The Foundation for the Rights of Citizens with Obesity is deeply concerned by the recently announced decision of the Quality Group of RIZIV-INAMI whereby there is now a moratorium of a “minimum of three months” from the time someone first sees their Bariatric surgeon to when they may undergo surgery in Belgium.

The announcement comes as a complete surprise given that there was no public consultation and no citizen involvement in the decision at Belgian level.

We are concerned that this decision has not been well thought through and risks to harm and further unnecessarily delay improving health outcomes for people living with obesity in Belgium.

1. Obesity has been classified as a disease by the WHO (World Health Organisation) since 1948 and in Belgium is addressed as a medical condition under ICD 10 with related basic reimbursement for bariatric surgery.
   
2. Currently, best practice in obesity treatment and long term management dictates that to be considered eligible for state-funded bariatric surgery, candidates must provide a letter from their treating physician (normally a GP (General Practitioner)) to the effect that they have tried various treatments of increasing complexity from first level therapeutic nutrition and therapeutic physical activity, to the next tier of pharmacological therapy (if available) and then if treatment unresponsive in the longer term, they can be referred to undergo bariatric surgery.
   

The RIZIV-INAMI decision erodes the rights of citizens with obesity under our consumer rights and patient rights legislation (2002 onwards).

1. All health system users have the right to receive treatment and continuity of care for officially diagnosed medical conditions. This decision pulls a halt to continuous treatment without the option for patients to make an informed decision.
   
2. All health system users have the right to know our health status and make informed decisions about treatments. During the now imposed minimum three months gap in moving forwards with treatment, we are highly disappointed not to have seen a move to ensure that bariatric surgery candidates can receive reimbursed psychological counselling, preparatory nutritional counselling and physical activity so that we can positively move towards long term positive outcomes from the surgery and most importantly, truly understand what a life-changing operation and process this is.
3. Under the Patient Rights legislation, affected populations have the right to be involved in the policy decision making process for actions which directly affect us. Given that 60% of people in Belgium already live with pre-obesity or obesity, we find it shocking that we are not represented on any of the RIZIV-INAMI Working Groups related to Obesity or any Chronic Conditions.

We are astounded and concerned that the evidence used to rationalise this decision is based on outdated scientific consensus from 2009.

Finally, we are disappointed that in taking this decision, RIZIV-INAMI has not considered the realities of current discriminatory practices in terms of lack of a consolidated health service delivery framework for people with obesity in Belgium. We cannot stress enough that bariatric surgery should not be considered the only form of reimbursed treatment for obesity. It is a last resort and not the right solution for everyone. This decision should have been taken as part of a broader reflection on how to implement our consumer rights to health service delivery and to ensure that all the necessary services including education for all impacted can be embedded and reimbursed.