Doctors publish ‘triage plan’ for obesity and diabetes treatments post-COVID-19
Doctors have cautioned against patients with obesity being ‘stigmatised’, in the re-start of non-COVID health treatments.
The Irish Society for Clinical Nutrition and Metabolism (IrSPEN) said that patients with obesity are at higher risk of complications from COVID-19 – and need equal access to treatments as the health system begins to address backlogs and schedule new appointments.
To help manage this challenge obesity consultants from around the world have together published guidance on prioritising access to surgery and treatments for those with obesity and associated diabetes.
Tallaght University Hospital, Consultant Endocrinologist, Dr Conor Woods stated: “Similar to most elective surgery, metabolic procedures have been postponed during the pandemic. However, 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. For the period ahead, a new triaging approach for obesity and diabetes surgeries and treatments has been agreed internationally.
IrSPEN Spokesperson and Metabolic Physician (one of the authors of the new guidance that appeared this week in The Lancet Diabetes and Endocrinology) Professor Carel le Roux said overcoming ‘obesity stigma’ was an essential first step for effectively delivering the plan.
“Obesity is at epidemic scale in Ireland, as over a million people live with or are at risk of the complications of the disease. Ireland’s 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% of the overall healthcare budget”.
James Cushnan a patient from Letterkenny with diabetes who had his metabolic surgery postponed due to COVID-19 added: “Doctors, policy makers, and hospital managers must recognise the seriousness of diseases that require metabolic surgery and ensure these operations are not further delayed due to the widespread misconception that obesity and diabetes are lifestyle conditions of laziness, and that surgery is a ‘last resort’.
“It is not people’s fault, but it is our responsibility together with doctors and the healthcare system to treat it successfully – and doing so will improve my health and save healthcare resources.”
The guidelines recommend that patients 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
Standard access to surgery for patients who are unlikely to deteriorate within six months, but these patients need to be optimised using intensive medical treatment.
St. James’s Hospital, Consultant Hepatologist, Professor Suzanne Norris stated: “The concern during and post this COVID-19 pandemic is rationing medical care with backlogs in the system and limited resources. This framework maximises fairness of access for a vulnerable group in this pandemic.”
IrSPEN member and Metabolic Surgeon Professor Helen Heneghan added: “Although we will be particularly focussed 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”.
Research on attitudes carried out by IrSPEN in 2019, found that people with obesity are looked down on as lazy, over-indulgent, and deserving of what they get – and this prevents effective treatments from being publicly funded.
A recent concern is an increase in stigmatisation following speculation that people with obesity may be asymptomatic carriers and increase the spread of COVID-19.
Given the risks of severe complications from COVID-19 in patients with diabetes and obesity, the recommendations include that COVID-19 screening be mandatory prior to any obesity treatment, that Keyhole surgery remains the best approach and that personal protective equipment (PPE) should be used.