Consultant surgeon James Halstead splits his time at work between operating on cancer patients and performing weight-loss surgery.

It might surprise some people to hear that he regards the weight-loss surgery every bit as life-saving as the cancer work.

“There are risks to the surgery, but overall those risks are remarkably small, whereas the risks of remaining obese are considerably higher,” he said.

“Bariatric surgery reduces the risk of getting cancer, reduces blood pressure and risk of stroke and heart attack, it cures sleep apnoea, reduces back and hip pain, cures or improves diabetes, increases fertility, reduces or treats depression – the list goes on and on. We are treating a deadly condition.”

The explosion in obesity, caused by people leading more sedentary lifestyles, has resulted in a massive upsurge in demand for weight-loss surgery.

Mr Halstead joined fellow surgeons John May and Jay Gokhale at Bradford Royal Infirmary, 16 months ago, and the hospital is now a specialist centre for the surgery and is training the bariatric surgeons of the future.

A hundred weight-loss operations will be carried out at BRI this year, compared to 37 last year. By taking patients from across the Yorkshire region, it is hoped to increase the number of weight-loss operations to 200 next year.

The majority (90 per cent) of operations are gastric bypass, with five per cent gastric bands and five per cent sleeve gastrectomy, an operation reserved for those with a Body Mass Index (BMI) in excess of 60 – the super, super morbidly obese. Each operation costs the NHS £10,000. “All surgery is done using keyhole techniques, which isn’t the case everywhere – that is where Bradford is ahead of the game,” said Mr Halstead.

“We are doing an average of two or three operations a week, although it varies because we fit it around the cancer surgery.

“The youngest patient we have done is 20 and the oldest about 65. The heaviest patient had a BMI of 100. Patients are in hospital for about two days and they receive ongoing support and come back to the clinic regularly.

“The risks come with not following up patients properly, that is why it is not the right decision to travel abroad for treatment. You need ongoing support for optimum results.

“I have had to sort out the complications of people who have had surgery abroad and in other parts of the UK.”

Mr Halstead says he has never known a patient fail to lose weight, with the most dramatic weight loss occurring in the first year to 18 months after surgery.

“We hope to get people close to a normal BMI, and they have a new lease of life,” he said.

In Bradford and Airedale, surgery is offered to patients who have a BMI of 50, or 45 if they also have long-term medical conditions such as cardiovascular disease including diabetes and heart disease.

All the patients accepted for surgery will have unsuccessfully tried other weight-loss techniques.

The cost to the taxpayer is offset in two major ways, said Mr Halstead.

“Patients need to see their GP less frequently – they no longer need insulin, for example – and people get back to work,” he said.

“We see a lot of people who are unable to work because of their morbid obesity. Once corrected they are able return to work.”

Clare Smart, head of planned care strategic development at NHS Bradford and Airedale, said the primary care trust expected to fund a maximum of 60 local patients for surgery in 2010/2011.

“When GPs or consultants refer patients for this surgery, a routine procedure is followed which involves seeking approval from the PCT, to make sure patients meet the clinical criteria and NHS funding is appropriate,” she said.

“If a referral is declined then a GP or consultant can contact our clinical priorities group, which is a standing committee and has both lay and clinical representation, which considers individual cases with exceptional clinical circumstances.”

Many patients who have undergone surgery attend a patient support group that meets on the last Wednesday of every month at 6pm in Field House at BRI.

Anyone considering weight loss surgery is invited to attend to hear at first hand what it is like to have surgery.


Bariatrics is the field of medicine that specialises in treating obesity.

Bariatric surgery is the term for operations to help promote weight loss.

A gastric bypass – the most popular form of surgery for weight loss at BRI – works by combining restriction and malabsorption.

Performed as a keyhole (laparoscopic) procedure, the stomach is reduced in size to provide restriction in the amount of food the patient is able to eat.

In addition, a small section of the small bowel is ‘bypassed’ which results in some malabsorption of the food you eat and results in weight loss.

Surgery takes about two hours and patients are usually discharged from hospital within a few days.

Case study

At the age of 45 and weighing more than 27 stone, Karen Hogg had been through all the usual diets and slimming clubs – but with no long-lasting success.

“I was your typical yo-yo dieter and a confessed chocoholic.” said the mother-of-four, of Crossflatts, Bingley.

“I’d travel 50 miles for one square of chocolate rather than have a proper meal. Chocolate, sweets, cakes, anything that wasn’t healthy, I’d eat it and eat lots of it.

“My blood pressure was high, I was borderline diabetes. I had problems with my joints and a bad back from carrying all the extra weight around. I was a heart attack waiting to happen.”

Her GP mentioned the possibility of weight-loss surgery four years ago, but Mrs Hogg was understandably worried about having a general anaesthetic.

However, as the years went on she became more depressed by her weight, particularly after hearing jibes when picking her children up from school.

So when her GP broached the subject again a year ago she decided to go for it, despite her fears. With a BMI of about 50 she was given the go-ahead for a gastric bypass operation.

A special pre-operation diet, designed to soften the liver before surgery, saw her weigh go down to 23 stone, and she was operated on by Jay Gokhale on June 4 last year at Bradford Royal Infirmary.

She has since shed more than six stone, going from a size 32 to a size 20 dress size in less than a year.

“I can’t begin to tell you how scared I was – I literally put my life into his hands,” she said. “But the operation has changed my life – I’m healthier and thinner.

“Once you have the bypass you only have a tiny space to fill with food, so I can’t eat the quantities that I used to. The feeling is terrible if you eat too much. It makes you ill.

“The surgeon’s given me the best possible start to weight loss but I have to keep on the work that he has started. I have had to change my attitude to food and my lifestyle.”

As well as watching what she eats, she now exercises by walking the dog and keeps generally more active. She continues to lose around one to two pounds a week and her goal is to get down to 15 stone.

“In ten years’ time I might not have been around but now I’ve got my future back and got something to look forward to,” she added.

“Hopefully, I’m going to be around to see my children grow up and become a grandparent. I can’t thank the surgeons enough for what they’ve done for me.”