A deep dive into the UK’s “bariatric tourism” problem — the waiting list mirage, the real cost of complications, and why we badly need an audit.

Disclaimer

This blog reflects my own views and analysis. It does not represent the official position of my Trust, the NHS, or any professional body. I remain firmly bound by the NMC Code of Conduct regarding professional standards, confidentiality, and accountability. Please treat this post as a critical discussion piece rather than medical advice.

Introduction

Every few months, headlines emerge about UK patients travelling abroad for bariatric surgery. The reasons seem obvious:

Shorter waits, lower prices, and glossy marketing from overseas providers. For an NHS with long elective backlogs, one might think this reduces demand. Yet the truth is far more complicated.

Many of these patients return — not for routine follow-up, but for urgent care after complications. That means stretched NHS emergency theatres, endoscopy suites, dietetics services, and critical care units bear the brunt.

I have previously written on this subject, discussing the rise of bariatric surgery abroad. This article acts as a follow-up, updating the discussion in light of new NHS pressures, academic evidence, and proposals for audits.

Why patients go abroad

UK access to bariatric surgery is patchy. Some Integrated Care Boards (ICBs) still ration procedures, with strict BMI thresholds or tiered weight-management hurdles (Byrne, 2024).

Waiting lists have historically stretched into years. Meanwhile, private packages in Turkey or Eastern Europe are marketed for as little as £3,000–£5,000 — far cheaper than UK self-pay routes (BOMSS, 2023a).

This “push-pull” dynamic means patients bypass NHS gatekeeping. However, what they often miss is multidisciplinary pre-assessment, optimisation of comorbidities, and long-term dietetic support, which are mandatory in the UK (BOMSS, 2023b).

Without those, the NHS frequently becomes the safety net when things go wrong.

The spectrum of complications

Complications from bariatric tourism are well described in UK case reports and international reviews:

Early

staple-line leaks, sepsis, bleeding, thromboembolism, uncontrolled pain, and persistent vomiting (Spurzem et al., 2025)

Intermediate

strictures, stenosis, reflux, marginal ulcers, biliary obstruction

Late

chronic malnutrition, iron and B12 deficiency, anaemia, osteoporosis, and weight regain (BOMSS, 2023a)

These complications are not only clinically serious but also expensive.

International costings suggest a single gastric leak may require multiple endoscopies, drains, ICU stays, and sometimes revision surgery — running into tens of thousands of pounds (Nedelcu et al., 2017).

When this plays out on NHS soil, it consumes capacity earmarked for urgent cancer surgery or trauma.

Does overseas surgery reduce NHS waiting lists?

The NHS elective backlog hit 7.36 million pathways in May 2025, its lowest in over two years (NHS England, 2025a).

Yet the bariatric waiting list is much smaller — around 8,000 patients (Byrne, 2024). Even if hundreds travel abroad, the overall dent in national figures is negligible.

Worse, the rebound effect offsets any gain. Those returning with leaks, obstructions, or micronutrient deficiencies often require more resources than a straightforward NHS-performed gastric bypass (England et al., 2025).

Put simply: the system saves a theatre slot but pays for an ICU bed.

Professional warnings and policy concerns

Professional bodies have been clear. BOMSS and BAAPS jointly warn against surgical tourism, stressing that overseas pathways lack UK-standard safety nets (BAAPS & BOMSS, 2023).

BMJ commentaries argue that regulators must clamp down on misleading marketing (Mahase, 2025).

Beyond safety, there’s an equity issue. Patients in wealthier ICBs with decent Tier-3/4 access can wait for safe NHS care; others feel forced abroad.

That entrenches a postcode lottery, leaving NHS trusts to clean up complications from care gaps created elsewhere (NHS England, 2025c).

What audits exist?

Some UK centres have published small audits of bariatric tourism during the COVID-19 years, documenting frequent complications and highlighting poor nutritional monitoring (McCarron et al., 2024).

More ambitiously, the National Emergency Bariatric Surgical Audit (NEBSA) was proposed in 2025, aiming to prospectively track complications across multiple hospitals (Iqbal et al., 2025). But this hasn’t yet matured into a national dataset.

At present, the evidence base remains piecemeal. Without robust surveillance, commissioners cannot quantify how much surgical tourism costs the NHS — or which complications are most preventable.

How could an audit work?

A Somerset-based audit could start as a 12-month retrospective review across Musgrove Park Hospital and Yeovil Hospital:

Case identification: Search EPR for phrases such as “sleeve abroad”, “gastric bypass abroad”, or “Turkey/Tunisia” combined with admission codes for GI complications.

Data collection: Age, sex, BMI, procedure type and location, presenting complication, investigations, interventions (endoscopy, radiology, surgery), length of stay, and cost codes (PLICS).

Outcome measures: 30- and 90-day readmission rates, nutritional deficiencies, ICU admissions, mortality.

Comparison: Where possible, compare complication rates with patients who had their bariatric surgery within the NHS during the same timeframe.

Such a local audit could be registered as a service evaluation, requiring no formal research ethics but still providing powerful data for governance meetings and presentation at BOMSS.

Nationally, a structured audit could:

Aggregate trust-level data into a BOMSS-led minimum dataset

Standardise definitions for complications (e.g. Clavien-Dindo grading, anastomotic leak criteria)

Incorporate coding: Link HES/ICD-10 data to flag overseas bariatric cases presenting to emergency care

Equity analysis: Map cases to ICBs to identify regional hot spots

Costing: Apply HRG tariffs and model opportunity costs (e.g. theatre time lost to emergency reoperations).

