New rules in Abu Dhabi to protect patients of weight loss surgeries

Abu Dhabi's Health Authority is planning to issue regulations to protect patients going for weight loss surgeries from falling into the hands of inexperienced surgeons.

Dr Faisal Badri, head of general surgery at Rashid Hospital, says all the general surgeons are doing bariatric surgery now. Pawan Singh / The National

ABU DHABI // The health authority is to introduce standards to protect people seeking surgery for weight-related problems.

The Health Authority Abu Dhabi (Haad) says rules will cover which patients are eligible for surgery, and qualifications of surgeons.

They will standardise diagnosis, treatment and ways of reporting data by the end of next month.

"We've had a few cases of serious complications [with weight-management procedures] and the standard will prevent this," said Dr Khaled Al Jaberi, department manager of non-communicable diseases at Haad.

World Health Organisation figures show 67 per cent of men and 72 per cent of women in the UAE are overweight or obese.

Authorities are also working with insurers to ensure those who need the surgery can receive it.

International criteria require a person's body-mass index (BMI) to be more than 40, or more than 35 if there is an associated illness such as diabetes. But many insurers refuse to cover costs of surgery for those with a BMI below 40.

"Someone with a BMI of 38 will be denied surgery and might try to put on four or more kilos so he is eligible," said Dr Al Jaberi.

"Which, with all due respect, is nonsense. The standard will require that both doctors and insurance companies consider the co-morbidities."

Hospitals now set their own standards and this made it difficult to hold doctors accountable.

"All the different age categories will be listed and all types of weight-management intervention will be considered, not just surgery," Dr Al Jaberi said.

Authorities are working with local and international experts, including the Emirates Obesity and Metabolic Surgery Interest Group, and the American Society of Metabolic and Bariatric Surgeons.

A number of studies have shown the benefits of bariatric surgery for chronic diseases.

Statistics from a 2004 study published in the Journal of the American Medical Association show remission rates for Type II diabetes patients were 77 per cent and hypertension was eliminated in 62 per cent of patients.

Dr Faruq Badiuddin, founder and secretary general of the Emirates expert group, said the term bariatric surgery must be reviewed.

"It promotes the concept that somebody is doing the surgery only to reduce their weight, which is not true," Dr Badiuddin said.

"Obesity is a metabolic disease. It includes complications such as diabetes and hypertension."

He said such complications were present in more than a third of cases he saw.

"We should speak of it as metabolic surgery, which is surgery designed to correct the metabolic defect in the body," Dr Badiuddin said.

The new standard will set minimum requirements for bariatric surgeons. As in most countries, bariatric surgeons are licensed as general surgeons, some with a specialist or consultant status.

Dr Fawaz Torab, president of the Emirates group of experts, said some of the new requirements could include that surgeons complete training and perform between 50 and 100 operations, depending on the type of procedure.

Dr Torab said a fellowship in bariatric surgery launched last year by Tawam Hospital and UAE University would help to address the resulting problem of high demand and few surgeons.

"People will be obliged to go for training to improve their situation to get accreditation," he said.

Experts in Dubai are also calling for regulations, saying many patients are being treated by inexperienced surgeons.

"Do we need to have a licence for bariatric surgery? The answer is yes," said Dr Faisal Badri, head of general surgery at Rashid Hospital. "Now the market is open. All the general surgeons are doing it. It's become more of a trend."

Rashid Hospital has one of the largest bariatric surgery units in the country, operating on about 80 patients a year. It is not unusual for doctors there to get patients who have had botched surgeries at other facilities, sometimes as many as 10 a year.

The hospital has a waiting list of about 300 for the surgery, which is why many go to private hospitals, Dr Badri said.

Rashid Hospital offers the procedure free to Emiratis and at lower rates for expatriates. A gastric bypass would cost about Dh30,000 compared with between Dh45,000 and Dh65,000 in private centres.

Hospitals belonging to the Dubai Health Authority work on a privilege basis, meaning doctors must complete a number of supervised operations before being approved to work within a specialised department. Private hospitals operate more freely.

Dr Badiuddin said his group was in talks with the health authorities to develop unified guidelines across the UAE.

"This is an immediate and urgent necessity, to have very clear guidelines which should be well promoted to the surgeons of the country," he said.

"The problems we face are when amateur surgeons who are not appropriately trained start to do bariatric surgery, and that is definitely well-documented as one of the biggest reasons why people have complications."