Bariatric surgery first line if BMI is over 50

Bariatric surgery should be offered as first-line therapy to adults with a BMI of 50 or above, and should be considered for all severely obese patients, according to draft NICE recommendations.

Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, duodenal switch BDP and staged surgery are among the interventions that NICE has recommended for the treatment of those with a BMI of 50 in its draft guidance on obesity.

The guideline states that bariatric surgery should also be considered for patients with a BMI of at least 40, or of 35 with life-threatening co-morbidities, if they are fit for anaesthesia and surgery and have not achieved or maintained clinically beneficial weight loss for at least six months despite receiving intensive management in a specialist obesity service.

Dr Ian Campbell, a Nottingham GP with an interest in obesity, said that although bariatric surgery was a drastic measure, it was highly successful.

'For the very morbidly obese, it is the one form of weight loss which has been proven to work,' he said. 'The results in terms of reducing BP, blood glucose and cholesterol are phenomenal.'

Meanwhile, a study presented at last week's meeting of the American College of Cardiology in Atlanta has shown that Roux-en-Y gastric bypass surgery can cut cardiovascular risk.

The US study showed that the risk of death or cardiovascular event over 10 years in 197 patients who had the surgery halved in the 3.3 years following the procedure.

Their 10-year risk dropped from 37 per cent to 18 per cent whereas a control group still had a 30 per cent 10-year risk.

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