Bariatric surgeryBMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h3802 (Published 30 July 2015) Cite this as: BMJ 2015;351:h3802
- Y Oskrochi, academic FY21,
- A Majeed, professor of primary care1,
- G Easton, general practitioner, lead for academic GP training programmes1
- 1Department of Primary Care and Public Health, Imperial College London, Charing Cross Hospital, London W6 8RF, UK
- Correspondence to: Y Oskrochi
- Accepted 24 June 2015
The bottom line
Refer patients for bariatric surgery if they have body mass index >35 with associated obesity conditions (type 2 diabetes, hypertension, obstructive sleep apnoea) and have failed to control their weight with non-surgical efforts
Consider referral at a lower body mass index if the patient is of Asian origin, has new onset type 2 diabetes, or both
An obese 34 year old man with a body mass index of 37.4, type 2 diabetes, and hypertension presents wanting advice on weight loss. He is concerned about his lack of progress despite adhering to a six month primary care led weight loss regime. He has heard of weight loss surgery being offered by the NHS and wants to know if he is eligible.
What you should cover
Ask the patient about what weight loss measures he has tried so far. For example:
-How has he modified his diet and physical activity?
-Has he tried weight support or management programmes?
Check dates of any prescriptions issued for drug interventions.
Check attendance (current or future) at a tier 3 weight management service, which may affect eligibility for bariatric surgery in England (table⇓).1
Assess whether any clinically beneficial weight loss has been achieved. As …