Let’s have a chat about publicly funded Weight Loss Surgery

Well I say let’s have a chat but here I am writing a blog post that’s totally uninterrupted and allows me to form my thoughts and argue my opinion. Please comment on this if you agree or disagree because I think opening up a dialogue around this is important and what’s something we all have? An opinion!

I was going to do an ask me anything post but one of the questions I got warranted a full post because it’s something that I’ve thought about for a while and I guess because it’s a little bit controversial I’ve never thought to write about it. This is what my friend asked, “How do you feel about those who have the surgery on the health system being asked to pay a percentage of the costs? Up to 50% depending on their means? Rather than the tax payer footing the full bill of between $20-30,000. I’m asking this question following up from our brief discussion around those who have it and think they should still eat the same crud they had before.

In New Zealand we have a health system that is funded by the tax payer. I know this is not the case overseas and I think we are very lucky to have a system like this. While the system is not perfect and there is always room for improvement to the services and volume of services provided by the public system I think we are very lucky to have it available to us. As I have said before many times I had my gastric bypass done on the public system and I am very thankful I was able to. At the time I was at home looking after my son and we were running our household on one wage, there’s no way we would have been able to afford for me to go private.

It’s also quite pertinent for me to point out that different District Health Boards allocate their funding in the ways they please and the access to bariatric surgery (in terms of the qualifying criteria) in the public system is different depending on where you live in New Zealand. Even if you meet the basic criteria of BMI with or without co-morbidities and having tried other diet and exercise regimes there are still a lot of hoops to jump through to get on the list and receive the surgery. As with any elective surgery just because you want it and are referred does not mean you will end up having any time soon or even at all.

But getting back to my friend’s question do I think people going for surgery on the public system should pay a percentage of the costs? Quite simply, no. To start with, I think it totally defeats the point of having a public system or offering it there if you could be expected to pay some of the costs yourself. While some patients do not change their behavior and go back to eating things they shouldn’t and don’t make the necessary lifestyle changes there is often far much more to and varied, very complex reasons why this happens.

As time goes on and DHB’s are funding more of these types of surgeries they are refining their selection processes. They are very aware that the whole point of this is to make investment where it’s going to pay off and ultimately, they can’t grant everyone who is referred to them surgery. To give you an example of the hoops I had to jump through after my initial referral from my GP I had to first fill in an extremely long questionnaire which asked some very personal questions, I had to lose 8 kilos in the space of two months, I had to go to a four-week series of seminars to educate me further about the process and the diet and lifestyle changes that were necessary, I then had to maintain my weight loss for at least three months and then I had an agonizing wait to get my surgery date.

Where I think the public system could go a step further but of course funding does not allow for is some psychological screening beforehand and some psychological support afterwards because that’s where I think the biggest struggles lay in relation to bariatric surgery. One of the main differences between the public and private systems is that psychological support is offered and I think (hope!) mandatory at different parts of the process if you go to see a surgeon privately.

Now I’m getting to the controversial part of my argument. Suggesting that people can only have this surgery if they pay all or some of it is discriminatory. It’s bringing right to the forefront the old tired attitudes and stereotypes about morbidly obese individuals in society. We live in a obesogenic environment and more and more of the current research is showing us how complex the issue of obesity and especially morbid obesity really is. Obesity is a disease not a lifestyle choice. I totally understand that lifestyle choices can exacerbate a condition such as obesity but the simple fact is that it’s not a choice it’s disease.

We need to drop judgmental attitudes and the misguided belief that all fat people have eaten themselves into this position and are now wanting to be rescued by surgery courtesy of the tax payer. It’s like denying knee replacement surgery to a marathon runner because, sorry you used it too much and it’s self-inflicted so you will need to cover that one yourself. There are so many comparisons I could make but do we even really need to go there, I hope not.

