Walsall to host mini gastric bypass session

Walsall Manor Hospital’s Bariatric Unit have managed to secure a visit by Doctor Rutledge who will be sharing his experience on Mini Gastric Bypass and he will be performing live surgery on Monday, 25 June.

Please click here for the programme for the day. If you would like to attend, contact Paula Lightwood, Bariatric Medical Secretary at Walsall Manor Hospital, on 01922 721172 ext 7763 to secure your place.

A date in Doncaster

The Bariatric unit at Doncaster Bassetlaw Teaching Hospitals is pleased to announce the second MGB/OAGB course on 24 May.

The course is for one day including live surgery and keynote lectures.The deadline for application is 24 April.

  • The course fee is £95 and the UGI trainees will enjoy 50% discount.
  • The course is for UGI trainees with bariatric interest and also for junior bariatric Consultants who are interested in the procedure.
  • Email Mr A Hussain, consultant bariatric surgeon, at abdulzahra.hussain@nhs.net or Sandra Patterson at sandrapatterson1@nhs.net  for a registration form and programme details.

By-Band-Sleeve Trial update

Message from Lead Surgeon Richard Welbourn

Nearly 10 years ago – January 2009 – I was co-chair of a scientific session at the Society of Academic & Research Surgery annual conference in Bristol.  My co-chair was Prof Jane Blazeby and over coffee we got talking about bariatric surgery.  After a few more meetings and time putting together a research team of surgeons, trials methodologists, statisticians, health economists and qualitative researchers we decided that we should conduct a randomised controlled trial (RCT) – but what operations to evaluate was the big question?  Fast forward two years and we were awarded a major NIHR grant for and RCT to compare gastric banding and gastric bypass operations.

We knew from data in the National Bariatric Surgery Registry that these two procedures comprised 80% of operations for severe and complex obesity in the UK and we thought it was important that we asked the most relevant question so the results would influence practice.  The operations and aftercare are very different and at the time no one thought it was possible to randomise patients – and this is where Prof Jenny Donovan and her team of qualitative researchers in Bristol came in.  She is a world-leading expert in teaching researchers how to randomise into clinical trials – putting patients into equipoise, a skill completely new to me – and for the first year of the study we had to demonstrate that we could indeed recruit.  The process involved all our clinic appointments being recorded and analysed so that the phrases we use encourage patient understanding of the equipoise and informed consent.  After much one-to-one tuition, the first two centres (Taunton and Southampton) were able to recruit sufficient patients to allow the study to progress from two centres to twelve.

Fast forward another five years from when the first patient was enrolled in 2012 and we have recruited altogether over 900 patients.  It is an extraordinary achievement for the UK, which has taken up bariatric surgery much later than many countries and still has one of the lowest per capita rates of surgery.  By comparison, the next largest RCT is around 220 patients.  “Collaboration is the new competition” is a phrase I have learnt from Jane Blazeby and Natalie Blencowe and this really represents a sea change from consultants doing individual pieces of research for the SpRs to publish in minor journals, to working together on a major project.

One of the challenges is that over time practice has changed and sleeve gastrectomy has largely taken the place of gastric banding in the NHS.  With primary endpoints of weight loss and quality of life at 3 years, there was always a risk that ‘technology creep’ would mean that the relevance of the original research question might change over time.  Therefore, the NIHR agreed to us adapting the study to add a third group, sleeve gastrectomy, and it became ‘By-Band-Sleeve’.  As a consequence, the sample size increased from 724 to over 1,300 patients – another hugely ambitious but get-able target.  It is a privilege to be involved in a research effort that could, when published, be regarded as a landmark demonstration of a well-conducted RCT.


Can you host BOMSS in 2019 or 2020?

We are looking for expressions of interest from anyone who wishes to host the BOMSS Annual Scientific Meetings in January 2019 & 2020.

If you are interested in hosting this event, please email Sarvjit Wünsch your expression of interest by 3pm on Thursday, 21 December.

