Clinical update
Bariatric surgery ALAMY
Essential facts Type 2 diabetes is linked closely to obesity. Bariatric surgery can lead to dramatic improvements in the management of the condition, according to the National Institute for Health and Care Excellence (NICE). There are two main types of bariatric surgery. A gastric band procedure uses a band to reduce the size of the stomach so a smaller amount of food is required to make the patient feel full. A gastric bypass is where the digestive system is re-routed past most of the stomach so less food is digested.
NICE draft on obesity guidelines update (2014) www.nice.org.uk/guidance/ GID-CGWAVE0682/ Consultation NICE obesity pathway pathways.nice.org.uk/ pathways/obesity Diabetes UK www.diabetes.org.uk
What’s new NICE is proposing an expansion of bariatric surgery in England to tackle the rise in type 2 diabetes. The draft guidelines say an assessment for bariatric surgery should be offered to people who have been diagnosed in the past ten years with type 2 diabetes and who are obese, with a BMI of 35 or higher. Surgery should be considered for those with a BMI of above 30. People with a lower BMI from an Asian background, who are at greater risk of type 2 diabetes, may also be eligible. Diabetes UK estimates up to 850,000 people could be eligible to be considered for surgery, but NICE expects the figure to be nearer 20,000 additional operations a year.
Causes/risk factors According to NHS Choices, the risks include complications immediately after surgery, such as blood clots and infections, excess skin from weight loss, and gallstones. Stomal stonasis, when a piece of food blocks the stoma between the stomach and the small intestine, is a common problem after gastric bypass. Patients
Expert comment Yasmin Ferguson is a bariatric clinical nurse specialist at Musgrove Park Hospital in Taunton, Somerset
Find out more
may also experience psychological problems. There is a 1 in 2,000 chance of dying shortly after a gastric band procedure, and a 1 in 100 chance of dying shortly after a gastric bypass.
Benefits NICE says evidence suggests that surgical intervention is more effective than standard care at achieving weight loss, reducing the use of diabetic medicine, increasing remission of diabetes, and improving diabetic control.
How can you help your patients Patients should be treated sensitively, and with respect and dignity. Nurses report that obese people experience prejudice and insensitivity daily, and that healthcare staff are among the culprits. It is important to have a non-judgmental approach to obese patients, many of whom have problems with self-esteem and confidence. Know the referral pathway for weight management services in your area, which will be generally be carried out through the GP.
‘It it is good news that more people may potentially receive bariatric surgery in the future. It can save the NHS money in the long term through the health improvements it brings about. However, patients need to understand that surgery is not a quick fix and that they will have to make sustainable lifestyle changes for the rest of the their lives.
British Obesity Surgery Patients Association www.bospauk.org Articles from Nursing Standard: Bariatric surgery: an overview Green N (2012) rcnpublishing.com/ doi/abs/10.7748/ ns2012.05.26.36.48.c9088 Bariatric surgery: nutritional considerations for patients Rickers L, McSherry C (2012) rcnpublishing.com/ doi/abs/10.7748/ ns2012.08.26.49.41.c9235
‘There needs to be a robust process before surgery to ensure patients are prepared psychologically and physically. It is still not clear whether we should offer gastric bands or bypasses to patients, but there is a major randomised trial currently going on that will give us good data on the best option.’
NURSING august 20other :: voluses 28 without no 51 ::permission. 2014 19 DownloadedSTANDARD from RCNi.com by ${individualUser.displayName} on Nov 23, 2015. For personal use only. No Copyright © 2015 RCNi Ltd. All rights reserved.
Bariatric surgery ALAMY
Essential facts Type 2 diabetes is linked closely to obesity. Bariatric surgery can lead to dramatic improvements in the management of the condition, according to the National Institute for Health and Care Excellence (NICE). There are two main types of bariatric surgery. A gastric band procedure uses a band to reduce the size of the stomach so a smaller amount of food is required to make the patient feel full. A gastric bypass is where the digestive system is re-routed past most of the stomach so less food is digested.
NICE draft on obesity guidelines update (2014) www.nice.org.uk/guidance/ GID-CGWAVE0682/ Consultation NICE obesity pathway pathways.nice.org.uk/ pathways/obesity Diabetes UK www.diabetes.org.uk
What’s new NICE is proposing an expansion of bariatric surgery in England to tackle the rise in type 2 diabetes. The draft guidelines say an assessment for bariatric surgery should be offered to people who have been diagnosed in the past ten years with type 2 diabetes and who are obese, with a BMI of 35 or higher. Surgery should be considered for those with a BMI of above 30. People with a lower BMI from an Asian background, who are at greater risk of type 2 diabetes, may also be eligible. Diabetes UK estimates up to 850,000 people could be eligible to be considered for surgery, but NICE expects the figure to be nearer 20,000 additional operations a year.
Causes/risk factors According to NHS Choices, the risks include complications immediately after surgery, such as blood clots and infections, excess skin from weight loss, and gallstones. Stomal stonasis, when a piece of food blocks the stoma between the stomach and the small intestine, is a common problem after gastric bypass. Patients
Expert comment Yasmin Ferguson is a bariatric clinical nurse specialist at Musgrove Park Hospital in Taunton, Somerset
Find out more
may also experience psychological problems. There is a 1 in 2,000 chance of dying shortly after a gastric band procedure, and a 1 in 100 chance of dying shortly after a gastric bypass.
Benefits NICE says evidence suggests that surgical intervention is more effective than standard care at achieving weight loss, reducing the use of diabetic medicine, increasing remission of diabetes, and improving diabetic control.
How can you help your patients Patients should be treated sensitively, and with respect and dignity. Nurses report that obese people experience prejudice and insensitivity daily, and that healthcare staff are among the culprits. It is important to have a non-judgmental approach to obese patients, many of whom have problems with self-esteem and confidence. Know the referral pathway for weight management services in your area, which will be generally be carried out through the GP.
‘It it is good news that more people may potentially receive bariatric surgery in the future. It can save the NHS money in the long term through the health improvements it brings about. However, patients need to understand that surgery is not a quick fix and that they will have to make sustainable lifestyle changes for the rest of the their lives.
British Obesity Surgery Patients Association www.bospauk.org Articles from Nursing Standard: Bariatric surgery: an overview Green N (2012) rcnpublishing.com/ doi/abs/10.7748/ ns2012.05.26.36.48.c9088 Bariatric surgery: nutritional considerations for patients Rickers L, McSherry C (2012) rcnpublishing.com/ doi/abs/10.7748/ ns2012.08.26.49.41.c9235
‘There needs to be a robust process before surgery to ensure patients are prepared psychologically and physically. It is still not clear whether we should offer gastric bands or bypasses to patients, but there is a major randomised trial currently going on that will give us good data on the best option.’
NURSING august 20other :: voluses 28 without no 51 ::permission. 2014 19 DownloadedSTANDARD from RCNi.com by ${individualUser.displayName} on Nov 23, 2015. For personal use only. No Copyright © 2015 RCNi Ltd. All rights reserved.
