TW: discussion of weight, weight loss and obesity.
Women are disproportionately being referred for weight loss surgeries by the NHS, Mancunian Matters can reveal.
Of patients referred for the procedure in 2021 and 2022, 75% were female, despite the gender ratio of patients eligible for surgery being more evenly split.
These new figures come from Freedom of Information requests sent to all 154 NHS Hospital Trusts in England, of which 27 performed weight loss surgery and were able to provide figures in full.
The years 2021 and 2022 were chosen as they were the most recent complete years which were mostly unaffected by coronavirus.
With one in four UK adults now classified as obese according to NHS figures, weight loss surgery in its various forms including gastric bands and gastric bypasses is being used to treat obesity.
While NHS figures show the percentage of females and males in England who fall within the obesity range based on Body Mass Index (BMI) is relatively similar (52:48), bariatric surgery eligibility also includes a co-morbidity and other assessments such as the likelihood to follow treatments.
Even considering that around 58% of patients who would qualify for weight loss surgery are female, our investigation has found an over-representation of women by 18 percentage points compared to the most recent eligibility figures available (2019).
In some parts of the country, these gender differences are even more stark, as represented here.
In Cornwall, for example, between 2019 and November 2023, weight loss surgery patients were 85.4% female.
Examining the four NHS Trusts closest to Greater Manchester offering weight loss surgery and able to provide relevant figures, Sheffield had the starkest gender difference. Between 2019 and November 2023, 82.6% of weight loss surgery patients were female.
But Wakefield bucked the national trend with more male than female patients – 55.2%.
This gender divide fits with global studies of weight loss surgeries – one found that 75% of people who undertook the surgery were women.
Dr Stuart Flint, Associate Professor of the Psychology of Obesity at the University of Leeds, highlighted the gendered nature of body image.
Flint said: “Weight has historically been a topic more associated with women because women have historically been judged related to their appearance and weight status more than males.
“For females, there certainly has been a difference in exposure to obesity stigma compared to males.”
Indeed, Freedom of Information data from 24 NHS Hospital Trusts shows that Tier 3 weight management procedures – like behavioural therapy – are also disproportionately undertaken by women.
On average, for all NHS trusts able to provide data for 2021 and 2022, 77.58% of patients referred for weight management services were female.
This sex divide is larger than that for weight loss surgery.
The data suggests weight and body image are heavily gendered concepts, with women more conscious of their appearance.
That’s a conclusion supported by a 2021 research paper found that women are more likely to be referred to weight loss programmes by their GPs. Men made up just 10% of referrals.
It’s also been argued that the culturally accepted ideal of the male body permits a higher weight for men than women – the “model” man may be muscular while female thinness is glorified.
But Dr Flint also suggested that the stigma around obesity could discourage men coming forward for treatment.
Flint said: “There’s a stigma around obesity that says it’s simply a matter of consuming more energy than what you’re expending. There’s also a perception that you can reverse that very quickly, very rapidly through increasing activity and decreasing how much you’re consuming. The reality is that obesity is extremely complex and multi-faceted.
“People living with obesity will stigmatise themselves because they internalise those messages.”
And Flint emphasised the geographical inequality of obesity treatment.
He said: “Not everyone has access to weight loss surgery. It’s being described as a postcode lottery – depending on where you live, there may not be a Tier 4 service.”
With increasing rates of obesity, weight loss surgery is likely to become more common. But with such a stark gap between men and women accessing care, patient equality – a key principle of the NHS – is in doubt.
