The National Institute for Health and Clinical Excellence (NICE) published guidance for the prevention, identification, assessment and management of overweight and obesity in adults and children (www.nice.org.uk/CG043fullguideline). The content of this website is in keeping with the guidance from NICE where possible. The NICE guidance document deals with the full spectrum of management of obesity and there is useful information about the alternative strategies to surgery. Surgery is recommended for patients with a BMI>40 after other strategies have failed and this is lowered to a threshold BMI >35 in the presence of established weight related illness. Examples of weight related illnesses include: diabetes mellitus, high blood pressure, ischaemic heart disease, hypercholesterolaemia, sleep apnoea, arthritis, asthma.
Surgery is recommended for such individuals providing the following criteria are fulfilled:
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All appropriate non-surgical measures have failed to achieve or maintain adequate clinically beneficial weight loss for at least 6 months
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They are receiving or will receive intensive specialist management
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They are generally fit for anaesthesia and surgery
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They commit to the need for long-term follow-up
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They are at least 18 years of age
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NICE does now recommend that surgery be now available as first line treatment for suitable patients with a BMI >50. Sibutramine or Orlistat should be considered prior to surgery if the waiting time is long. |
