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Obesity - Management
How should I manage someone with a BMI >= 40 (obesity III)

  • Offer structured advice regarding diet and physical activity.
    • This may be via a specialised weight management programme where available.
  • Consider starting drug treatment once dietary and physical activity interventions have been evaluated.
  • Consider referral for surgery.
Clarification / Additional information
  • Bariatric surgery is recommended as a treatment option if all of the following criteria are fulfilled:
    • The person has a body mass index (BMI) equal to or greater than 40 kg/m2.
    • All appropriate non-surgical measures have failed to achieve or maintain adequate clinically beneficial weight loss for at least 6 months.
    • The person is receiving, or will receive, intensive specialist management.
    • The person is generally fit for anaesthesia and surgery.
    • The person commits to the need for long-term follow up.
  • Surgery should be considered as a first-line option in adults with a BMI greater than 50 kg/m2 in whom surgical intervention is considered appropriate. Antiobesity drugs should be considered whilst the person is waiting for surgery.
  • Local criteria and policies on access to bariatric surgery may vary. Usually referral for surgery will be made via a specialist obesity management service.
Basis for recommendation
  • Recommendations for the level of intervention in someone with a BMI greater than or equal to 40 kg/m2 are from the NICE guidance on the prevention, identification, assessment, and management of overweight and obesity in adults and children [NICE, 2006b].

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