Specialist Obesity and Bariatric Service

• Obesity

Obesity with weight-related comorbidities such as:

• Type 2 Diabetes
• Cardiovascular disease (CVD)
• Sleep apnoea
• Hypertension
• Dyslipidaemia

All referrals must meet Eligibility Criteria for Bariatric Surgery (2025 NICE NG246)

• BMI ≥ 40kg/m*
• BMI ≥ 35 kg/m* with at least one obesity-related comorbidity

*BMI threshold reduced by 2.5kg/m2 for ethnic groups that are prone to central adiposity and cardiometabolic risk at lower BM

• Aged 18 or over
• Independently mobile or able to attend in-person sessions
• Registered with a GP within the Mid Yorks catchment

We are unable to accept referrals for patients who are:

• Pregnant or breastfeeding
• Experiencing uncontrolled psychiatric disorders
• Diagnosed with untreated Cushing’s Syndrome
• With recent history (last 12 months) of deliberate self-harm or suicide attempt
• Abusing alcohol and/or drugs 

Referral

Your journey begins with an electronic referral to our service from your GP. 

Once received, your referral will be reviewed by our multi-disciplinary team (MDT). This process is called MDT clinical triage. 

Your referral may be declined if any important information is missing, or you do not meet our eligibility criteria. 

Initial Assessments 

If your referral is accepted, you will be invited to two initial assessment appointments with the Consultant Endocrinologist and Clinical Psychologist. 

Failing to attend these appointments, or re-scheduling, will result in being discharged from the pathway. 

When attending one of your initial appointments, you will meet with our Assistant Psychologist to complete a set of questionnaires. These are done with you again after the 12-week group programme and at 6-weeks, 12-weeks, 6, 12, 18 and 24 months after surgery – if this is something you decide on having. They help the team to monitor your progress and identify where you may need some more support. As well as helping us to improve the service for yourself, and future patients. 

12-week Programme 

This programme is part of the new, specialist service. Although you may have completed groups in the past, these sessions have been developed in line with the latest guidance and evidence and are led by a multidisciplinary team of healthcare professionals. It is different from other group programmes and focuses on supporting those considering surgery, or who may benefit from more specialist support. 

This 12-week programme has been designed to support you in making positive changes to your health and lifestyle, and weight management. 

The programme can be:

• a stand-alone intervention,
• part of your care alongside medication, and/or
• an essential step if you are preparing for/ considering bariatric surgery.

All patients must then attend our 12-week programme, apart from rare, exceptional cases which will be referred directly to the surgical pathway. 

The programme involves input from: 

• Dietetics 
• Physiotherapy 
• Clinical Psychology

Over the 12-week programme, you will: 

• Begin establishing new healthy eating habits. 
• Explore psychological barriers that may be affecting your relationship with food and making lifestyle changes. 
• Practice accessible ways of increasing physical activity.

The team will monitor your readiness for surgery and identify any additional support needed; as part of offering patient-centred, tailored support throughout your journey. 

Progress review 

After completing the programme, the MDT will review your progress and determine the most appropriate next step. This may include:

• Continuing onto the surgical pathway.
• Being referred to the weight-loss medication only pathway. (Depending on your response to the medication and your progress over time, you may be reconsidered for surgery at a later stage). 
• Discharge from the service, if surgery is not suitable, not desired, or if there has been a lack of engagement.

Surgical Pathway 

Bariatric Group Seminar 

Patients who progress onto the surgical pathway will then attend the Bariatric Group Seminar. This involves presentations from the Specialist Bariatric Dietitian, Clinical Nurse Specialist in Bariatrics and Clinical Psychologist. This is designed to be an informative session, which you will attend with other patients, in which we discuss different surgical procedures. You will also be provided with support around managing expectations for life after surgery including expected outcomes, challenges and the commitment required - so you can begin to think about which may be most suitable for you. 

Surgery Assessments 

You will then attend two risk assessment appointments. During these sessions, the team will explore your previous and current relationship with food and expectations for life after surgery. You may also be asked to begin making changes to your diet and lifestyle to prepare for surgery.

Patients will then be brought to another discussion with the multi-disciplinary team in which you may be: 

• Provided with additional sessions (1-3) if necessary (Dietetics and Clinical Psychology),
• Discharged, 
• Or referred for a surgical appointment. 

During your surgical appointment, you will meet with our Consultant Bariatric Surgeon to discuss the most appropriate surgical procedure for you, and you may be added to the waitlist for surgery. As part of your assessment, you may require further investigations, including blood tests and an OGD (gastroscopy), which is a camera test used to examine the stomach and upper digestive system. It is also possible to be discharged at this stage if surgery is no longer deemed appropriate or if you choose not to proceed. 