We will invite you to present your chosen venue to BOMSS Council from 2pm on Wednesday, 24 January 2018 at the Telford International Centre.

Please see venue specifications below.

Criteria for hosting a BOMSS Meeting

The Meeting takes place in the 3rd week on January and runs from Wednesday to Friday.

The Venue

Hotel conference venue

Total number of hotel bedrooms: 350

The current formula is that all delegates and industry are able to stay in same hotel. We would like to encourage this, therefore hotel room prices should be negotiable (easier in January) to a level which allows AHPs and trainees to stay in same venue.

Range of alternative hotel accommodation (if necessary) within walking distance of main HQ Hotel.

Trade Exhibition

  • Minimum Trade Exhibition space of 400sqm²
  • Please note all catering should be contained in Trade exhibition area, this will facilitate delegate footfall and keep Industry very happy!
  • Exhibition set up on Wednesday
  • Breakdown on Friday, after lunch.

BOMSS Training Day

  • This takes place on Wednesday and is sponsored event.
  • 3 – 4 breakout rooms are required for the whole day.
  • It would be beneficial if the Training Day is serviced by a separate entrance.
  • This year there were 72 Training Day delegates.

The Scientific Programme

  • Main conference: Plenary room for 400 to be arranged in a cabaret seating layout
  • 3 x Breakout rooms to hold: 150/100/150 delegates
  • Additional rooms available for Industry sponsored sessions or workshops


  • Drinks reception and Gala Dinner in Hotel up to 300 people
  • Council Dinner venue up to 25 people
  • Trainee’s Dinner venue up to 100 people

Transport links

How stigma affects patients after surgery

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.”


Call for Abstracts for BOMSS 2018

BOMSS 9th ANNUAL SCIENTIFIC MEETING, 25 – 26 January, 2018
International Centre, Telford

Deadline for abstract submission: 9am on Monday, 20 November 2017
The 9th Annual Scientific Meeting of the British Obesity and Metabolic Surgery Society will be held at International Centre in Telford from 25 – 26 January, 2018.

The deadline date for the submission of abstracts is 9am, Monday 20 November 2017 and successful authors will be notified by the Wednesday, 6 December 2017.

To find out more and to submit an abstract, please visit the BOMSS 2018 website at: https://www.bomss.org.uk/2018conference/abstracts/

The BOMSS Training will be taking place on Wednesday, 24 January 2018,and registration for BOMSS 2018 will open shortly so please look out for updates on the BOMSS 2018 website. 


Experts publish updated guide to providing services for overweight and obese patients

Guidance on commissioning weight assessment services and management clinics, first published in 2014, has been updated and now includes guidelines on children and young people.

The guidance is sponsored by and represents the views of 22 professional organisations including nine medical Royal Colleges directly concerned with patient care.

Commissioning Guidance: Weight Assessment and management clinics (Tier 3) says about two-thirds of adults in the UK are overweight, 1 in 4 are clinically obese, and 1 in 3 children aged 10-11 are overweight or obese. Both conditions predispose to diseases such as type 2 diabetes, high blood pressure, strokes, heart attacks, cancer and general ill-health.

But it says most hospitals do not have services for these patients and, even if clinics do exist, patients and many GPs may not be aware of them, so patients who need and could benefit from expert assessment and management are not referred in a timely manner including children and young people.

As the treatment is often complex, a wide range of professionals, including medical and surgical doctors, nurses, psychologists and anaesthetists may need to be involved.

The Guidance – released on World Obesity Day – calls for the NHS to prioritise and develop services to allow patients with severe diseases caused by obesity to have access to treatment and describes the infrastructure needed to set up or commission Weight Assessment and Management Clinics (Tier 3 Clinics) in the NHS in England.

The document describes in detail which patients may most benefit from being referred for assessment for surgery (bariatric surgery) and includes a section on specialist Children’s and Adolescent Weight Assessment and Management Clinics.

