Endocrine Abstracts

Background: Obesity levels and the demand for obesity services are increasing. Those with morbid obesity require specialist care and consideration for bariatric surgery. Based on recent figures and NICE guidelines, at least 35 000 individuals in Birmingham alone may be suitable for surgery. Numbers currently assessed are limited due to lack of resource and expertise. This audit reviewed baseline characteristics of patients referred for specialist obesity and bariatric services to see if this was the most appropriate use of the service.

Method: A retrospective review of the medical records of patients referred for specialist obesity services between April and August 2005 (Group 1 n=195) and those undergoing bariatric surgery between January 2003 and May 2006 (Group 2 n=105). Data collected included patient demographics, self-reported onset of obesity, motivation for weight loss, route of referral and significant co-morbidities.

Results: Group 1: 70% were female with <5% from ethnic minorities. Mean age was 41 years and at least 48% were obese during childhood. Seventy-five percent were referred by their GP. At least 41.1% asked to be referred. Seventy-one percent had no significant co-morbidity and only 20% had diabetes.

Group 2: 80% were female with <1% from ethnic minorities. Sixty-one percent were aged between 31 and 50 years. Thirty percent had no co-morbidity whilst 26% had only one. Diabetes was present in only 38% and sleep apnoea in 6.7%.

Discussion: Obesity services are heavily over-subscribed. Specialist obesity clinics are the gateway to bariatric services. Patients accessing these services tend to be self-selected, middle-aged, caucasian women with few or no co-morbidities. Although they fulfil current NICE guidelines for bariatric surgery, current evidence suggests that those with significant co-morbidity are more likely to derive benefit from weight reduction surgery. There is concern that we should be targeting those with multiple co-morbidities. Furthermore, this is a poor representation of our local population. We suggest there is a need for discussion of the current referral criteria.