SCOTLAND ONLY CARRYING OUT FRACTION OF GASTRIC BAND OPS

Andrew Young

8 years ago

Pregnant women with whose blood pressure is even slightly raised can be dramatically more at risk of developing diabetes or heart disease, say scientists. In the first study of its kind a condition called pre-hypertension - where blood pressure is in the upper range of normal - has been shown to be potentially dangerous. Up to one-in-seven expectant mothers in the UK already suffer high blood pressure and the discovery could lead to many more requiring monitoring. Professor Jian-Min Niu, of Guangdong Women and Children Hospital in China, said: "Our findings underscore an important issue that has been long ignored in clinical practice - the fact criteria for hypertension in pregnancy are derived from the general population. "We anticipate if reaffirmed in further research, our study could spark a change in what we currently deem healthy blood pressure in pregnant women." The research found pregnant women whose blood pressure is in the upper ranges of normal could be at high risk of developing metabolic syndrome - a combination of diabetes, hypertension and obesity - and heart disease risk after giving birth. Current guidelines do not distinguish between pregnant women and the general population and define hypertension as persistently elevated blood pressure that is 140 millimeters of mercury (mm Hg) systolic or 90 mm Hg diastolic and above. Readings of 120-139 mm Hg systolic over 80-89 mm Hg diastolic is deemed 'pre-hypertension' - a warning sign of high blood pressure in the future. But the study published in Hypertension said pregnant women with blood pressure in this range had 6.5 times greater odds of developing metabolic syndrome compared to those in the lower normal range. It looked at 507 Chinese women with uncomplicated pregnancies, no history of hypertension and normal blood sugar and cholesterol who underwent seven or more blood pressure measurements along with other standard tests including weight measurements and foetal ultrasounds. Blood sugar and cholesterol levels were also tested at the start, shortly before and after giving birth and once every few months for up to 1.6 years after giving birth. The participants were grouped into three categories including those whose blood pressure remained on the lower end of normal (34%), around the mid-point (52%) or in the pre-hypertension range (13%). A series of snapshot measurements did not predict future risk but patterns of repeated elevations did - highlighting the dynamic nature of blood pressure during pregnancy. The results support the idea of pregnancy as a cardiovascular stress test for women that can reveal underlying disturbances in blood pressure regulation, glucose and cholesterol metabolism. Abnormalities in all three areas can disrupt functions and lead to full-blown cardiovascular disease years down the road. Prof Niu said globally the burden of cardio-metabolic diseases in women has been rising steadily over the last decades. He said: "Blood pressure measurements are already done as matter of routine and cost-effective checkups during pregnancy so our findings underscore this tool's potential to gauge a woman's post-partum cardiovascular risk. "Early identification of metabolic risk factors and implementation of lifestyle modifications may help delay the onset of cardiovascular disease that would present itself 20 to 30 years after delivery."

Scotland is only carrying out a fraction of the gastric band operations it should be for the scale of its obesity problems, experts have revealed.

The consultant who is responsible for every referral for weight-loss surgery in Scotland called for funding for ops to be ring-fenced, like other countries including England, which does five times as many operations.

Dr Jennifer Logue, Honorary Consultant in Metabolic Medicine for NHS Greater Glasgow and Clyde, said it “made sense” to offer patients a treatment that would incur a fraction of the longer-term costs of treating the life-threatening health problems associated with obesity such as Type 2 diabetes.

Scotland currently carries out around 200 operations a year, generally on patients with a BMI of more than 35, which she said was a “tiny amount” for a country rated among the top five for obesity.

It comes after TV presenter Lorraine Kelly provoked an angry backlash after suggesting gastric band surgery allowed patients to “guzzle deep-fried lard.”

Broadcasting watchdog Ofcom received 20 objections following the Lorraine programme on ITV, during which the presenter also said the procedure was an “easy option” for people losing weight.

Dr Logue said: “I’ve got a colleague from Australia who says, you don’t treat melanoma with suncream. You don’t treat obesity with a leaflet or a diet sheet.

“You need something different. It’s not that these people have decided they want to be this size.

“Some people within the population become obese, but not everyone, and that is not just down to choice and restraint.

“Diets don’t work if are you really big.

“The ‘eat less, do more’ diets do work but generally people can only lose around 5kg (just under 1 stone) that way, which for someone who is very obese is not as much as they would want or need to lose for health benefits.

“There are huge associated health costs to the NHS.

“It seems sensible to give them a treatment that will cost a fraction of the costs would be if they continued on their current path. Otherwise you are just paliating them.

“It doesn’t just stop when you have had the operation. You have a severely restricted diet but it also works by suppressing your appetite so you don’t want to eat as much.

“We have a huge problem with obesity in Scotland. It is basically the US, Mexico and then us.

“In England the funding is ringfenced. They have a central pot and dedicated centres. In Scotland funding is generally from the surgery budget so it comes from the same budget as gastric surgery, when it should probably come from the budget for diabetes.

“We carry out around 200 operations a year. A tiny amount compared to countries like Sweden and France.

“In France they do a huge amount and they have a 16 per cent rate of obesity while we have a 30 per cent rate.

However, she said gastric band surgery was part of a “layer of prescribed treatments” which include weight loss groups, medication, liquid diet and injectable treatments.

A spokeswoman for the Scottish Government said: “Health boards have delegated responsibility to decide how they spend their budgets on local services, including bariatric surgery.”