Adult weight management pathway

Scope

This guidance covers referrals into weight management for Adults of 18 years or more and follows NICE guidance.

The Tier 3 service is not a bariatric surgery clinic.

All referrals to Tier 3 will have an initial assessment to ensure the service is the most appropriate placement for them.

Onward referral for bariatric surgery may be made for patients aged 18 or more who have engaged with the Tier 3 service to lose weight over an agreed period. All referrals for bariatric surgery will be assessed by the Joint Tier 3 and Bariatric Service Multi Disciplinary Team (MDT).

This is the only route for NHS funded surgery in Devon.

As there are major implications for both, it is important that the GP and the patient understand what is involved if referral to the Tier 3 and Tier 4 services is accepted.

This is particularly true for Tier 4 (bariatric surgery) treatment which has life long consequences for the patient and long term prescribing and monitoring responsibilities for the GP.

Please see the links below:

There is a wealth of patient focused information on the MyHealth website which will help support your patient to make the right decisions for them.

Please consider referring them to this MyHealth-Devon: Obesity

Out of scope

  • Patients who are not registered with a Devon GP
  • In Devon, there is currently no weight management service for people below 18
  • For under 18s consider a referral to paediatrics or a dietician
  • Pregnant women
  • Patients who are unwilling or unable to engage with the complexities of the service e.g. active psychosis, suicidal ideation severe learning difficulties (please assess suitability of Mental Health and Learning Disability patients and contact a member of Weight Management team if required on 01392 402294)

Assessment

History and examination

  • Ensure patient is ready to make behaviour change
  • Assess patient's BMI
    • (For patients who are South Asian, Chinese, Black African or Caribbean, lower BMI thresholds should be applied. For all BMI thresholds use 2.5kg/m2 less. E.g: BMI 35 equivalent to 32.5.)(This advice comes from NICE and relates to a greater propensity in these ethnic groups to develop diabetes and its complications)
  • Blood pressure (BP) – use appropriate size cuff
  • Heart rate and rhythm
  • Check for signs of cardiovascular, abdominal, respiratory and endocrine disorders, e.g. hypothyroidism, steroid excess, acanthosis nigricans
  • Oxygen saturation measurement

Investigations

If BMI is more than 35kg/m2 consider the following

  • Full blood count (FBC)
  • Urea and electrolytes (U&Es)
  • BP
  • Fasting lipid profile
  • HbA1C
  • Thyroid function test including TSH
  • Liver function test – including alanine transaminase (ALT)

The results of these investigations must be included in any referral to Tier 3.

Management

As there are major implications for both, it is important that the GP and the patient understand what is involved if referral to the Tier 3 and Tier 4 services is accepted.

This is particularly true for Tier 4 (bariatric surgery) treatment which has lifelong consequences for the patient and long term prescribing and monitoring responsibilities for the GP.

Please see the links below

There is a wealth of patient focused information on the MyHealth website which will help support your patient to make the right decisions for them.

Please consider referring your patient to MyHealth-Devon: Obesity

Referral

Referral criteria

Tier 1&2
  • South Devon and Torbay and North East and West Devon For 18 years of age and older, with BMI 25 – 40kg/m2 refer to OneSmallStep
Tier 3

The following results must be included in any referral to Tier 3 or the referral will be returned to the practice:

  • Full blood count (FBC)
  • Urea and electrolytes (U&Es)
  • BMI
  • BP
  • Fasting lipid profile
  • HbA1C
  • Thyroid function test including TSH
  • Liver function test – including alanine transaminase (ALT)

Patients 18 years or more with a BMI greater than 40kg/m

Patients aged 18 years or more with newly diagnosed (within the last 4 years) type 2 diabetes and have a BMI greater than 30kg/m

Patients with BMI greater than 35kg/m and one or more of the following comorbidities:

  • Established (over 4 years) Type 2 diabetes or previous gestational diabetes
  • Hyperlipidaemia uncorrected by maximum tolerated doses of Statins
  • Sleep apnoea
  • Gastro-oesophageal reflux disease (GORD) after assessment by a GI surgeon
  • Severe Osteoarthritis requiring listing for joint replacement
  • Intracranial hypertension Infertility in which weight is a barrier to therapy
  • Non-alcoholic steatohepatitis (NASH)

Referral instructions

For South Devon and Torbay and Northern Eastern and Western Devon patients refer to Tier 1&2 OneSmallStep - link

Referral to Tier 3 Weight Management

e-Referral service selection:

Referral forms

DRSS Referral forms

Supporting Information

Patient information

Pathway Group

This guideline has been signed off by the Eastern Locality and the Devon Weight Management Group on behalf of Devon CCG.

Publication date: May 2019

 

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