Poster Presentation Australian & New Zealand Obesity Society 2014 Annual Scientific Meeting

Publicly funded bariatric surgery in Australia. What guidance is provided by the States and Territories? (#239)

Melanie J Sharman 1 , Martin Hensher 2 , Stephen Wilkinson 2 , Tim Greenaway 2 , Julie A Nermut 1 , Alison Venn 1
  1. Menzies Research Institute Tasmania, University of Tasmania, Hobart, TAS, Australia
  2. Department of Health and Human Services, Government of Tasmania, Hobart, TAS, Australia

Background: Bariatric surgery is considered the most effective treatment option for severe obesity and associated morbidity (eg type 2 diabetes). The public health system is pressured by rising demand for primary and reoperative bariatric surgery (revisions and reversals) and associated surgeries such as body contouring. We aimed to determine the level of guidance each Australian State and Territory provides on publicly funded bariatric surgery. Methods: Bariatric surgery policies and guidelines were sought from each State and Territory and reviewed to compare their origins and level of guidance on patient eligibility and priority, and their recommendations for patient care and follow-up. Reference to the 2013 NHMRC guidelines for the management of overweight and obesity was made where appropriate. Further, data was extracted from the Australian Health Survey (AHS) to determine prevalence of severe obesity by socioeconomic status and variance in private health insurance status by BMI. Results: All states (except Queensland) but no territories had policies or guidelines directing the practice of publicly funded bariatric surgery. The documents were not uniform and not all reflected current evidence or the NHMRC guidelines. Guidance on patient prioritisation and gastric banding adjustments was limited and absent for reoperative and body contouring surgeries across all jurisdictions, including by the NHMRC. All states (except SA) recommended pre and post-surgical multidisciplinary care. Severe obesity is more prevalent when socioeconomic disadvantage is experienced and rates of private health insurance coverage declines with increasing BMI. Conclusion: The disproportionately high prevalence of severe obesity among socioeconomically disadvantaged Australians and those without private health insurance suggests high potential demand for publicly funded bariatric surgery. State policies and guidelines should be updated to reflect current evidence and the NHMRC guidelines. Greater guidance is recommended for gastric banding adjustments and on the critical policy issues of patient prioritisation, reoperative procedures and body contouring.