Bariatric and metabolic surgery medical tourism: the compelling need for regulation through transnational collaboration

<p dir="ltr">Obesity is a chronic disease defined by the WHO.<a href="https://gh.bmj.com/content/10/7/e019546#ref-1" target="_blank">¹</a> The management of obesity involves a multifaceted approach including lifestyle, pharmacological, endoscopic and/or surgical management. The high prevalence of obesity coupled with healthcare resource constraints and increased globalisation has resulted in more people accessing obesity treatment outside their home country. To meet the higher demand for obesity management medicines (OMM), a concerning market providing unregulated OMM access has emerged, which poses unique risks and regulatory and ethical challenges.<a href="https://gh.bmj.com/content/10/7/e019546#ref-2" target="_blank">^{2 3}</a> Some data suggests that increased use of pharmacotherapy may result in a reduction in bariatric and metabolic surgery (BMS), though the number of people travelling abroad to access BMS continues to rise.<a href="https://gh.bmj.com/content/10/7/e019546#ref-4" target="_blank">^{4 5}</a>The term bariatric and metabolic surgery medical tourism (BMT) is used to describe this phenomenon.<a href="https://gh.bmj.com/content/10/7/e019546#ref-6" target="_blank">⁶</a>In the absence of reliable data, the extent of this industry is difficult to ascertain. The wider medical tourism industry is worth more than $400 billion annually with anticipated annual growth of 25%.<a href="https://gh.bmj.com/content/10/7/e019546#ref-7" target="_blank">⁷</a> Despite the estimated size of the BMT industry, it remains largely unregulated. This commentary focuses on the BMT industry through a global health lens, outlining the opportunities and risks it poses for individuals and for health systems. The need for regulation is highlighted, and recommendations to support regulatory processes are proposed. Key terminology is defined in <a href="https://gh.bmj.com/content/10/7/e019546#T1" target="_blank">table 1</a>.</p>