finding was the bariatric surgery saved lives. Among 1,000 individuals with body mass index (BMI) ≥ 40 kg/m2 or BMI ≥ 35 kg/m2 with obesity-related co-morbidities bariatric surgery would prevent 117 deaths due to COVID-19 alone. The number needed to treat to prevent one death was nine.
Looking at the impact on hospital usage, in the same group and assuming that they would all get COVID-19, 124 people would not be admitted to the hospital and 161 would not be admitted to the intensive care unit.
“The number needed to treat to prevent one death was nine”
Therefore effective obesity care, currently mediated with gastrointestinal surgery, can save lives in a pandemic and can even support the health service. These striking figures are only focusing on outcomes associated with the pandemic. The benefits of bariatric surgery with sustained weight loss maintenance will have a persistent effect on improving survival, reducing the burden of obesity-associated disease and improving functional outcomes for the individuals who have received this type of treatment.
At times of challenging decisions in the context of prioritisation of care, healthcare policy, and even research, the cost of doing nothing should be accurately measured and considered. It may be unaffordable not to provide appropriate obesity care during the pandemic in terms of human, operational, and monetary cost. Now is the time to ensure care for people living with obesity is commissioned and delivered. The evidence is clear, the next step is to change the trajectory of people living with this disease.
‘The Cost of bariatric and metabolic surgery and implications of COVID-19 in the United Kingdom’ manuscript is available to read here.