Synopsis
Refer appropriately for metabolic surgery, recognise early and late complications, and deliver lifelong procedure-specific nutritional, reproductive and medicine follow-up without losing shared-care ownership.
- NICE recommends referral for specialist bariatric assessment using BMI, significant weight-related conditions, suitability for anaesthesia and surgery, and commitment to long-term follow-up rather than automatic operation.
- Common procedures include sleeve gastrectomy, Roux-en-Y gastric bypass and adjustable gastric band; more malabsorptive operations create greater micronutrient and medicine-absorption risk.
- Surgery changes appetite biology and gastrointestinal anatomy, but it does not remove the need for dietary, psychological, reproductive and chronic-disease care.
Key red flags
Intermittent or severe postprandial abdominal pain, vomiting, tachycardia or obstruction years after bypass can reflect an internal hernia; examination may be deceptively soft and CT does not always exclude it.
Investigation priorities
Define the procedure, revisions and expected malabsorption before interpreting symptoms.
Management branches
Severe obesity and weight-related disease persist despite appropriate non-surgical care.
- Verify current NICE BMI and comorbidity thresholds, applying lower intervention thresholds for relevant ethnic backgrounds and expedited diabetes pathways where applicable.
- Refer to a multidisciplinary service for medical, dietetic, psychological, anaesthetic and surgical assessment, including eating disorder, substance use and reproductive plans.
Key medicines
Complete bariatric multivitamin and mineral supplementTake a procedure-appropriate complete formulation every day for life, meeting BOMSS minimum thiamine, iron, zinc, copper, selenium and folate content rather than using a standard low-content retail product.
Thiamine for vomiting or rapid-loss riskBOMSS primary-care guidance uses oral thiamine 200 to 300 mg daily plus vitamin B co-strong when oral intake is reliable; give immediate parenteral therapy under the emergency protocol if vomiting or neurological features impair safety.