Quality standard

Quality statement 5: Referring adults for bariatric surgery assessment

Quality statement 5: Referring adults for bariatric surgery assessment

Quality statement

Adults with a body mass index (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, 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 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. 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 follow-up after surgery. Assessing all these criteria will identify people with a qualifying BMI who could benefit from bariatric surgery.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

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

Data source: Evidence can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from service pathways and protocols.

Process

a) Proportion of adults with a BMI of 40 kg/m2 or more 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 of 40 kg/m2 or more.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

b) Proportion of adults with a BMI of between 35 kg/m2 and 39.9 kg/m2 with a significant health condition that could be improved if they lost weight 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 of between 35 kg/m2 and 39.9 kg/m2 with a significant health condition that could be improved if they lost weight.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

Outcome

Bariatric surgery assessments for adults with 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.

Data source: National Obesity Audit bariatric surgical procedures includes data on the number of NHS funded bariatric surgical procedures delivered in England.

What the quality statement means for different audiences

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

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

Commissioners ensure that services that they commission offer a referral for bariatric surgery assessment to adults with a qualifying BMI.

Adults whose body mass index (a measure of height and weight, usually shortened to BMI) of 40 kg/m 2 or more, or between 35 kg/m 2 and 39.9 kg/m 2 with a significant health condition that could be improved if they lost weight, are offered a referral to find out if they could benefit from an operation to help them lose weight (called bariatric surgery).

Source guidance

Obesity: identification, assessment and management. NICE guideline CG189 (2014, updated 2023), recommendation 1.10.1

Definitions of terms used in this quality statement

Significant health condition that could improve after bariatric surgery

Conditions that could improve after bariatric surgery include:

These examples are based on the evidence identified for the NICE guideline on obesity: identification, assessment and management, and the list is not exhaustive. [NICE's guideline on obesity: identification, assessment and management, recommendation 1.10.1 and box 2]

Referral for bariatric surgery assessment

The comprehensive, multidisciplinary assessment aims to establish whether bariatric surgery is suitable for the person. It assesses:

  • the person's medical needs (for example, existing comorbidities)

  • their nutritional status (for example, dietary intake, and eating habits and behaviours)

  • any psychological needs that, if addressed, would help ensure surgery is suitable and support adherence to postoperative care requirements

  • their previous attempts to manage their weight, and any past response to a weight management intervention (for example, provided by a specialist weight management service)

  • any factors that may impact their response to surgery (for example, language barriers, learning disabilities and neurodevelopmental disabilities, deprivation and other factors of health inequalities)

  • whether any arrangements need to be made, based on the person's needs, ahead of surgery (for example, if they need additional dietary or psychological support, or support to manage existing or new comorbidities).

  • fitness for anaesthesia and surgery.

[Adapted from NICE's guideline on obesity: identification, assessment and management, recommendation 1.10.7]

Equality and diversity considerations

People of South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean family background who are prone to central adiposity 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 these family backgrounds who are prone to central adiposity should be considered at a lower BMI than other populations (reduced by 2.5 kg/m2). [NICE's guideline on obesity: identification, assessment and management, recommendation 1.10.2]

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. [NICE's guideline on obesity: identification, assessment and management, recommendations 1.10.21 and 1.10.22]