referral from primary care - adult obesity

Last reviewed 10/2021

• Referral to specialist care should be considered if:
  • the underlying causes of overweight and obesity need to be assessed
  • the person has complex disease states and/or needs that cannot be managed adequately in either primary or secondary care
  • conventional treatment has failed in primary or secondary care
  • specialist interventions (such as a very-low-calorie diet for extended periods) may be needed, or
  • surgery is being considered

Referrral regarding bariatric surgery:

• bariatric surgery is a treatment option for people with obesity if all of the following criteria are fulfilled:
  • they have a BMI of 40 kg/m2 or more, or between 35 kg/m2 and 40 kg/m2 and other significant disease (for example, type 2 diabetes or high blood pressure) that could be improved if they lost weight
  • all appropriate non-surgical measures have been tried but the person has not achieved 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
    
    
• bariatric surgery is the option of choice (instead of lifestyle interventions or drug treatment) for adults with a BMI of more than 50 kg/m2 when other interventions have not been effective
  
  
• bariatric surgery for patients with type 2 diabetes
  • an expedited assessment for bariatric surgery should be offered to people with a BMI of 35 or over who have recent-onset type 2 diabetes as long as they are also receiving or will receive assessment in a tier 3 service (or equivalent
    
    
  • consider an assessment for bariatric surgery for people with a BMI of 30-34.9 who have recent-onset type 2 diabetes as long as they are also receiving or will receive assessment in a tier 3 service (or equivalent)
    
    
  • consider an assessment for bariatric surgery for people of Asian family origin who have recent-onset type 2 diabetes at a lower BMI than other populations as long as they are also receiving or will receive assessment in a tier 3 service (or equivalent)

Reference:

1. NICE (November 2014).Obesity: identification, assessment and management of overweight and obesity in children, young people and adults