Guidelines for psychological support pre- and post-bariatric surgery
Jane Ogden, Vanessa Snowden-Carr and Denise Ratcliffe
Research indicates that psychological factors are an integral part of the bariatric process. In line with this, several research teams have argued that bariatric patients require psychological input pre- and post-surgery and that surgery should only be undertaken by a multidisciplinary team (MDT) that can provide psychological support.
To date, however, although there are guidelines for the nutritional management of patients post-bariatric surgery, how weight management services should be structured and a quality statement by NICE on the need for appropriate follow care after surgery no guidelines exist for the provision of psychological support pre- and post-bariatric surgery. As a result we were approached by BOMSS council in September 2017 to produce guidelines for psychological support pre- and post-bariatric surgery.
This is now ongoing and involves the following steps:
i) Review of the evidence base;
ii) Expert input;
iii) Feedback from the BOMSS delegates;
iv) Feedback from the Special Interest Group (SIG);
v) Service user feedback;
vi) Presentation to BOMSS council;
vii) Presentation to the UK Association for the Study of Obesity (ASO).
To date, steps i – iv have been completed and a draft guidelines paper is being written for presentation to BOMSS. This describes three service models for the delivery of psychological support pre surgery, 9 months post surgery and for ongoing support up to 36 months post surgery.
The guidelines are founded upon the following principles to reflect both the existing evidence and the feedback we have received:
i) A living document: Due to the absence of strong evidence these guidelines are presented as a work in progress and should be considered a living document which can be amended in light on new research evidence and feedback from service providers and service users. This document will be therefore linked to an online blog where new evidence and feedback can be added so that the guidelines can be amended over time.
ii) Flexible and pragmatic: The guidelines are designed to be flexible and pragmatic as a means to aim towards a better service model which is feasible rather than an ideal service model which will never be implemented.
iii) Advisory: Given the concerns expressed in the feedback we received the guidelines are considered advisory rather than prescriptive.
iv) Broad based content: The service models presented involve a range of different types of psychological support which can be delivered using a range of modes such as face to face, online, workshops and groups.
v) Skills based delivery: Given the existing literature and feedback received in the development of these guidelines it is recommended that the different components of the service models are delivered by health care professionals deemed suitably skilled according to the necessary competencies rather than just by professional label.
It is hoped that the final guidelines will be presented at the ASO in September 2018, be available on this website and published in a peer review journal.
Certified bariatric nursing course
Bariatric Surgery is a great specialty to be working in. I have been working as a Bariatric Nurse Specialist in Cornwall for the last 8 ½ years and have loved every minute of it. One thing I have found challenging is learning everything I need to know to make this role work well for the patients I support and the hospital I work for. However hard I try to look for courses to gain that extra knowledge, I can never seem to find them. Recently BOMSS was approached by the ASMBS Bariatric Nurses, they are keen to support bariatric nursing education by helping us introduce a Certified Bariatric Nursing course into the UK.
I have been asked alongside Jenny Abraham from University Hospitals Coventry and Warwickshire to look at how this could work. There is a lot of work to do to bring this to fruition but it is a positive step towards improving our education and the care we can give our patients. We will be seeking support in the future to look at what we need to include to make it relevant to us in the UK.
Please contact us with areas of knowledge and competencies you feel should be included in a Bariatric Nurse Course. To capture your opinions and views on a Bariatric Nurse Course a survey will be published via BOMSS later in the year and we hope you will respond. If you are a bariatric nurse and would like to help with this project please feel free to email me Jeremy Gilbert email@example.com or Jenny Abraham Jenny.Abraham@uhcw.nhs.uk
These tweet chats are held on the fourth Wednesday of the month at 8pm. Recent topics have included physical activity hosted by Prof Paul Gateley, improving follow-up after bariatric surgery by Mary O’Kane and weight stigma by Dr Stuart Flint. Patient support groups led by Ken Clare and psychological issues by Dr Denise Ratcliffe will be future topics. Join us by following #obsmuk , Mr Zaher Toumi @ZaherToumi and Mary O’Kane @mpmok
IFSO integrated health
Dr Silvia Leite Faria led a webinar on Necessary Supplements following Bariatric Surgery. Mary O’Kane participated as a discussant. This is now available to IFSO members on the Virtual Academy page http://www.ifso.com/ifso-virtual-academy/ There are also a number of other educational awards of interest to IH members.