We do not and should not provide healthcare through the public system on a basis of perceived worthiness, which is so objective anyway, and I don’t see any difference why we should hold these prejudices against people who are morbidly obese. It’s discrimination, it’s fat shaming, it’s judgmental, it’s reinforcing the rhetoric in society that fat is not good enough and it’s not socially acceptable. Once again we’re trying to punish someone for something they can’t necessarily control, remember what I said a bit further up, obesity is a disease.

No morbidly obese person necessarily wants to be that way. Don’t for a second think they don’t know they are overweight and are just sailing through life. We’ve had enough rude or ‘helpful’ people point it out to us already, thanks.  Imagine trying to control a very visible part of your life, failing multiple times and then being judged again by health professionals who decide your worthiness and commitment. I’ve already written about how I was treated differently in the health system when I was morbidly obese here.

I do think as much education and information needs to be passed to potential surgery candidates before they decide it is the right thing for them. This should happen whether you go private or public. If you go into it thinking you can continue on with food how you did beforehand then there’s something wrong in the pre-op selection process. While it’s the responsibility of the person choosing to have surgery to learn about how their lifestyle and dietary requirements will change there is a huge chunk of responsibility resting on the health professionals to educate and inform their patients about what’s to come, in some respects it falls under their duty of care.

The mental battle is a huge part of this journey, which gets harder the further out from surgery you get, cannot be underestimated and it cannot be predicted how someone is going to cope with it prior to surgery. To partly penalize people based on how compliant the surgical team thinks they may or may not be with their new dietary requirements is insane and I think defeats the purpose of offering the surgery through the public health system. I would like to see more investment in bariatric surgery for the whole of New Zealand so that more people who would like and are suitable candidates can get the surgery and change their lives for the better.

Please comment on this post if you have something intelligent and considered to say. While I won’t be overly harsh on the comments I approve to be published if it’s not valuable to the discussion or is just downright offensive then I will delete it. My blog is a safe and positive space for weight loss surgery patients and my first priority is to maintain that.

Next Post:
Previous Post:
This article was written by
There are 24 comments for this article
  1. Nerida at 6:53 pm

    I don’t think that it should be means tested. The DHB criterias are what they are and if you qualify, then that’s terrific. I do think that the psychological support is imperative. In fact, I thought it was part of the “package” so to speak, that you had to have a psychological consult to get funding? I do know of someone that had their surgery publically in Taranaki 5 years ago that is really struggling and doesn’t have access to a dietitian or psychologist and would really benefit from both. I think if you meet the criteria for public funding, then you should get it but I think that the government needs to look at funding MORE gastric surgery as a treatment for morbid obesity rather than the $’000’s that are being spent on the ambulance at the bottom of the cliff treatments of the long term health care costs we are currently spending money on.

    I applied for public funding, but didn’t qualify as the ADHB requires high blood pressure and/or full blown type 2 diabetes to be considered. My surgeon told me I would never have qualified for public funding because, even though I had the sky high BMI (44 I think) and plenty of co-morbidities, I wasn’t type 2 diabetic and did not have high blood pressure.

    I was fortunate enough to have some money left to me by my grandmother that paid for my surgery and I have since paid out of pocket for psychological appointments and found this to be really crucial to my success in helping me to align my head with the changes happening in my body.

    • Melissa Peaks Author at 7:50 pm

      The qualifications vary by DHB and I qualified under WDHB without any comorbidities my BMI was very high though. Also under WDHB there isn’t any psychological (or wasn’t when I went through, it may have changed now) support or checks. I agree that there should be more funding across the whole country for weight loss surgery.

  2. Sara Lake at 8:45 pm

    Very interesting topic of conversation. Also, I hadn’t actually realised that the criteria differ between DHB’s, so that definitely answers a question I had in my mind about why some get surgery only with comorbidities and some don’t.

    I definitely think that surgery should be publicly funded and it’s encouraging that the govt. has earmarked money for it. I can’t remember the amount, but from memory, it would cover an additional 800 surgeries over four years (starting from 2014). At the moment there are just under 900 bariatric surgeries done in NZ every year.

