Tier 3 Clinic
Significant long-term weight loss without surgery
1 in 500 only
LAGB, LRYGB and LSG all have..
5-8% risk, bands lifetime, others in initial few days
Beware those with …
BMI >67, severe mental health issues, chronic pain, immobility, previous major abdo surgery
A structure for consultations:
Expectations
Learning about obesity as a chronic, progressive disease
Behavioural changes in diet and physical activity
Health benefits of weight loss
Motivational system – cues, settings and the risk of excessive calories and restraint
Influencing factors – stress, fatigue, mood, alcohol, weight promoting medications
Responding to setbacks
Aim Of The Clinic
Patient Details
Demographic measurements:
– Height, weight, BMI
– Blood pressure, O2 Sats
– Malampatti Score
Blood Test Results:
– HbA1c, Cholesterol, Triglycerides, HDL, LDL,
Vitamin D
Co-morbidities:
– T2DM, Treated HTN, OSA, IHD
– Idiopathic intracranial hypertension
– Endometrial ca.
Previous Surgical History
Medications
Weight Related Questions
When did your weight problem start?
(Teenage years and onwards in most cases…)
When did it become an issue?
If a problem since childhood = genetic testing?
What methods of weight loss have you tried in the past?
Whats the most weight you’ve managed to lose?
What are your triggers for eating?
What would you say are the typical foods that are
your weakness?
Diabetes in the family?
BP issues?
Heart attack/stroke?
Problems with breathing/daytime tiredness/snoring?
Regular medications?
Previous operations/scars?
Smoke/alcohol? (Non-nicotine vaping acceptable)
Family history?
Other Issues to consider:
Vitamin D needs to be treated and shown to be
improved prior to surgery
Concluding:
We’ll let the dietician and psychologist continue with
their assessments and treatment and get in touch in
a few months to see how you’re getting on.