Dear Editor-in-Chief, Obesity is of growing concern in Nigeria, with recent data showing that about 42% of adults are overweight or obese. 1 This increases the risk of chronic diseases, including cardiovascular diseases, type 2 diabetes, stroke, mental health disorders, and certain cancers. 2 In the short term, dietary restrictions and exercise may lead to modest weight loss but they are often limited by adherence and sustainability often giving poor long-term results. 3, 4 The adoption of evidence-based weight loss interventions within the local context remains limited, largely due to insufficient public awareness regarding bariatric surgery, coupled with financial constraints that pose significant barriers to access. 5, 6 In Nigeria, common bariatric procedures include temporary gastric balloons and more permanent options like sleeve gastrectomy and gastric bypass. 6 In March 2025, we surveyed all bariatric centers routinely performing these procedures (more than five cases annually) across three of Nigeria’s six geographical zones. The dollar equivalent of the prices was calculated using the March 2025 average exchange rate of ₦1529 to 1, as reported by the Central Bank of Nigeria. 7 The median cost of gastric balloon insertion was ₦3, 700, 000 (2420), ranging from ₦1, 800, 000 to ₦5, 000, 000) ; while gastric sleeve surgery had a median price of ₦8, 500, 000 (5559), with costs varying from ₦5, 000, 000 to ₦12, 000, 000. Gastric bypass procedure had a higher median cost at ₦9, 000, 000 (5886), with a range of ₦8, 000, 000 to ₦12, 000, 000). These figures largely exclude additional costs such as dietitian services, investigations and follow-up care. The upfront costs of bariatric interventions remain prohibitively high for many Nigerians. To put this in context, the Nigerian monthly minimum wage is ₦70, 000 (about 46), meaning a procedure like gastric bypass, which costs about ₦9 million (5886) would require over 10 years’ salary, excluding living expenses. While these procedures can be even more expensive in countries such as the United Kingdom (£10, 000–£15, 000; 13, 000–20, 000) and the United States (14, 389), higher earnings in these countries as well as health insurance coverage make them arguably more affordable. 8, 9 Consequently, Turkey has become a primary destination for health tourism in bariatric surgery offering all-inclusive packages for as low as 2500 (₦3, 800, 000), though there are concerns about communication and language barriers, long-term follow up and management of post operative complications. 6 Despite the increasing number of patients in Nigeria who could benefit from bariatric procedures to improve their physical and mental health, the affordability and uptake of these procedures in Nigeria remains very low. Only 80 bariatric surgeries were performed in Nigeria in 2023, a rate of 0. 04 per 100, 000 people. 6 In contrast, in 2018, Belgium performed 127 interventions per 100, 000 inhabitants, Egypt, 24 interventions per 100, 000 inhabitants and South Africa 0. 9 per 100, 000 inhabitants. 10 The relatively high cost of the bariatric procedures in Nigeria is largely driven by reliance on imported equipment, foreign exchange instability, and lack of insurance cover as bariatric procedures are often misclassified as cosmetic. Furthermore, at the time of this writing, there is minimal public sector involvement, as no public hospitals in the country perform bariatric procedures routinely. This plethora of factors has created a system in which only a small affluent segment of the population, mainly in urban cities like Lagos, Abuja, and Kano, can afford these weight loss interventions while depriving underprivileged people access to beneficial treatment. We recommend three strategic actions: (1) Stimulation of local production of surgical consumables to reduce dependence on foreign exchange and lower logistic costs, (2) including bariatric care in public and private insurance coverage, and (3) expanding bariatric services and specialist training to tertiary government hospitals to improve access and equity. Addressing these barriers would enhance the affordability of bariatric care, reduce Nigeria’s obesity-related disease burden and improve the quality of life of millions of citizens. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Adenuga et al. (Fri,) studied this question.