King's College London

The recommendations are published in the International Journal of Surgery by authors including Dr Laurence Dobbie, from the School of Life Course & Population Sciences at King’s.

The new guidance sets out requirements for patients seeking weight loss surgery who might be seeking procedures overseas due to long waiting lists in the UK. Obesity surgery, also known as bariatric and metabolic surgery, can sometimes be botched and lead to infections, temporary or permanent injuries and/or scarring, and in the worst cases, be fatal. In Europe, there is currently no published data evaluating how to improve the safety of obesity surgery medical tourism.

“Unfortunately, some of these providers fail to meet basic standards of care, resulting in serious injuries and, tragically, even death. These new guidelines—developed in collaboration with healthcare professionals and patients from across Europe—set out clear standards for obesity surgery in the medical tourism sector, with the aim of improving patient safety and preventing further harm.”

A collaboration between key organisations in the field - The European Association for the Study of Obesity (EASO), the International Federation for Surgery of Obesity and Metabolic Disorders European Chapter (IFSO-EC) and the European Collation for People Living with Obesity (ECPO) - has gathered opinions from members of all three organisations to agree a set of standards to apply to medical tourism in the context of obesity surgery.

The recommendations were divided into six areas, and included:

Regulation

• Bariatric and metabolic surgery in Europe should only be performed at centres of obesity management which are accredited by either EASO (The European Association for the Study of Obesity) or the country’s representative national Bariatric and Metabolic surgery (BMS) society or Surgical society.
• Only surgical procedures/methods which are accredited by either IFSO (International Federation for the Surgery of Obesity and Metabolic Disorders) or a National Bariatric and Metabolic Surgery society, which regularly evaluates surgical procedures, should be performed in the context of surgical tourism.
• Bariatric and metabolic surgical procedures in the stages of research development should not be performed in the context of medical tourism.

Provision of care

• In the context of surgical tourism, bariatric follow up should be provided for 2 years by the unit performing the surgery.
• Prior to bariatric surgery, patients should be provided with clear information about the risks and benefits of the surgery including the increased risk of having this surgery away from home, before travelling abroad.
• Patients should have written and verbal consent taken prior to bariatric and metabolic surgery

Eligibility

• In the context of medical tourism, patients with BMI <30 kg/m ² should not undergo bariatric and metabolic surgery.
• A copy of the patient’s medical records, from the patient’s home country, should be assessed for the medical history, prior to proceeding with bariatric surgery abroad.

Operative care questions

• In the context of medical tourism, patients should stay at least 5 days post-operatively in the geographical location of the bariatric and metabolic surgery before travelling home.
• In the context of medical tourism, the operating bariatric surgeon should liaise with the patient’s treating doctor/general practitioner in their home country to facilitate follow-up.
• Patients should be advised on the changes in the absorption of some medications (i.e., anti-epileptics, anticoagulants, psychotropic medications) following bariatric and metabolic surgery.
• In the context of medical tourism, when patients have significant complications following bariatric and metabolic surgery, they should only be cleared to travel home by their treating bariatric surgical team once these have been addressed.

Advertising and online information

• When discounted rates or special offers for bariatric and metabolic surgery are offered by bariatric centres, this raises concern about the quality of the care provided.
• Bariatric centres should provide publicly available information regarding the financial cost and required payment methods for bariatric surgery at their site.
• Bariatric centres should provide publicly available information regarding the type of accreditation their surgeons have (i.e., international or national accreditation and what institution has awarded it).

Patient representative panel results

• Patients must be informed whether the bariatric surgery being offered is internationally recognised.
• Patients must be provided with all relevant clinical documentation from their bariatric surgery to allow them to have safe follow up in their home country.
• Patients must be provided with a translator if they cannot speak the same language as their bariatric surgeon.

Among their conclusions, the authors said: “We recommend multiple aspects in providing bariatric surgical care abroad, aligning with international standards. Surgical units should provide at least 2 years of follow-up, in line with published literature^. The multi-disciplinary team (MDT) is central to bariatric care; we recommend MDT assessment for all patients undergoing obesity surgery abroad. We recommend an upper gastrointestinal endoscopic evaluation before obesity surgery, as a recent study shows patients undergoing obesity surgery have various endoscopic pathologies, potentially impacting procedure choice. For lifestyle, we recommend pre-operative alcohol screening and counselling on limiting alcohol intake pre- and post-operatively due to the increased risk of alcohol use problems following obesity surgery.”