Surgery and follow-up care 

After surgery, patients will be supported for 2 years with post-operative follow-up care. This involves six routine follow-up appointments at 6 weeks, 12 weeks, 6 months, 12 months, 18 months and 24 months with Dietetics and Clinical Psychology. You may also be offered additional appointments with clinicians if appropriate. As well as 2 appointments with your surgeon. The frequency and type of support will depend on your individual needs.  

How long does this process take? 

We understand that patients and referrers would like to know how long the full process takes. While individual timeframes can vary, the first stage of the pathway involves completing the 12-week group programme.

After completing the programme, patients who wish to proceed with surgery and are considered suitable will enter the surgical pathway and receive follow-up care for two years.

Please note that each patient’s journey may differ depending on individual health needs, any additional assessments or treatments required, and surgical waiting list times.

The new pathway has been designed to provide more streamlined and coordinated care, helping to ensure patients move through the process as efficiently and safely as possible.

Patient Commitment and expectations

To progress towards surgery as quickly as possible, patients must:

• Attend the 12-weekly group sessions 
• Attend all scheduled assessments and group seminar 
• Demonstrate co-operation with the team by engaging with advice and making any recommended changes

Attendance and engagement will be monitored throughout the pathway. This ensures patients are fully supported and appropriately prepared for surgery as well as long-term lifestyle change.

Referrals must be made by a GP using the electronic SystmOne template (Mid Yorks eReferral dashboard) or Arden’s eReferral template - select the Mid Yorkshire eReferrals button.

We are unable to accept self-referrals or referrals from other professionals. 

I’m currently taking weight-loss medication, will this affect my ability to have surgery? 

No. However, we ask that patients co-operate with the team by being transparent about their use of any medication. This ensures we can offer relevant medical advice and support.

Is excess skin removal (Adoplasty) included in this pathway? 

No. This procedure is not routinely available on the NHS. 

Can I bring someone with me to my appointments? 

Yes, bringing somebody for support is okay. However, we ask that you sit in on your appointments with Clinical Psychology alone if possible. 

What happens if I miss an appointment? 

If you miss an appointment, you will be sent a letter offering a new appointment. Failing to respond and request a further appointment within 2 weeks will result in being discharged from the pathway. A second referral will then not be accepted for at least one year. 

What happens if I miss a group session? 

Most people attend all group sessions, which we find helps the group work together and can lead to the best outcomes for you. If you have difficulty attending any session, please let us know as soon as possible so that we can try to arrange an alternative session for you to attend. If you are preparing for bariatric surgery attendance at every session is mandatory. Missing sessions without notice may result in you being discharged. 

Is there support for people with accessibility needs? 

We are committed to making all of services at Mid Yorks accessible to everyone. 

In line with the Mid Yorks Trust values, we will do our best to make reasonable adjustments for your accessibility needs. 

Aspire Health and Wellbeing Service 

Aspire offer a range of non-medical programmes to help residents of Wakefield live healthier lifestyles and move towards a healthier weight.

This service offers group support, e-learning and can provide 12- weeks funded access to Slimming World. Other opportunities include funded access to Aspire health leisure facilities (link to 12-week success pathway) and ‘Lets Get Cooking’; a hands-on programme for individuals to gain knowledge and skills to prepare healthier meals. 

Oviva Tier 3 NHS weight management service 

Oviva is a free, digital service to help individuals lose weight effectively and safely. Service users are provided with tailored nutritional advice and support with exercise and lifestyle changes. Support is personalised to meet each service user’s needs. Following initial assessments, some individuals may be offered psychological support or weight loss medications. 

NHS National and Digital Services 

These tools and programmes can be accessed from home and are designed to support weight loss and healthy lifestyle changes.

• NHS Better Health Weight Loss App.
• NHS Diabetes Prevention Programme.
• NHS Digital Weight Management Programme.

Local Community Support  

• Turing Point Workshops.
• Wakefield Recovery College. 

Healthy Weight | Kirklees Wellness Service

The Healthy Weight service helps adults learn how to achieve and maintain a healthy weight through gradual, sustainable lifestyle changes rather than quick fixes. 

What the Programme Offers:

One-to-one support: sessions with a Health Coach to set personalised goals and work on healthy eating and behaviour change. Sessions are available face-to-face, online, or by phone. 
Group Courses: Weekly 1-hour sessions over six weeks, in a comfortable and friendly environment each week covering healthy eating and behaviour change. 

The timetable of group sessions can be found on their website.

Peer Support 

For support from others who are considering or have already had bariatric surgery. 

• Obesity UK 
• UK CPO
• Bariatric support group at MY: Face to face meetings with other patients who have had surgery, and patients waiting or considering surgery. Held once a month. Please speak to somebody involved in your care for further information.