It’s well-known that millions of Americans are overweight or obese. The U.S. Centers for Disease Control and Prevention (CDC) has even classified obesity as an epidemic within the country and the American Medical Association now considers obesity a disease. Now it appears that obesity is becoming a larger problem in the UK as well.

A new study recently published in JRSM Open has found that two million UK citizens are now eligible for bariatric weight loss surgery. The number has surprised the study’s authors, as it is much higher than previous estimates for eligibility. The new figure also puts current weight loss surgeries in perspective, showing that very few of those eligible for such procedures actually undergo them.

“Despite clear guidelines outlining who can undergo such surgery with the NHS, and evidence that these procedures are cost-effective in the long run, less than one per cent of those eligible have weight loss surgery each year,” said Dr. Sonia Saxena, a co-author of the study and a researcher at Imperial College London. “This raises questions about why more procedures are not currently being carried out.”

The study found that those who qualify for bariatric surgery are likely to be retired women with lower socioeconomic and education statuses. This could mean that those most in need of weight loss surgery are part of the same demographics that use medical services at a lower rate. Also, the study’s authors believe that cutbacks in required pre-surgery weight loss programs could be contributing to low surgery rates among those who qualify.