For the first time, five IH scholarships were made available for an IH member (one from each of the five IH chapters) to attend IFSO 2018. The successful award winners have now been informed. Congratulations to Sally Abbott, BOMSS member and dietitian, who as the EC successful winner will be attending IFSO 2018 in Dubai. We hope that IFSO will be in a position to offer IH scholarships again next year.
IFSO circulated an IH questionnaire to understand the needs of members and help plan future webinars and other educational events. Please complete it if you have not done so.
APPG on Obesity
Looking forward to seeing AHPs in Telford
Dr Yitka Graham, a senior lecturer in public health, has produced a ground-breaking piece of research into how bariatric patients adjust to life after surgery. Healthcare professionals will be able to use her findings to support patients pre- and post-operatively by raising awareness of issues that they may encounter in social situations, discussing how other patients have dealt with these situations and how they might cope themselves.
The study, carried out by researchers from the Faculty of Health Sciences and Wellbeing, University of Sunderland, looked at the experiences of patients who underwent bariatric surgery and how it affected their lives and social interactions. The researchers found that social aspects of bariatric surgery did not appear to be widely understood by those who had not undergone bariatric surgery.
So far there has been little research into patient experiences of daily life and social interactions after bariatric surgery. Now AHPs can look at the paper – ‘Patient experiences of adjusting to life in the first 2 years after bariatric surgery: a qualitative study’, published in Clinical Obesity ( doi: 10.1111/cob.12205) – for guidance.
Dr Graham’s paper found that after bariatric surgery, patients make major changes to their lifestyles, including dealing with altered eating habits and a rapidly changing physical appearance, while at the same time experiencing a period of psychosocial adjustment.
Patients were involved in the research, from design to dissemination to make sure that the patient voice was embedded into the study. Patients were encouraged to speak about their experiences openly without being constrained by set questions. Most participants reported that prior to surgery, they had experienced weight-related stigma from others. This had been a source of anxiety which they felt would reduce following surgery as they lost weight. However, the stigma of obesity was exchanged for the judgment of bariatric surgery as the weight loss mechanism.
Dr Graham says: “This study sought to explore patients’ experiences of adjustment to life after bariatric surgery. We found that many participants were reluctant to discuss their experiences of surgery in social situations, sometimes even with close relatives, with frequent partial or non-disclosure of the method of their weight loss. Within social environments, discussions surrounding bariatric surgery were reported to be a source of worry with regards to the potential risks of revealing having undergone bariatric surgery due to being judged by others.”
BDA and BOMSS agree to closer collaboration
Following the recent World Obesity Day, the BDA is pleased to announce the signing of a Memorandum of Understanding with the British Obesity and Metabolic Surgery Society (BOMSS).
A number of BDA members are already members of BOMSS, so this step will build on existing strong links. It will commit both bodies to raise awareness of the other within their own membership, alongside greater collaboration on joint communications and policy on the important topics of obesity and weight management.
The BDA’s Obesity Specialist Group will continue to take the lead on the Association’s relationship with BOMSS. Mary O’Kane, BDA Obesity Specialist Group Bariatric Officer and Allied Health Professional representative to BOMSS Council said;
“I am delighted that we have taken this step to further bolster the relationship between the BDA and BOMSS. Obesity is probably the biggest public health challenge now facing the UK, and it is vital that healthcare professionals work together to tackle this issue, be developing training, campaigns or resources of professional relevance.”
- Read the BDA and BOMSS MoU here.
- The British Dietetic Association, founded in 1936, is the professional association and trade union for dietitians in Great Britain and Northern Ireland. It is the nation’s largest organisation of food and nutrition professionals with almost 9,000 members.
