BACKGROUND
Obesity rates in the UK are high with over one-quarter of adults being classified as obese.1 Obesity is associated with a number of medical comorbidities, including type 2 diabetes mellitus, hypertension, obstructive sleep apnoea, and osteoarthritis. Consequently, obesity is linked with increased cardiovascular morbidity and mortality, cancer, functional impairment, and premature death, placing a financial burden on the NHS.
Bariatric surgery has been demonstrated to be the most effective method for substantial and sustained weight loss, with a significant reduction in obesity-related comorbidities and long-term mortality.2 As a result, bariatric surgery rates are increasing in the UK for patients who have failed to respond to non-surgical therapies. GPs will therefore see an increasing number of patients with severe obesity who wish to be referred for surgery.
ROLE OF THE GP
GPs play a pivotal role in the management of obesity with early referral of motivated individuals who have failed to achieve substantial weight loss. Further, given the high level of psychosocial disorders in this patient group it is important to make an early assessment and provide support if appropriate. The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) reported that only 29% of patients received psychological input, which mostly occurred following referral.3
Indications for bariatric surgery have been clearly defined by National Institute for Health and Care Excellence (NICE).4 However, in light of new evidence NICE has recently issued draft guidance on the management of obesity.5 As bariatric surgery has been demonstrated to improve glycaemic control and even remission of type 2 diabetes, NICE recommends that obese patients (body mass index [BMI] 30–34.9) with recent-onset type 2 diabetes (within the past 10 years) may benefit from surgery. Furthermore, patients of Asian origin with recent-onset type 2 diabetes may benefit from bariatric surgery at a lower …