Guidance:
1.1 For the purposes of this guidance, people are defined as having morbid obesity if they have a body mass index (BMI) either equal to or greater than 40 kg/m2, or between 35 kg/m2 and 40 kg/m2 in the presence of significant co-morbid conditions that could be improved by weight loss.
1.2 People with morbid obesity who are considering surgery to aid weight reduction should discuss in detail with the clinician responsible for their treatment (that is, the hospital specialist and/or bariatric surgeon) the potential benefits and longer-term implications of surgery, as well as the associated risks, including complications and postoperative mortality.
1.3 Surgery is recommended as a treatment option for people with morbid obesity providing all of the following criteria are fulfilled: - this type of surgery should be considered only for people who have been receiving intensive management in a specialised hospital obesity clinic - individuals should be aged 18 years or over - there should be evidence that all appropriate and available nonsurgical measures have been adequately tried but have failed to maintain weight loss - there should be no specific clinical or psychological contraindications to this type of surgery - individuals should be generally fit for anaesthesia and surgery - individuals should understand the need for long-term follow-up.
1.4 Surgery should be undertaken only after comprehensive, multidisciplinary assessment. In addition, arrangements should be made for appropriate healthcare professionals to provide pre-operative and postoperative counselling and support to individuals being considered for surgery.
1.5 Given the uncertainty surrounding the evidence for the relative safety and effectiveness of different surgical interventions, it is not possible to distinguish between them on grounds of cost effectiveness. The choice of surgical intervention should therefore be made jointly by the individual and the clinician after considering the best available evidence, the facilities and equipment available, and the experience of the surgeon who would perform the operation.
1.6 Databases should be established by hospitals wanting to develop their service, to enable the outcomes and complications of different procedures, including their impact on quality of life, to be monitored both in the short and long term.
1.7 It is important that services and skills to support surgery for people with morbid obesity are developed in a planned and coordinated way. Existing collective mechanisms for specialist commissioning groups may offer an appropriate way for the development of detailed implementation strategies. Each group, in discussion with other groups, should decide how best to develop and expand the service, and the number of sites from which it should be provided.