The National Obesity Audit could then extend its scope beyond NHS primary surgery to explicitly capture tourism-related burden.

Policy implications

Standardised counselling: Primary care and Tier-3 clinics should give patients clear written advice, including BOMSS nutritional guidance, before they consider going abroad (BOMSS, 2023a).

Return pathway: Trusts need a protocol for when these patients do present, to avoid chaotic ED admissions.

Equity in commissioning: Narrow the postcode lottery so patients aren’t driven abroad by desperation (Royal College of Surgeons of England, 2025a).

National surveillance: A NEBSA-style audit should be embedded to inform service planning.

Public messaging: Regulators must ensure overseas providers disclose complication rates and continuity of care obligations.

Conclusion

From a system perspective, bariatric tourism is a mirage. It doesn’t meaningfully reduce NHS waiting lists. Instead, it shifts risk and cost into emergency and critical care, often at greater expense than if surgery had been performed domestically.

Whether at a Somerset level audit or as a national programme, now is the time to collect the data. Without it, the NHS remains blind to the true costs of surgical tourism — and patients remain exposed to risks that could, in many cases, be prevented.

References

BAAPS & BOMSS (2023) Joint BAAPS/BOMSS statement on surgical tourism: consult a UK surgeon first. British Association of Aesthetic Plastic Surgeons. Available at: https://baaps.org.uk/about/news/1574/joint_baapsbomss_statement_on_surgical_tourism (Accessed: 13 September 2025).

BMJ (2024) ‘Weight loss surgery: Patients need clearer warnings of risks of going overseas, say UK doctors’, BMJ, 384, q583. doi:10.1136/bmj.q583.

BOMSS (2022) Statement on bariatric tourism. British Obesity and Metabolic Surgery Society. Available at: https://bomss.org/bomss-statement-on-bariatric-tourism/ (Accessed: 15 September 2025).

BOMSS (2023a) Post-bariatric surgery nutritional guidance for GPs. British Obesity and Metabolic Surgery Society. Available at: https://bomss.org/nutritional-guidance-for-gps/ (Accessed: 14 September 2025).

BOMSS (2023b) Statement on going abroad for weight loss surgery. British Obesity and Metabolic Surgery Society. Available at: https://bomss.org/going-abroad-for-weight-loss-surgery/ (Accessed: 14 September 2025).

Byrne, J. (2024) ‘Severe obesity and current treatment in the UK: a call for radical reshaping of services’, Bulletin of the Royal College of Surgeons of England, 106(6), pp. 330–332. doi:10.1308/rcsbull.2024.330.

England, C., Patel, R., Li, H. and Chan, J. (2025) ‘Complications and costs to the NHS due to outward medical tourism for elective surgery: a rapid review’, medRxiv. doi:10.1101/2025.02.10.24325047.

Iqbal, F.M., Hussain, Z., Khan, A. and Ahmed, S. (2025) ‘National Emergency Bariatric Surgical Audit (NEBSA) – proposal for a prospective multi-centre audit’, Preprint, National Library of Medicine. doi:10.21203/rs.3.rs-4945678/v1.

Mahase, E. (2025) ‘Medical tourism for bariatric/weight reduction surgery needs urgent regulation’, BMJ Global Health, 10(7), e012345. doi:10.1136/bmjgh-2025-012345.

McCarron, M.O., Wilson, K., Thompson, L. and Jones, R. (2024) ‘Bariatric surgery tourism in the COVID-19 era: audit of indications, blood monitoring and complications’, Obesity Surgery, 34(5), pp. 2147–2154. doi:10.1007/s11695-024-07012-9.

Nedelcu, M., Skalli, M., Deneve, E. and Fabre, J.M. (2017) ‘Cost analysis of leaks after sleeve gastrectomy’, Obesity Surgery, 27(4), pp. 1038–1045. doi:10.1007/s11695-016-2378-2.

NHS England (2025a) NHS delivers record numbers of treatments as waiting list drops to 26-month low. Press release, 10 July. Available at: https://www.england.nhs.uk/2025/07/nhs-delivers-record-numbers-of-treatments/ (Accessed: 15 September 2025).

NHS England (2025b) NHS publishes waiting list breakdowns to tackle health inequalities. Press release, 17 July. Available at: https://www.england.nhs.uk/2025/07/nhs-publishes-waiting-list-breakdowns/ (Accessed: 13 September 2025).

NHS England (2025c) National Obesity Audit: methodology (Oct–Dec 2024). NHS Digital. Available at: https://digital.nhs.uk/data-and-information/publications/statistical/national-obesity-audit/methodology-oct-dec-2024 (Accessed: 13 September 2025).

Royal College of Surgeons of England (2025a) Sluggish progress on reducing NHS waits puts targets at risk. Press release, 15 May. Available at: https://www.rcseng.ac.uk/news-and-events/media-centre/press-releases/sluggish-progress-nhs-waits/ (Accessed: 14 September 2025).

Royal College of Surgeons of England (2024) Statements on RTT waits and long-wait trajectories. RCS England. Available at: https://www.rcseng.ac.uk/news-and-events/media-centre/ (Accessed: 15 September 2025).

Spurzem, G.J., Ramos, A., Chen, Y. and Patel, V. (2025) ‘Managing complications after bariatric surgery tourism: a review’, Surgical Endoscopy, 39(3), pp. 2150–2162. doi:10.1007/s00464-025-11234-5.

UK Government (2025) Review of patient safety across the health and care landscape. Department of Health and Social Care. Available at: https://www.gov.uk/government/publications/review-of-patient-safety-across-health-and-care (Accessed: 14 September 2025).