It recommends that a multi-disciplinary team for children and young people should contain at least a paediatrician with a special interest in obesity, a children’s / adolescent dietitian, a specialist children’s or adolescent nurse, a clinical psychologist with expertise in paediatrics and with access to a social worker, a physical therapist and a liaison child and adolescent psychiatrist.

A minimum of six months of comprehensive assessment and management is recommended as appropriate for children and young people and says they should only be referred for surgery when all other options have been tried.

Lead author Mr Richard Welbourn, a consultant bariatric surgeon and a past-President of the British Obesity & Metabolic Surgery Society (BOMSS) said: “There is an urgent need for services to help people of all ages who have severe weight problems which address their needs and find ways to lead more fulfilling and productive lives.

“The new Guidance offers a blueprint for the NHS to provide better care, starting in primary care with suggested pathways for General Practitioners depending on the patient’s history and current health. It offers suggestions for the care of children and adolescents with the most severe obesity and gives several options for people with diabetes.

“Looking at secondary care, the challenge of managing the epidemic of patients with severe and complex obesity disease is largely unmet despite repeated guidelines from NICE. The updated Guidance describes in detail how services can be provided by multi-disciplinary teams in weight assessment and management clinics. This includes advice on setting up services for children and young people who unfortunately suffer the same problems as adults and are just as much in need of treatment for weight loss and management.

“These services have been developed in several parts of the UK but there are many areas where there is nothing available – an unfair postcode lottery of care. The models for setting up weight assessment and management clinics should be urgently adopted across the NHS to provide the services so many people need.”

Other additions to the updated guide include recommendations on anaesthetic assessment and ongoing shared care with general practitioners.

Professor Russell Viner, Officer for Health Promotion at the Royal College of Paediatrics and Child Health, said: “Obesity is affecting more children at a younger age – and it’s only going to be tackled through robust policies that focus on prevention.  Medical intervention and particularly surgery should always be a last resort. But it’s crucial that children and young people who are currently severely overweight get the right help through weight advice and management clinics which are designed to cater specifically for their needs. This guidance is much needed and I urge all CCGs to adopt it.”

The Royal College of Physicians’ obesity spokesperson, Professor John Wass, said: “There are currently significant differences in coverage when it comes to Tier 3 services and, as such, many do not have ready access to help. This guidance is helpful, because it puts in clear advice and support for the future and provides a framework for better care for people who have an obesity or weight problem.”

Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, said: “Obesity is a serious health issue for patients regardless of their age, but that one in four children are now thought to be overweight or obese in the UK is a serious cause for concern given that it condemns our next generation for a lifetime of other potentially serious and debilitating health conditions, such as diabetes, cardiovascular disease and cancer.

“The College is proud to endorse this updated guidance, which should give CCGs the advice and support they need to commission the most appropriate services to allow GPs – and other healthcare professionals across the NHS – to deliver the care our young patients who are struggling to maintain a healthy weight need.”


Notes to editors
The 2017 Commissioning Guide: Weight assessment and management clinics (Tier 3)

Obesity Review article http://onlinelibrary.wiley.com/doi/10.1111/obr.12601/full

BOMSS is the sponsoring organisation for the guide. Joint-sponsoring organisations are:

Associations of British Clinical Diabetologists
Association for Clinical Biochemistry & Laboratory Medicine Association of Physicians Specialising in Obesity Association for the Study of Obesity
British Association of Paediatric Surgeons
British Dietetic Association
British Psychological Society
Diabetes UK
Faculty of Public Health
Royal College of Anaesthetists
Royal College of General Practitioners
Royal College of Nursing
Royal College of Obstetrics and Gynaecology
Royal College of Paediatrics and Child Health
Royal College of Physicians (London)
Royal College of Pathologists
Royal College of Psychiatrists
Society for Endocrinology
Society for Obesity and Bariatric Anaesthesia
Weight Loss Surgery Info (WLSInfo)

Third IFSO Global Registry Report released

The Third IFSO Global Registry Report (2017) has been released. Published by Dendrite Clinical Systems, under the auspices of the IFSO, the publication reports data from more than 40 countries on more than 196,000 operations, including baseline obesity related disease, operation types, operative outcomes and disease status after bariatric surgery.

