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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