Experts highlight urgent need to regulate bariatric and metabolic surgery medical tourism

Medical tourism for bariatric and weight reduction surgery needs urgent regulation to protect recipients' health, especially as the data show that tourist numbers are increasing despite the advent of weight loss drugs, say experts in a commentary published online in BMJ Global Health.

The high prevalence of obesity coupled with healthcare resource constraints and increased globalisation have resulted in more people accessing obesity treatment abroad, amid the rapid growth of services to meet this demand, note Dr Jessica McGirr of the Obesity Research and Care Group RCSI University of Medicine and Health Sciences, Dublin, Ireland and Imperial College London, and colleagues.

Despite its size, this industry is largely unregulated, point out the authors. Although reliable data are in short supply, the wider medical tourism industry is worth more than U$400 billion annually, with anticipated year on year growth of 25%, they highlight. 

And while it's anticipated that access to weight loss drugs may curb some of the demand for weight reduction surgery, the numbers of medical tourists in search of bariatric surgery continues to rise, particularly as this is often cheaper overseas, they add.

The out-of-pocket cost for this type of surgery done privately in the UK is around £10, 000–£15,000, but £2500–£4500 in countries, such as Turkey, they say.

The largest global survey to date of providers of bariatric and weight reduction surgery shows that most patients (71%) self-refer. They may therefore not have appropriate medical indication to undergo major surgery: ineligibility for this type of surgery in their home country is often cited by patients as a reason for accessing it overseas, say the authors.

And there are other risks in opting for this type of surgery overseas, they suggest. Providers may not always be clear about the potential complication rates; there's no preoperative and long-term nutritional, psychological, or other medical follow-up; and there's often no multidisciplinary care, which is integral to appropriate case selection, they argue.

"When considering adverse outcomes, including anastomotic [surgical tissue join in the gut] leakage, sepsis, and even death, equally concerning is the absence of regulation to ensure that only accredited procedures are performed by appropriately qualified providers," they highlight. 

"Further concern arises in the context of medical tourism 'packages' in which patients are offered multiple procedures within the same trip," which are often accompanied by financial incentives, they add.

And there are also ethical issues to consider, they point out. They highlight the results of a provider survey, showing that nearly a third of respondents believed the consent process was "inappropriate" while 14% believed that patients were personally responsible for surgical complications.

"The need to regulate the [bariatric and metabolic tourism] industry to mitigate these safety, ethical, and legal risks for patients is essential," urge the authors.

The financial and resource impacts of dealing with postoperative complications in returning medical tourists–and in those countries offering this type of surgery-of disinvesting in public health services to boost private sector trade, raise ethical questions, they add.

The current situation "highlights the need for transnational collaboration among all sectors to implement regulation," explain the authors, suggesting that bodies, such as the World Trade Organisation, the World Health Organization, and the European Union, among others, should be involved in a global forum designated with this task.

They conclude: "This unregulated industry presents opportunity for quicker access to effective treatment for individuals with obesity but carries potential safety, ethical, and legal risks. 

"The economy and healthcare resources of both home and destination countries may benefit financially from [bariatric and metabolic tourism], but the potential for unintended negative consequences and widening health inequity are significant. 

"Establishing regulation through transnational collaboration is essential to protect health and health equity."