This latest report includes 196,188 operation records from 42 countries from five continents, and has detailed information on 106,219 gastric bypass operations (54.1% of all the records submitted), 58,885 sleeve gastrectomy procedures (30.0%) and 19,101 gastric banding operations (9.7%). The publication has some interesting county-to-country analysis and notes a wide variation of BMI pre-surgery between different contributor countries, ranging from 36.7kg m2 in Peru to 51.1kgm2 in Egypt (43.1 kgm2). The highest proportions of gastric bypass surgery were reported in Venezuela (100.0%) and Sweden (95.6%), compared with Kuwait (100.0%), Australia (100.0%) and Saudi Arabia (100.0%), who reported the highest rates of sleeve gastrectomy operations.

Prior to surgery, 21.8% of patients were on medication for type 2 diabetes, 31.4% of patients were treated for hypertension, 15.3% of patients were on medication for depression, 20.2% of patients required treatment for musculo-skeletal pain, 20.3% of patients had sleep apnoea and 24.8% of patients had gastro-esophageal reflux disorder.

Other highlights of the report show:

  • 86.7% of patients who had a gastric band inserted were discharged within one day of their operation after gastric bypass n 63.7% of patients were discharged within two days of surgery;
  • 79.4% of sleeve gastrectomy patients went home within three days of their operation n Unsurprisingly, 98.8% of all operations were performed laparoscopically
  • The Obesity Surgery Mortality Risk Score (OSMRS) varied widely by country with Georgia, Hong Kong and Argentina reporting the highest-risk patient populations (OSMRS groups B & C: 88.2%. 75.0% and 62.0% respectively) and Kuwait, Colombia and the Netherlands reporting the least risk patient populations (OSMRS groups B & C: 17.9%, 20.4% and 23.9% respectively).

The Global IFSO Registry Project was headed by Kelvin Higa (United States), Jacques Himpens (Belgium), Richard Welbourn (UK), John Dixon (Australia), Peter Walton (Dendrite Clinical Systems) and Robin Kinsman (Dendrite Clinical Systems).

If you are interested in participating in the Fourth IFSO Global Registry Report, please email: ifsoregistry@edendrite.com for more information.


Read Prof Batterham’s report on weight management services and health

AHP representative, Prof Rachel Batterham, has produced an important report looking at how weight management services can improve health outcomes and we would encourage everyone to read this important work.

Executive Summary

Improving Health Through The Provision of Weight Management Services.1

It includes suggested steps to establish weight management services in a region 

1. Find out the degree of obesity in the local population. What is the need for and potential uptake of each Tier of the service?

2. Use the NICE local costing template to estimate initial and future expenditure. Enquire about funds available from NHS England and allocate budgets accordingly.

3. See what services are already available in the region and nationally. Many Tier 2 and exercise referral services are well-established and funded. These may contribute to a specialist Tier 3 weight management service with additional input.

4. Look at models for effective commissioning of Tier 3 and Tier 4 services. Work with your acute provider to commission effective services, ensuring appropriate pathways into bariatric surgery, enough theatre time and effective after-care with at least 2 years follow-up.

5. Identify a champion for obesity. This could be a lead physician or a commissioning champion.

6. Produce local primary care guidance to cover how to raise the issue of obesity with patients, what the local referral pathways are and what is required from GPs post-surgery.

7. Implement effective monitoring and evaluation of services, including contributing to national registries.

8. Liaise with other CCG regions. Explore existing commissioning policies and shared needs with regions of similar population demographics. This will be advantageous in achieving the economies of scale, sharing limited specialist resources and adhering to the IFSO guidelines for safety, quality and excellence in bariatric surgery.