THE NHS in Scotland should be placing more people on low-calorie diets to help them lose weight faster and potentially avoid surgery, a professor says.
Iain Broom, from Robert Gordon University in Aberdeen, said in many cases those put forward for weight-loss surgery were able to avoid this by losing weight on dieting regimes.
He is concerned that new guidance for the NHS in England recommending greater use of weight-loss surgery could influence future advice to the NHS in Scotland, leading to more operations which might not be necessary.
Prof Broom, a research professor in clinical biochemistry and metabolic medicine, said he started working in obesity in early 1980s when he was involved in assessing patients for weight-loss surgery.
He put patients on diets to reduce fat and carbohydrate in their liver, so it shrunk to allow access for surgery.
This involved using low carbohydrate diets, with many patients doing so well they ending up cancelling their surgery, Prof Broom said.
Low calorie diets
Before retiring from clinical work in 2009, he went on to run an obesity clinic, again using low-carb diets and very low calorie diets (VLCDs) - diets typically containing 800 calories a day or less.
But he said these were not used frequently by the NHS at the moment, despite evidence of their success, and their increased use could help people avoid surgery in many cases.
“We have published data showing that 50 per cent of individuals who stay with the programme maintain 20 per cent of the weight they lost initially in the first three to six months of treatment,” Prof Broom said.
“Providing you the pick the patient for the appropriate diet and management they will do better. One size fits all is not appropriate.”
Prof Broom denied that VLCDs were “yo-yo diets” where the weight was put back on just as quickly. He said other studies had shown that the faster weight was lost, the more likely people were to have weight loss in the longer term.
But he said those taking on such diets would need specialist support, such as vitamin supplementation.
Prof Broom has expressed concern about recent guidance produced by the National Institute for Health and Care Excellence (Nice) in England advocating an increase in patients having weight-loss surgery to tackle obesity problems.
Prof Broom said guidance in Scotland produced two to three years ago supported the use of weight loss surgery, but not to the same extent as had been proposed by Nice.
“Although Nice is not driving Scottish care, it does have an impact on what individuals will do,” he said.
“So while the guidelines do not impact on the Scottish NHS, they might in the future and cognisance might be taken of what Nice has done with any updates in the future.”