While it's going to make government accountants cringe, 2,000,000 people in England could be eligible for weight loss surgery, according to a paper in JRSM Open.

That figure far exceeds previous estimates of eligibility in England for bariatric surgery. People fulfilling the national criteria were more likely to be women, retired, have lower educational qualifications and have lower socioeconomic status. But in fuzzy estimates, proponents say spending the money on bariatric surgery – a set of surgical procedures performed on obese people to decrease their stomach size – now can greatly reduce the likelihood of obesity-related diseases including type 2 diabetes, stroke and coronary heart disease and eventual death due to those.

Recent data show surgery rates have risen year-on-year in England, yet service delivery rates still fall significantly below the level needed to support everyone who needs it, especially when new estimates say even more people need it.

Prevalence of obesity-related comorbidities in people aged greater than 18 years according to body mass index (BMI) in England. Credit and link: 
doi: 10.1177/2042533313512479

Dr. Sonia Saxena of Imperial College London said, "Despite clear guidelines outlining who can undergo such surgery with the NHS, and evidence that these procedures are cost-effective in the long run, less than one per cent of those eligible have weight loss surgery each year. This raises questions about why more procedures are not currently being carried out."

The researchers point to several factors that could contribute to low surgery rates. "At the patient level, this study could be consistent with an inverse care law whereby those most in need of bariatric surgery are in socioeconomic groups who tend to make less use of healthcare services" said Saxena.  

Except health care is free, so there is no economic obstacle.

"Another barrier might be patient awareness of bariatric surgery and commitment to complete lifestyle intervention programmes prior to surgery." It has been reported recently that in some areas weight loss programmes that are a prerequisite to surgery have been decommissioned due to funding cuts.

Greater investment in service provision may be required as obesity rates continue to rise. Dr Saxena concludes: "Since those eligible are more likely to be of a lower social class and have lower qualifications, resources would need careful allocation to ensure equitable access on the basis of need."