Quality statement 5: Referring adults for bariatric surgery assessment

Quality statement

Adults with a BMI above 50 are offered a referral for bariatric surgery assessment.

Rationale

Bariatric surgery can improve quality of life and reduce the risk of premature mortality, and is the main option of choice for adults with a BMI above 50. There are additional criteria that need to be met before making a referral for bariatric surgery including, for example, whether a person has received (or will receive) appropriate intensive management and whether there is a commitment to long-term postoperative follow-up. Assessing all these criteria will identify people with a BMI above 50 who could benefit from bariatric surgery.

Quality measures

Structure

Evidence of local arrangements and written clinical protocols to ensure that adults with a BMI above 50 are offered a referral for bariatric surgery assessment.

Data source: Local data collection.

Process

Proportion of adults with a BMI above 50 who are referred for bariatric surgery assessment.

Numerator – the number in the denominator who are referred for bariatric surgery assessment.

Denominator – the number of adults with a BMI above 50.

Data source: Local data collection.

Outcome

Bariatric surgery assessments for adults with a BMI above 50.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (primary, community-based and secondary care tier 3 services or equivalent) ensure that adults with a BMI above 50 are offered a referral for bariatric surgery assessment.

Healthcare professionals ensure that adults with a BMI above 50 are offered a referral for bariatric surgery assessment.

Commissioners (NHS England and clinical commissioning groups) ensure that services that they commission offer a referral for bariatric surgery assessment to adults with a BMI above 50.

What the quality statement means for patients and carers

Adults whose body mass index (a measure of height and weight, usually shortened to BMI) is more than 50 are offered a referral to find out if they could benefit from an operation to help them lose weight (called bariatric surgery).

Source guidance

Definitions of terms used in this quality statement

BMI

BMI is calculated by dividing weight (in kilograms) by the square of height (in metres).

[Adapted from Obesity: identification, assessment and management (NICE guideline CG189), recommendation 1.2.12]

Referral for bariatric surgery assessment

The assessment aims to establish whether bariatric surgery is suitable for the person. Bariatric surgery is a treatment option for people with obesity if all of the following criteria are fulfilled:

  • All appropriate non-surgical measures have been tried but the person has not had or maintained adequate, clinically beneficial weight loss.

  • The person has been receiving or will receive intensive management in a tier 3 service.

  • The person is generally fit for anaesthesia and surgery.

  • The person commits to the need for long-term follow-up.

[Adapted from Obesity: identification, assessment and management (NICE guideline CG189), recommendation 1.10.1]

Equality and diversity considerations

People of Asian family origin have comorbidity risk factors that are of concern at BMIs different from those of the general population. Clinical judgement is needed when considering risk factors in these groups. Assessment for bariatric surgery for people of Asian family origin should be considered at a lower BMI than other populations.

[Obesity: identification, assessment and management (NICE guideline CG189), recommendation 1.11.3]

Surgical intervention is not generally recommended for children and young people. Bariatric surgery may be considered for young people only in exceptional circumstances and if they have reached or nearly reached physiological maturity.

[Obesity: identification, assessment and management (NICE guideline CG189), recommendations 1.10.12 and 1.10.13]