What's next for KOS-BAR? "This model of bariatric care should become permanent"

• Obesity above 40 kg per ^m2 of body weight leads to a 10-year reduction in life. There are several hundred thousand such people in Poland - says Prof. Wiesław Tarnowski
• Since 2021, the KOS-BAR (Comprehensive Specialist Care - Bariatrics) program has been in operation, to the great benefit of these patients - it reminds
• We can only operate on patients qualified for the KOS-BAR program until the end of June this year. They can also count on a year of post-operative control. We can no longer qualify new patients for the program - he explains
• We do not have any information about the future of the program, but efforts are underway to introduce this model of comprehensive care permanently to the benefits basket - he adds

- Obesity is not a defect of appearance, but a fatal disease. The problems that result from it are more serious than those related to smoking and alcohol consumption - said prof. Wiesław Tarnowski , president-elect of the Association of Polish Surgeons, head of the General, Oncological and Bariatric Surgery Clinic of the Medical Center of Postgraduate Medical Education at the Independent Public Clinical Hospital named after prof. W. Orłowski.

He recalled that disorders and disease states accompanying obesity include hypertension, type 2 diabetes, hyperlipidemia, increased risk of coronary and cerebral embolism, degenerative changes in bones and joints, and increased risk of cancer. Obesity is also associated with social and economic impairment.

The expert pointed out that the problem of obesity affects 25% of men in Poland, and the problem of overweight - 68%. Children are not free from it either. 13% of boys and 5% of girls are obese. Meanwhile, obesity above 40 kg per ^m2 of body weight , and there are several hundred thousand such people in Poland, leads to a shortening of life by 10 years. The risk of death in a man with a BMI above 40 is almost three times greater than in a man with a normal BMI .

- Indications for surgical treatment of obesity include a BMI above 40 without any comorbidities or a BMI of 35-40 with at least one disease related to obesity, e.g. hypertension, type 2 diabetes, sleep apnea, dyslipidemia, or diseases of the musculoskeletal system that limit physical activity. As for the latter point, very often patients are referred for bariatric surgery by orthopedists, which is hardly surprising, because what is the point of replacing a hip or knee joint in a patient weighing, for example, 180 kg - noted Prof. Tarnowski.

He added that the indications for bariatric surgery also include a BMI of 30-35, depending on the type of comorbidities, but this is currently only the case in Asian countries.

- We operate on people aged 18-65, although this upper limit is becoming increasingly fluid – we look more at the general condition of the patient - he noted.

As he said, on September 3, 2021, a regulation of the Minister of Health was published on a pilot program for comprehensive specialist care for patients treated for morbid obesity KOS-BAR (Comprehensive Specialist Care – Bariatrics) .

- It was a breakthrough document because it precisely defined the conditions that a facility that wants to treat bariatric patients should meet. Another positive thing was that the program was to be financed from the so-called sugar tax - indicated Prof. Tarnowski.

He recalled that the program was intended for patients whose conservative treatment had failed to produce long-term weight loss results. In addition to bariatric surgery, it offered outpatient services and medical rehabilitation lasting up to 18 months from the start of treatment.

The program did not allow people with incurable diseases leading to wasting, with diseases that were life-threatening, or with endocrine diseases that are the basis for obesity. Others who were excluded from participation in the program included severe blood clotting disorders, active addiction to alcohol or drugs, mental illnesses that cannot be controlled despite treatment, severe mental retardation, and the inability to participate in long-term follow-up after surgical treatment.

- Centers that perform many bariatric surgeries per year, and therefore are very experienced in bariatrics, were selected to implement the program. The number of required surgeries was set at 100-150, although of course we have centers in Poland that perform much more, i.e. 300-500 - said the expert.

As he pointed out, one of the elements of comprehensive specialist care within the program is preoperative care, in which the patient is prepared for the procedure 3-6 months before the surgery . During this time, he is consulted by many specialists, a treatment program is determined, and dietary and psychological preparation is also implemented.

- Before bariatric surgery, the patient must lose 5-10 percent weight , which later translates into increased safety of the operation. After the surgery, specialist care is offered for 12 months - the patient comes for check-ups and has tests, so their health is constantly monitored - listed Prof. Tarnowski.

- This will only be the case until the end of June 2025, because only until then can we operate on patients qualified for the KOS-BAR program. Patients operated on in June can also count on a year of postoperative control. However, we can no longer qualify new patients for the program . Will this change? We have no information on this subject - emphasized the specialist.

As he noted, thanks to the program, steps have been taken to make this model of bariatric care a permanent part of the benefits package.

- This would be best for both patients and hospitals, which the National Health Fund does not pay for some of the procedures that could be performed on an outpatient basis. The centers are not able to bear the costs that no one will reimburse them - said Prof. Tarnowski.

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