Ten Top Tips for the management of patients post-bariatric surgery in primary care

Obesity is recognised as a major health and economic issue for the NHS. The rate of severe obesity with BMI >40 is increasing rapidly and these patients have a disproportionate increase in health and social care needs. NICE recognises bariatric surgery as an appropriate and cost-effective treatment for this group of patients and the number of surgical procedures is likely to increase. With a lack of commissioned local Tier 3 weight management services many of these patients may be lost to follow-up and be at risk of nutritional deficiencies and metabolic complications. The RCGP Nutrition Group has developed these guidelines in response to this problem. Patients who have had their procedure carried out under the NHS have follow up within specialist services for the first 1-2 years post surgery. These guidelines are aimed at all nonspecialist clinicians, dietitians and nurses to aid management of these patients once they are discharged back to primary care and aid management of any patients where follow up guidance by the surgical team was not issued. Please note that patients who have moved area or who undergo a private procedure are likely to have had less specialist follow up and may need to be managed in primary care earlier post procedure. Any new concerns should always trigger referral to a Tier 3 weight management service (if available) or the local bariatric surgical team for further advice.