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NICE lowers threshold for weight-loss surgery

NICE has advised more patients should be considered for weight-loss surgery if they have recently been diagnosed with diabetes, in new final guidance on obesity published today.

The regulator has lowered the threshold for referral for bariatric surgery to a BMI of 30 kg/m2 for patients newly diagnosed with type 2 diabetes, or to appropriately lower BMIs in black or ethnic minority patients in line with separate public health guidance.

It also recommends an earlier, more rapid assessment for bariatric surgery in patients with a BMI of 35 kg/m2 or over, the usual cut-off, if they have recently diagnosed with diabetes.

The new recommendations, which were welcomed by GP diabetes experts when first proposed earlier this year, will still require patients to be treated in a specialist, multidisciplinary weight management, or ‘tier 3’, service, as well as being assessed for the surgery.

The guidance says: ‘Offer an expedited assessment for bariatric surgery to people with a BMI of 35 or over who have recent-onset type 2 diabetes as long as they are also receiving or will receive assessment in a tier 3 service (or equivalent).

‘Consider an assessment for bariatric surgery for people with a BMI of 30–34.9 who have recent-onset type 2 diabetes as long as they are also receiving or will receive assessment in a tier 3 service (or equivalent). Consider an assessment for bariatric surgery for people of Asian family origin who have recent-onset type 2 diabetes at a lower BMI than other populations as long as they are also receiving or will receive assessment in a tier 3 service (or equivalent).’

Professor John Wilding, professor of medicine and honorary consultant physician in diabetes, endocrinology and general medicine at the University of Liverpool and Aintree University Hospitals NHS Foundation Trust, who advised on the guidance, said: ‘At the moment only 1% of people eligible for surgery actually have it, most people should try diet and exercise first. However, if someone is obese and they are diagnosed with type 2 diabetes, it is really important that their doctor talks to them about the benefits undergoing surgery could provide them.’

NICE - Obesity: identification, assessment and management of overweight and obesity in children, young people and adults


Readers' comments (4)

  • Vinci Ho

    The right track but
    can CCGs afford if we actively refer those type2 DM with BMI>30 to tier 3 service and really struggle to get weight down despite all therapies and lifestyle changes?

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  • I sometimes wonder if the perceived availability of quick and 'easy' solutions to morbid obesity actually feeds the problem. People see superfast weight loss programmes on TV where contestants typically lose 6 - 12 or more lbs a week. Magazine articles feature before and after pictures of gastric band patients - usually with women looking extremely glamorous with no hint of the loose hanging skin beneath their clothing. When they themselves try sensible dieting and 'only' loose a couple of lbs they feel cheated and give up. I have a dear friend with type2 who has talked excitedly about the prospect of a gastric band for the past couple of years, during which time she has got even larger. She knows the bigger she gets the more likely she is to get the surgery. She also feels a need to 'eat big while she still can'. In the meantime I have been to a weekly slimmers group and lost 108 lbs at a 'boring' rate of just over one lb a week - eminently doable with no great suffering involved. My starting BMI was 43.2. My current BMI is 26.3. I knew any sort of weight loss surgery was unlikely for me as I have severe COPD and am on oxygen - my weight gain was the comined result of giving up smoking, prednisolone and little activity due to breathlessness. In reality mine was the easy way - I just had to accept that results would not be rapid.

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  • Anonymous | Other healthcare professional | 28 November 2014 9:58am: Wow, and big well done. That's a fantastic result.
    WE have access to an abundance of help and advice with healthy eating, exercise and weight management in primary care, but none of it is as effective as attending a large group and being weighed by others, combined with the "I'm paying for this so I'm going to make it work" ethos.
    I see plenty of patients come in and register with the health trainer, last two or three weeks and then leave - they have no-one with who to discuss what they are experiencing during the week who is going through the same.
    Why are we not employing the help of slimming clubs more before we chose anything else. We had access to 12 week deals with slimming clubs a few years ago - the commissioners should seriously think about bringing those back - even if we paid for a year's membership you are looking at around £250 - a far cry from gastric banding and far less risk.

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  • Vinci Ho

    While BS is an option , we need to listen to every single story of our patients. The fact the option is there does not necessarily mean the patient agrees that is the option to him/her.

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