    There is a definite bias against not just bariatric surgery, but against letting go of the idea that the obese just need to ‘do something about themselves’. This bias seems to exist even within people that are obese. They don’t want to admit that they are the one that can’t lose weight, seeing as the media bombards us with messages that all you need to go is eat veges and walk a bit.

    The thing is, resolving obesity at an earlier stage solves so much money later. A heart bypass costs five times what a bariatric operation does. However the ‘wait until things get really bad’ attitude doesn’t just apply to bariatrics. For example, my grandma just paid $10,000 for a double cataract op. She wasn’t even close to being bad enough to go on the public waiting list, but her sight was so bad she worried daily about falling. The difference being though, that nobody told her it was a waste of money. Everyone agrees it should have been publicly funded… she didn’t have to be selective about who she told for fear of judgement..

    • Melissa Peaks Author at 7:11 am

      I think where it may get confusing about the DHB’s criteria is that they all have the same basic criteria listed on their websites where it’s just in relation to BMI with or without co-morbidities but they do filter out applications based on different things. I’ve heard that quite a few won’t do it unless you already have diabetes.
      I agree about the cost being negated by saving more on health spend later on. Bariatric surgery really should be viewed as an investment on ourselves and our future. That’s a shame to hear your grandma couldn’t get essential surgery done through the public system. I guess in pretty much every area the health system is underfunded and we could be doing more. I’m glad your grandma was able to pay for it and get it sorted before she had a fall.

  3. Lana at 11:09 pm

    Very well written post. I agree this should be means tested, however like someone else mentioned I do think it’s hard when different dhb’s have different criteria. I do not fit the criteria at all, my health insurance would pay $8000 towards the surgery, but that still leaves a huge difference

      • Melissa Peaks Author at 7:14 am

        Thank you Lana! I’m sorry to hear you don’t fit the criteria, it does get confusing so quickly when the DHB’s are selective in different ways. Yes that is a huge difference I think to go private the cost is usually around $25,000 which is out of reach for many people, even if health insurance would pay some towards it.

  4. Samantha (@PlanetBakeLife) at 8:08 am

    I’ve been turned down twice as my DHB requires me to have Type 2 or sleep apnea of which I have neither. I have a high BMI and high blood pressure as well as a narrow disc in my back that would be relieved greatly with the loss of a huge amount of weight.
    I understand there is only so much funding available so I will try to lose the weight and reapply in the mean time. I do not have a problem with those qualifying having the surgery. I do have a problem with those that have it done and then go back to their normal lives and (in my opinion) waste their opportunity. I think the mental side of things needs a heavier focus so that candidates who are selected are in the right frame of mind to make changes and that they’re going to benefit from their surgery.
    As I talked to you about yesterday, support groups would be great although funding is tight and I understand that some people can be incredibly negative or pigheaded about it all. I think giving some incentive would be good at these types of groups. Like WW’s gold coin, something to remember the achievements by and drive people to succeed would be nice and those that are not positive influences on the group should be asked to leave.

    I really liked this post. There’s a lot to think about and a lot to consider. It also makes me think a considerable amount about how I feel about being turned down when I have serious health issues that could benefit so much from the surgery yet they don’t fit into little boxes.

    • Melissa Peaks Author at 10:09 am

      I’m still in disbelief that you haven’t yet been accepted by the public system. While you don’t have the two conditions they look out for you certainly have things that would be greatly improved with the expected weight loss after bariatric surgery. I can see value in support groups and while I don’t know of any formal ones I have found some online but as you point out not all of them are the best influence and there’s only one that is amazing and is what you would hope for out of any of them. I hope your persistence ends up paying off because you took a long time to consider if bariatric surgery would be the right thing and it is very much a researched and informed decision from your point of view.

