Hi michelle ive never done weight management before as I was a private patient. I don't mind doing the weight management my bmi is 45/46 and I have arthritis which I believe is classed as a comorb. Also having a sleep apnoea test soon, so I qualify to go straight into teir 3 which Is great. But im worried that although im accepted for that at the end of it all, when they refer me for bariatric surgery I will still be turned down as the threshold is bmi of 50 irrespective of comorbs and whether the patient has completed teir 3 or not. They work from different policies, here is the one they claim to be working to
Bariatric surgery is a treatment for appropriate, selected patients with severe and complex obesity that has not responded to all other non-invasive therapies. Within these patient groups bariatric surgery has been shown to be highly cost effective. Bariatric surgery is recommended by NICE as a first-line option for adults with a BMI of more than 50kg/m2, in whom surgical intervention is considered appropriate. However, it will be required that these patients also fulfil the criteria below. Selection criteria of patients for bariatric surgery should prevent perverse incentives for example patients should not become more eligible for surgery by increasing their body weight. Similarly the selection criteria should not forbid bariatric surgery for patients who have lost weight with non-surgical methods
Eligibility for bariatric surgery Surgery will only be considered as a treatment option for people with morbid obesity providing all of the following criteria are fulfilled: The individual is considered morbidly obese. For the purpose of this policy bariatric surgery will be offered to adults with a BMI of 40kg/m2 or more, or between 35 kg/m2 and 40kg/m2 or greater in the presence of other significant diseases. There must be formalised MDT led processes for the screening of co-morbidities and the detection of other significant diseases. These should include identification, diagnosis, severity/complexity assessment, risk stratification/scoring and appropriate specialist referral for medical management. Such medical evaluation is mandatory prior to entering a surgical pathway. Morbid/severe obesity has been present for at least five years. The individual has recently received and complied with a local specialist obesity service weight loss programme (non surgical Tier 3 / 4), described as follows: This will have been for duration of 12-24 months. For patients with BMI > 50 attending a specialist bariatric service, this period may include the stabilisation and assessment period prior to bariatric surgery. The minimum acceptable period is six months. The specialist obesity weight loss programme and MDT should be decided locally. This will be led by a professional with a specialist interest in obesity and include a physician, specialist dietician, nurse, psychologist and physical exercise therapist, all of whom must also have a specialist interest in obesity. There are different models of local MDT structure. Important features are the multidisciplinary, structured and organised approach, lead professional, assessment of evidence that all suitable non invasive options have been explored and trialled and individualised patient focus and targets. In addition to offering a programme of care the service will select and refer appropriate patients for consideration for bariatric surgery.
This makes me think the threshold for derby is 50 no matter what, which would mirror what the nurse said. If this is true I stand no chance irrespective of weight management, comorbs, or complications what a joke!
I feel so reassured coming on here. Catherine at the hospital stated that she didn't know what went of in the meeting, what evidence they had, or how they came to the conclusion that I don't qualify. I believe because im a revision, they aren't sure If I would get funding and because of that doubt they have said no. Things that qualify instantly are band erosion/slip, however my symptoms are not ov that, however they are still medical in my opinion. She also said that if I get funding via prior approval they will go ahead simple as that. So basically that's what im going to do, im due to get a phone call today to speak to my gp about prior approval. Im going to go in with the revision surgery policy, highlight which grounds I feel I should be on, and why. I understand its a touchy subject with the sensation as I could be lying about that, but my medical history shows that for those 2 years I committed easily to that life and consistently had a slow but steady loss. Untill that one fill when all hell broke loose. I really really hope they accept me, I would love to see the prior request document to think of what im going to put first, but cannot find it anywhere online.
