Indications

The National Institute of Clinical Excellence (NICE) guidelines issued in 2006 are typical of the indications for weight-loss surgery worldwide. They recommend that bariatric surgery be considered as an option in individuals with a BMI greater than 40 kg/m2 (or > 35 kg/m2 in the presence of significant co-morbidity which would be expected to improve with weight loss, such as Type 2 Diabetes mellitus). Bariatric surgery may be considered as a first-line option in individuals with BMI > 50 kg/m2.

However, many authorities use other cut-offs, such as BMI > 50 kg/m2, or BMI > 40 with recent onset type 2 diabetes mellitus (e.g., within 2 years).

The British Obesity Surgery Patient Association (BOSPA) have collected an excellent list of criteria followed by English PCTs, listed by individual PCT. The list is not complete, but if you have information regarding your own PCT or Hospital, please help them update the information.

Scottish data are currently being collected, and will be summarised here as soon as the information is available.

Contraindications and Cautions

Individuals medically unfit for general anaesthesia and abdominal surgery carry high risk of morbidity or mortality.

A history of poor compliance with medical treatment, appointment keeping or follow up instructions can prove dangerous following bariatric surgery.

Psychological contraindications to bariatric surgery include active or recent (within the past 12 months) psychosis; history of multiple suicide attempts within the past 5 years; alcohol or substance abuse; or borderline personality disorder.

Binge eating disorders and the use of food as emotional coping strategies may result in a delay in progression to surgery depending on mental health assessment/intervention.

Learning disability or significant cognitive impairment will impede the implementation of diet and lifestyle modifications essential to safe bariatric surgery outcomes.