  5. Ange at 2:44 pm

    Wow Melissa another amazing blog. I do see all the different points but I still feel after not qualifying ( I believe HBDHB only allow 4 publicly funded ops a year) We still couldn’t afford it and as I waited more years up and down the scales went. Then at start of this year felt so sick we had to find away. Yep we will be paying back a bank loan for awhile but it was that or continuing the vicious cycle of being morbidly obese. I did think Melissa that if a subsidy or so much was given across the board to patients wld mean for me my loan wld be less and paid off faster and others may be able to consider surgery if it was $10,000 instead of $22,000. It really is tricky I still agree about are we then being discriminated from other surgeries but for those that can’t get publicly funded because we don’t have diabeties yet for example… are already being discriminated because we are considered not sick enough ….hmmm def lots to consider good on you for putting it out there.

    • Melissa Peaks Author at 8:11 pm

      Thanks for reading Ange 😀 I really feel for you not qualifying, it’s really not fair is it. I’m glad to hear you have found a way though and it will be the best investment you will ever make in yourself.

  6. J D at 3:18 pm

    High Melissa, Im am a 4 day post op bariatric in hamilton. Had op done public i had Type2, sleep apnea, high b/p, asthma and high colestryryl. I found there were’nt to many hoops to jump thru. Sorry if i have wrong spelling of some words.

  7. A at 9:17 pm

    I only got through half of your blog and felt angered not by your opinions but by the selection criteria needed just to be accepted by public system. I for one was not accepted as I did not tick all boxes. I guess being 145kg overweight, Borderline diabetic, endless diets, boot camps and Frequent GP visits did not fit there requirements? Who knows. All I know is, maybe the people that decide who or who doesn’t fit criteria has never had a eating disorder? Never been fat-shamed? But when receiving a score of 17 points on their list where 60 points is the accepted requirement, I guess dampened mood is an understatement.

    Don’t be mistaken by my distasteful post, I am happy to read you were accepted along with many other much needed candidates but if I am given the chance to pay only a fraction of over Thirty Thousand dollars then I happily would

    • Melissa Peaks Author at 8:45 am

      I’m sorry to hear you didn’t get through, it sounds like you could really benefit from weight loss surgery. Unfortunately the funding of weight loss surgery is done differently at each district health board and while some are really strict others aren’t. I agree with you that we need more funding and to make it available for more people, I really hope the government recognizes how many people could benefit from it and increases the amount of people going through getting it.

  8. Jean at 11:15 pm

    Hi there thank you for your blog very helpful, I got a loan to have my operation privately only to have surgery cancelled because surgeons found my iron levels were too low. I got this sorted then they discovered blood issues so 3 months later no operation and money now gone to pay bills, so I have to save up now, I didn’t think I could ask for health care as I always believed I am responsible for being this way. My obesity has caused me have health issues and I am tired of being sick, high blood pressure etc. Reading you blog I am going to ask my Doctor to check if I may qualify… Thank you for sharing

  9. Luke at 6:56 pm

    Hiya, I’ve been wanting this for years but can’t afford it obviously Im a 39yr old male Samoan/maori I live in Tauranga, work full time shift work mainly graveyard , father of 3 primary school kids, have a large mortgage, live week to week, tried majority of the diets, some worked well but weight always came back on and more.
    Can you give me information on how or where I go to try and apply for this/ I went years ago to doctor about this but never heard any more about it, not sure why I’m 170kg and been working since I was 17, I pay my taxes but it seems they only give it to people that sit on the benefit for years.
    Cheers Luke

    • Melissa Peaks Author at 7:01 pm

      Hey Luke, the first step to take is to visit your GP and ask them to refer you to the hospital for bariatric surgery. They can do a referral for you and you should hear from the hospital from there. The funding varies from DHB to DHB so it’s hard to say how likely you are to get the surgery but you can only try by asking to be referred. Good luck!

  10. Maria at 9:22 am

    Hi there,Melissa,my GP refer me for weight loss surgery in Tauranga.How long before you get an appointment to be seen for this?

    • Melissa Peaks Author at 10:29 am

      Hi Maria, I’m not sure how long it will take to get an appointment. I imagine anything from 4-6 weeks to hear back from the hospital would be fairly standard. Good luck xx

Leave a Reply

Your email address will not be published. Required fields are marked *