1. Bariatric Surgery Mhairri Duxbury
Bariatric Specialist Nurse/ Service Lead
NHS Lothian Bariatric Surgical Service

2. NPF Guidelines (2011) Obesity Treatment Subgroup report
NHS Scotland review of bariatric services
Encompassed: Public Health Route map, SIGN guidelines and definition of severe and complex obesity
Needs Assessment: Obesity prevalence, Health Impact and Diabetes (T2)
Also reviewed weight management programmes, surgical provision and compared surgery across UK/ Sweden

3. NPF Guidelines (2011)
Bariatric surgical provision increase from 5 to 9/ 100,00 per capita ( cases per year)
Access to weight management fundamental to surgery success
Research supports priority being given to T2DM pts
All other weight related co-morbs should be assessed individually
Acknowledged impact on plastic surgery

4. NPF Guidelines- Criteria
Priority Group 1
Age: yrs
BMI: kgs/m²
T2DM: < 5 yrs
5kgs WL
6 months WM
HbA1c <9%
All others assessed with
Priority Group 2
Age: yrs
BMI: kgs/m²
T2DM: < 5yrs
5kgs WL
6 months WM
HbA1c <9%
individual assessments

5. Current Patient Pathway
Referred by GP to Tier 3 (community weight management service)
Completes Tier 3 (7 group sessions) with 2.5% weight loss
Completes Tier 4 Advanced weight management
(3 group sessions) with weight maintenance
Presentation at JMDT
Confirmed for Tier 5 ( assessment for bariatric surgery)

6. Bariatric Pathway (Tier 5)
Invited to Information Seminar
Patient to opt-in to Intensive Pre-op Information Course (IPIC)
Commences IPIC:
6 sessions fortnightly (attend 5/6),
5 % weight loss target
Encouraged to keep food diary
Gradual reduction in intake with augmented Pre-op Diet plan

7. Bariatric Pathway (Tier 5)
If 5 % WL achieved goes on to have:
Psychological Assessment
Surgical Assessment
Anaesthetic Assessment
Surgical date offered
No current waiting list for surgery
Presented to JMDT: 85
numbers: 29

8. Diabetic Numbers 2016-17 Progressed to Surgery: PG1: 0 PG2: 1
T2DM: 4 (13.8%)
Discussed at JMDT:
PG1: 1
T2DM: 3

9. Diabetic Outcomes 4 T2DM Age 41-51 yrs 3 LSG /1 LGB
3-10 months post-op
All of all medications
HbA1c reduction range %
EWL: %

10. Future Developments Target PG1/ PG2 patient group
Revise weight management pathway