Policy number: MSEICB 075
Policy name: Specialist Obesity Services
Status: Group Prior Approval
Effective date: 1 April 2023
Next review date: 1 April 2024
Mid and South Essex ICB commissions specialist obesity services on a restricted basis, including Bariatric Surgery.
Patients may be referred for assessment and subsequent treatment by Specialist Obesity Services in line with service specification, which include assessment for bariatric surgery, if they meet ALL the following criteria:
- Patient is 18 year or older.
- The person has a body mass index (BMI) of 40 kg/m2 or more without comorbidities, OR between 35 kg/m2 and 40 kg/m2 and other significant diseases (for example type 2 diabetes, hypertension, cardiovascular disease, osteoarthritis, dyslipidaemia, and sleep apnoea) that could be improved if they lost weight.
- The person has completed Tier Three weight management service including the maintenance period, and the person has not achieved or maintained adequate, clinically beneficial weight loss. (A tier three service is a weight management programme that supports adults with severe and complex obesity to lose weight through a range of interventions including psychological approaches and dietary changes)
- GP has addressed and optimised management of any underlying clinical conditions which may be affecting weight management in the patient:
– hormone problems such as underactive thyroid, Cushing’s syndrome, polycystic ovarian syndrome (PCOS)
– substance misuse
– lack of sleep- exclude obstructive sleep apnoea – Epworth score of 10 or less
– depression- patients with a score of more than 17 on PHQ9 screening tool must be referred to IAPT and condition managed before referral
– alcohol consumption-refer to http://openroad.org.uk and condition managed before referral
Obesity surgery for children and adolescents is commissioned by NHSE.
Patients not meeting the above criteria will not be funded unless there are clinically exceptional circumstances.
Individual funding requests should only be made where the patient demonstrates clinical exceptionality.
Further information on applying for funding in exceptional clinical circumstances can be found on the ICS’ website.
A downloadable version of this document is available below: