referral from primary care - bariatric surgery for obesity

Last edited 07/2023 and last reviewed 08/2023

• Referral to specialist care should be considered if:
  • the underlying causes of overweight and obesity need to be assessed
  • the person has complex disease states and/or needs that cannot be managed adequately in either primary or secondary care
  • conventional treatment has failed in primary or secondary care
  • specialist interventions (such as a very-low-calorie diet for extended periods) may be needed, or
  • surgery is being considered

Referrral regarding bariatric surgery:

• bariatric surgery is a treatment option for people with obesity if all of the following criteria are fulfilled:
  • 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 for examples)

    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.

  • and
  • agree to the necessary long-term follow up after surgery (for example, lifelong annual reviews)
    
• 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) thanto account for the fact that these groups are prone to central adiposity and their cardiometabolic risk occurs at a lower BMI
  
  
• bariatric surgery - when to offer expedited assessment
  • 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
      
      
  • 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
      
      
  • 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) to account for the fact that these groups are prone to central adiposity and their cardiometabolic risk occurs at a lower BMI
    
    
• medicines while waiting for surgery
  • drug treatments may be used to maintain or reduce weight before surgery for people who have been recommended surgery, if the waiting time is excessive

Reference:

1. NICE (July 2023).Obesity: identification, assessment and management of overweight and obesity in children, young people and adults