Stomach surgery added to basic insurance for obese teenagers

Teenagers with morbid obesity will now be able to have stomach reduction surgery (as a last resort) covered by the basic health insurance package, healthcare assessment body Zorginstituut Nederland has announced. The coverage will apply from May 26.

Only young people aged 13 to 18 will be eligible for the operation, known as bariatric surgery, and only after they have already completed an intensive programme to change their lifestyle and eating habits.

The Zorginstituut expects 100 to 150 teenagers a year to qualify for an extended selection process, of whom around 10 to 20 will ultimately be eligible for surgery.

To qualify, a young person must have a body mass index (BMI) above 40 – for someone 1.70 metres tall, that means weighing 116 kilos or more. Teenagers with a BMI of 35 to 40 can also be treated if they have a related illness.

Surgery is never a standalone treatment – it is part of a wider programme of lifestyle and psychological support, and patients remain under intensive treatment for at least five years and must eat smaller portions for life.

A growing problem

Around 500 to 800 young people in the Netherlands have severe or very severe obesity, which puts them at risk of type 2 diabetes and cardiovascular disease at an early age, as well as psychological problems.

The numbers are rising: between 1990 and 2024, the share of 12- to 17-year-olds with obesity climbed from 1.4% to 4.1%. Late last year, paediatricians warned of a doubling of waiting lists at obesity clinics and a fivefold rise in the use of obesity medication.

The Zorginstituut had ruled in 2012 that teenagers were not eligible for the surgery, citing a lack of long-term evidence on its safety and effectiveness. It revisited the decision at the request of medical professionals after new long-term studies.

Cost on society

Obesity also carries a heavy financial cost. Overweight and obesity together cost Dutch society around €79 billion a year, or nearly €11,500 per adult affected, according to a 2022 Maastricht University study.

Healthcare made up only about a quarter of the total, with lost productivity from illness the largest cost. Karin Timm of the Zorginstituut’s executive board said the rise in obesity is a problem “that we as a government and society have to tackle”, and welcomed the cabinet’s plans for a sugar tax.

For the teenagers facing surgery, she added, “there is far more going on than ‘eating too much’”.