ELIGIBILITY

ELIGIBILITY

Eligibility criteria were first proposed by the US National Institutes of Health in 1991, when the obesity epidemic was first recognised. All bariatric surgery was done by open lapa rotomy , and the safety profile was very di ff erent. The National Institute for Health and Care Excellence (NICE) in the UK recommends consideration of bariatric surgery f or people with severe obesity in whom all non-surgical measures have been tried with no adequate weight loss achieved or maintained. Commitment to long-term follow-up and behaviour change are also advised. After a review of recent RCTs, NICE updated its guidance and lowered the BMI threshold to 30 /uni00A0 kg/m recent-onset type 2 diabetes ( Table 68.3 ). The criteria accord ing to the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Asia Pacific chapter for Asian patients include lower BMI thresholds because of the suscepti bility of Asian populations to type 2 diabetes at a lower BMI. - NICE estimated that about 80% of people fulfilling the eligibility criteria would have no medical or psychological rea - son why they would not be fit for surgery . An estimate is that perhaps 10% of these might want it, if bariatric/metabolic surgery were to be promoted or recommended by physicians to patients. -

TABLE 68.3 Summary of updates to National Institute for Health and Care Excellence (NICE) guidance on bariatric surgery, 2014 (CG189). Bariatric surgery is a treatment option for anyone with BMI ≥ 40 2 kg/m Offer an expedited assessment for people with BMI ≥ 35 /uni00A0 kg/m with onset of type 2 diabetes in past 10 years Consider an assessment for people with BMI of 30–34.9 /uni00A0 kg/m with onset of type 2 diabetes within 10 years Consider an assessment for people of Asian origin with onset of type 2 diabetes at a lower BMI than other populations Bariatric surgery is the option of choice for adults with BMI 2

50 /uni00A0 kg/m when other interventions have not been effective People /f_i tting the above criteria are also required to be receiving or to receive assessment in a specialist weight management service before referral to a surgical team BMI, body mass index. Excellence (NICE)-accredited guidance on the make-up of the medical and surgical bariatric multidisciplinary team. Bariatric physician in primary (can be the general practitioner) or secondary care (usually a diabetologist) Dietician Specialist nurse Appropriately trained mental health professional Bariatric surgeon Anaesthetist Radiologist ± Exercise therapists Other secondary care specialties, e.g. respiratory/sleep medicine, cardiology