Paper: Douglas IJ, Bhaskaran K, Batterham RL, Smeeth L. Bariatric Surgery in the United Kingdom: A Cohort Study of Weight Loss and Clinical Outcomes in Routine Clinical Care. PLoS Med. 2015 Dec 22;12(12):e1001925.

Link: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001925

F1.largeAhmed Rashid is an academic clinical fellow in general practice at the University of Cambridge. He writes the regular monthly column “Yonder” in the BJGP and is chairing the next #gpjc. @Dr_A_Rashid

Obesity is a public health issue and not a general practice one. Right?

I’ve recently had the good fortune to have talked about obesity with two wise and experienced GPs who held quite differing opinions on this. Although they were both in agreement that it is a serious and growing problem, one felt it was predominantly a social problem with solutions in policy and government whilst the other thought it a more clinical problem with solutions in the consultation room and NHS more broadly.

Although the social causes of obesity are unquestionable and the need for policy change is clear, the already alarming rates of obesity and related diseases mean that we probably need solutions across the spectrum. Weight loss surgery is a concept that often divides opinion amongst clinicians and patients alike. However, it has become an important aspect of obesity management in recent years and is now an established discipline across various specialist centres in the UK. Although the results of bariatric surgery RCTs have been promising, we know that trial findings are not always replicated in routine clinical practice. This month’s paper is a UK observational study that investigated whether there is an association between bariatric surgery and weight, BMI, and obesity-related co-morbidities.

As well as the focus on obesity and related diseases and the relevance to GPs involved in commissioning bariatric surgery services, the paper is also of interest because of the use of the Clinical Practice Research Datalink (CPRD) – an increasingly important research service in UK primary care.

I hope you can join us for the Twitter chat at 8pm on 28th February 2016. Please don’t forget to include the #gpjc hashtag in all tweets. Below are the 5 questions that we’ll be generally basing the chat around but please feel free to raise other points that come to mind when reading the paper.

  1. Was it appropriate to use the CPRD to answer this question? (Are there other data sources that could have been used?)
  2. Were all of the clinical outcomes relevant? (Which are the most important?)
  3. Are you surprised by the speed of weight reduction?
  4. Was it acceptable to use discontinuation of medication as a definition of T2DM and HTN resolution in the absence of HbA1c and BP measurements?
  5. Should NHS thresholds for bariatric surgery be changed?