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NICE-Accredited Commissioning Guidance for Weight Assessment and Management Clinics: a Model for a Specialist Multidisciplinary Team Approach for People with Severe Obesity

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Abstract

Despite increasing prevalence of obesity, no country has successfully implemented comprehensive pathways to provide advice to all the severely obese patients that seek treatment. We aimed to formulate pathways for referral into and out of weight assessment and management clinics (WAMCs) that include internal medicine/primary care physicians as part of a multidisciplinary team that could provide specialist advice and interventions, including referral for bariatric surgery. Using a National Institute of Health and Care Excellence (NICE)-accredited process, a Guidance Development Group conducted a literature search identifying existing WAMCs. As very few examples of effective structures and clinical pathways existed, the current evidence base for optimal assessment and management of bariatric surgery patients was used to reach a consensus. The model we describe could be adopted internationally by health services to manage severely obese patients.

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Authors and Affiliations

  1. Department of Upper GI and Bariatric Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK

    Richard Welbourn

  2. Baker IDI Heart and Diabetes Institute, Melbourne, Australia

    John Dixon

  3. Chemical Pathology and Metabolic Medicine, Leeds General Infirmary, Leeds, LS1 3EX, UK

    Julian H. Barth

  4. UCLH Centre for Weight Loss, Metabolic and Endocrine Surgery, University College London Hospitals, 250 Euston Rd., London, NW1 2PG, England, UK

    Nicholas Finer

  5. Fakenham Weight Management Service, University of East Anglia, Norfolk, NR21 8SW, UK

    Carly A. Hughes

  6. Conway Institute, Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland

    Carel W. le Roux

  7. Royal College of Physicians of London, 11 St Andrews Place, Regent’s Park, London, NW1 4LE, England, UK

    John Wass

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  1. Richard Welbourn
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  3. Julian H. Barth
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  4. Nicholas Finer
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Correspondence to Richard Welbourn.

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The article does not contain any studies with human participants or animals performed by any of the authors. Informed consent does not apply to the paper.

Conflict of Interest

RW received sponsorship for attending conference/educational workshops from Ethicon Endo-Surgery, member of the National Obesity Advisory Board, Novo Nordisk; Past President of the British Obesity and Metabolic Surgery Society (unpaid), Chair of the UK National Bariatric Surgery Registry (unpaid) and GDG member of NICE Guidance update CG189, 2014 (unpaid). Musgrove Park Hospital, Taunton UK, received funding for a bariatric surgery training fellowship from Ethicon Endo-Surgery.

JD is a consultant for Apollo Endosurgery, and Bariatric Advantage, and is a member of the Optifast® Medical Advisory Board for Nestle Health, Australia, and the Specialist Obesity and GP Obesity Advisory Boards for Novo Nordisk. He has been supported to provide educational programs and develop educational material for iNova Pharmaceuticals. He has received speakers’ fees from Novo Nordisk, iNova Pharmaceuticals and Eli Lilly and fees as a co-director of the Metabolic/Bariatric programme of the Minimally Invasive Surgery Symposium.

JHB received fees for consultancy from Slimming World and Lighterlife and for research from Roche Counterweight Project.

NF received fees for consultancy, sponsorship for meeting attendance or lecture fees from Novo Nordisk, Janssen, Vivus and Arena; shares in Counterweight PLC, current value nil; Editor-in-Chief in Clinical Obesity, the official journal of World Obesity Federation, published by Wiley; Medical Advisor to Weight Concern (unpaid), a charitable organisation; and received unrestricted CME grant from the International Medical Press.

CWleR received fees for consultancy from Novo Nordisk and Herbalife Advisory Boards and speaker fees from Novo Nordisk, AstraZeneca, Lilly and Boehringer Ingelheim.

CAH received fees for consultancy from Orexigen, Mundipharma, Oviva, Janssen and Ethicon; an education grant from Nutricia; GDG member of NICE Guidance update CG189, 2014 and NICE quality standards Obesity 2015 (unpaid); a co-opted member of board of the Association for the Study of Obesity; and a medical advisor to KasTech (unpaid).

JW declared no conflict of interest.

Funding Declaration

The Department of Health Right Care initiative funded the costs of the Guidance Development Group and literature searches and contributed towards administrative costs. The Royal College of Surgeons of England and the British Obesity and Metabolic Surgery Society provided staff to support the guideline development.

Sponsoring Organisations

This study was sponsored by Royal Colleges of Surgeons of England, Royal College of Physicians (London), Royal College of General Practitioners, Royal College of Pathologists, Royal College of Psychiatrists, Faculty of Public Health, British Obesity and Metabolic Surgery Society, British Dietetic Association, British Psychological Society, National Obesity Forum.

Additional information

Other members of the Guidance Development Group are included in the Web version of the full guidance.

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Welbourn, R., Dixon, J., Barth, J.H. et al. NICE-Accredited Commissioning Guidance for Weight Assessment and Management Clinics: a Model for a Specialist Multidisciplinary Team Approach for People with Severe Obesity. OBES SURG 26, 649–659 (2016). https://doi.org/10.1007/s11695-015-2041-8

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