- Dietitians are the only qualified health professionals that assess, diagnose and treat diet and nutrition problems at an individual and wider public health level. Uniquely, dietitians use the most up to date public health and scientific research on food, health and disease, which they translate into practical guidance to enable people to make appropriate lifestyle and food choices.
- Dietitians are the only nutrition professionals to be statutorily regulated, and governed by an ethical code, to ensure that they always work to the highest standard. Dietitians work in the NHS, private practice, industry, education, research, sport, media, public relations, publishing, non-government organisations and government. Their advice influences food and health policy across the spectrum from government, local communities and individuals.
Looking ahead to IFSO in London
We are looking forward to IFSO 2017 takes place at QE11 Centre, Westminster, London from 29 August to 2 September.
For AHPs, the conference starts with the AHP/primary care pre-congress day on the 30th August. It opens with a key note lecture: Bariatric surgery and type 2 diabetes by Professor Francesco Rubino. The rest of the morning consists of 4 parallel sessions enabling participants to choose their preferred sessions. In the afternoon, all disciplines join together. This study day will appeal to all healthcare professionals in primary and secondary care, including doctors, nurses, dietitians and psychologists, involved in the management of patients with severe and complex obesity. Please spread the word to your colleagues including those in primary care.
Within the main conference there are further sessions which will appeal to AHPs (Integrated Health professionals). These include Bariatric surgery and mental health; Fertility and pregnancy after bariatric surgery session; Exercise and bariatric surgery; Multidisciplinary management and Nutrition and bariatric surgery. It is a fantastic opportunity for BOMSS AHPs to attend the IFSO conference, share good practice and build up and widen networking opportunities. Further details of the pre-congress day and the conference itself can be found at http://www.ifso2017.com/
Obesity Empowerment Network
Prof Rachel Batterham has been instrumental in setting up Obesity Empowerment Network UK. This is a new non-profit, user led, advocacy organisation, dedicated to giving people affected by obesity a public voice through empowerment.
The mission is to improve access to healthcare and treatment for individuals with obesity, to increase awareness that obesity is a chronic serious medical condition, to advocate for nationwide obesity prevention and treatment strategies and fight to eliminate weight-bias and discrimination. Further information can be found on the website http://www.oen.org.uk/ and on the Facebook page and by following twitter @ObesityEmpower and Instagram https://www.instagram.com/kcoenuk/ .
Please spread the word and inform your patients.
Obesity: How prejudiced is the NHS?
Professor Rachel Batterham was featured in an excellent BBC documentary regarding access (and lack of access) to bariatric surgery. It highlights the difficulties that patients have in accessing help with severe and complex obesity in addition to raising awareness of the positive work that is being undertaken in this area. IFSO sent the following statement to its members:
“We are pleased to announce you a documentary featuring Prof Rachel Batterham (UK), on the BBC, focusing on lack of access to bariatric/metabolic surgery by the NHS. Prof Batterham brings to light the stigma and prejudice our patients face, even in developed countries. Lack of recognition of this disease and denying scientifically proven therapies or supporting research that can help the millions of individuals affected is a global issue and is an unconscionable denial of basic human rights.”
The programme is available for viewing on YouTube https://www.youtube.com/watch?v=VwSz7SuHs9w
Join us in Staffordshire
We hope many of you will join us for BOMSS 2017 in Alton. Mr Chandra Chevru has put together a superb multidisciplinary programme with world-leading national and international speakers. This is supported by an excellent training programme. Further details can be found at www.bomss.org.uk/2017conference
IFSO 2017 is fast approaching and will include a pre-conference course aimed at AHPs, nurses and GPs. We hope you have the dates in your diaries and are beginning to think ahead about what you will present at IFSO!
Diet sheet update
The gastric bypass and gastric diet sheets have been reviewed and updated. In addition the Ayrshire and Arran dietitians have produced a preoperative “liver shrinking” leaflet and a bariatric cookery book. All should be ready and for sale through NDR UK in the near future.