TNRF2: Weight management

Overview

Bariatric surgery includes a variety of procedures performed on people who are obese. 

Bariatric surgeries involve making changes to your digestive system to help you lose weight.

Bariatric surgery is carried out when diet and exercise haven't worked or when you have serious health problems because of your weight. Some procedures limit how much you can eat.

Other procedures work by reducing the body's ability to absorb nutrients. Some procedures do both.

Thresholds and eligibility 

The clinical commissioning threshold criteria below directly match the recommendations made in the National Institute for Health and Care Excellence (NICE) Obesity: identification, assessment, and management Clinical guideline (CG189) (section 1.10 Surgical interventions) (updated 26th July 2023).

This guidance applies to those aged 18 or over.

When to refer adults for assessment for bariatric surgery:

Section 1.10.1 states: offer adults a referral for comprehensive assessment by specialist weight management service providing multidisciplinary management of obesity (see note below) to see whether bariatric surgery is suitable for them if they:

• Have a BMI of 40 kg/m2 or more, or between 35 kg/m2 and 39.9 kg/m2 with a significant health condition that could be improved if they lost weight (see box 1 for examples)

AND

• Agree to the necessary long-term follow up after surgery (for example, lifelong annual reviews)

Section 1.10.2 states: consider referral for people of South Asian, Chinese, other Asian, Middle Eastern, Black African, or African-Caribbean family background using a lower BMI threshold (reduced by 2.5 kg/m2) than in recommendation to section 1.10.1, to account for the fact that these groups are prone to central adiposity and their cardiometabolic risk occurs at a lower BMI.

Examples of common health conditions that can improve after bariatric surgery

Some conditions that can improve after bariatric surgery include:

• Cardiovascular disease
• Hypertension
• Idiopathic intracranial hypertension
• Non-alcoholic fatty liver disease with or without steatohepatitis
• Obstructive sleep apnoea
• Type 2 diabetes

These examples are based on the evidence identified for this guideline and the list is not exhaustive.

When to offer expedited assessment:

Section 1.10.3 states: offer an expedited assessment for bariatric surgery to people:

• With a BMI of 35 kg/m2 or more who have recent-onset (diagnosed within the past 10 years) type 2 diabetes

AND

• As long as they are also receiving, or will receive, assessment in a specialist weight management service.

Section 1.10.4 states: consider an expedited assessment for bariatric surgery for people:

• With a BMI of 30 kg/m2 to 34.9 kg/m2 who have recent-onset (diagnosed within the past 10 years) type 2 diabetes

AND

• Who are also receiving, or will receive, assessment in a specialist weight management service

Section 1.10.5 states: consider an expedited assessment for bariatric surgery for people of South Asian, Chinese, other Asian, Middle Eastern, Black African, or African-Caribbean family background using a lower BMI threshold (reduced by 2.5 kg/m2) than in recommendation to section 1.10.4, to account for the fact that these groups are prone to central adiposity and their cardiometabolic risk occurs at lower BMI.

Patients should be encouraged to stop smoking prior to treatment, if applicable.

Resources

Treatments not routinely published policy (TNRF2)

Additional information

Assuming patients meet the criteria for this procedure, the consultant can provide the treatment.  

However, if the patients does not meet the criteria, the consultant has the option of submitting an Individual Funding Request (IFR) application to the Effective Commissioning Initiative Team at NHS Surrey Heartlands via the Blueteq database if they consider them to be clinically exceptional.