Specialist services

Specialist weight management pathway including medical (Wegovy) and surgical treatments

Surrey Heartlands commission a specialist weight management pathway that combines referrals for both medical and surgical treatments within the hospital service for obesity.

The medical pathway utilises semaglutide (Wegovy) as advised by NICE TA875. There is a phased implementation with regards to the implementation of NICE TA875 in line with the guidance issued by the Society for Endocrinology and Obesity Management Collaborative UK.

Eligible patients

Initially patients who meet the eligibility criteria listed in phase one of the guidance will be prioritised for referral to the specialist weight management service. This will allow those with the combination of the highest and most urgent clinical need to be assessed.

Those patients are those with a Body Mass Index (BMI) of 35 kg/m2 or above (-2.5 kg/m2 for ethnic minorities) and one of the following:

  • Precancerous or cancerous condition in which weight loss would aid access to therapies
  • Patients requiring urgent weight loss for organ transplant
  • Idiopathic intracranial hypertension (IIH) requiring frequent lumbar punctures under neurology specialist and/or with visual compromise
  • Patients awaiting surgery for life limiting conditions, where high BMI is the primary barrier to surgery and weight loss would be beneficial
  • Weight loss required for assisted conception in women currently not eligible for fertility treatment and have been advised to lose weight
  • Proven genetic cause of obesity and not eligible for Setmelanotide (Imcivree®)
  • Severe (AHI > 30) Obstructive Sleep Apnoea established on CPAP

Over time, these criteria will change.

Ineligible patients

For those individuals who do not fulfil the criteria, or who do not wish to receive injectable or surgical treatments, other sources of care are provided.

  1. Criteria: Over the age of 18 and has a BMI greater than 30 (greater than 27.5 or over more for people from South Asian, Black and minority ethnic groups). BMI reading must have been recorded within the last 12 months of referral.
    Service: One You Surrey (Local Authority funded T2WMS)

  2. Criteria: Over the age of 18 and has a BMI of 30 or more (greater than 27.5 or over more for people from South Asian, Black and minority ethnic groups) and has a diagnosis of diabetes (Type one or Type two) or hypertension or both.
    Service: NHS Digital Weight Management Programme

  3. Criteria: Not pregnant and has diabetes with a HbA1c level between 42 – 47.9 mmol/mol (6.0-6.4%) or has a Fasting Plasma Glucose reading between 5.5-6.9 mmol/mol within the last 24 months.
    Service: NHS Diabetes Prevention Programme (NHS DPP)