About the Service:
Bariatric surgery (Tier 4) is part of the Specialist Weight Management Service for Worcestershire.
Whether a patient is interested in surgery or not, all referrals initially need to be made to the
hospital-based Tier 3 weight management service. Patients wanting Bariatric surgery will be seen for a minimum of 6 months by one the specialist dietitians to address lifestyle and behaviour change.
The Tier 3 weight management service has 3 dietitians who offer both one-to one and group programmes. We offer
support to help patients develop the skills and confidence to manage their weight in the longer term. These skills benefit patients regardless of whether they choose to have bariatric surgery or not.
When patients have successfully completed the Tier 3 program they will either be referred back to the care of their local healthcare provider for continued support, or considered for weight loss surgery with our team of specialist surgeons, nurses and dietitians in the Tier 4 service.
Who Are We?
We are a friendly, approachable and experienced team who specialise in weight management. Our team is designed to fully support patients with all aspects of weight loss and consists of a Consultant Physician, Specialist Dietitians, Specialist Nurses, a part-time psychologist, a bariatric coordinator and Consultant surgeons .
Where Are We Based?
We deliver services at Worcestershire Royal Hospital, Kidderminster hospital and Smallwood house Health centre in Redditch.
Bariatric (Tier 4) Service Information
For thos wanting Bariatric surgery, once you have completed the Tier 3 program you will need to attend the pre-surgery groups, 2 sessions in total, in the Tier 4 service. The groups provide you with information about bariatric surgery, the pre and post surgery diets and an opportunity for you to speak to someone who has already had surgery. If you still wish to proceed with bariatric surgery you will be made an appointment with the surgeon.
The aim of bariatric surgery is to help patients lose weight, keep the weight off long term and improve other health conditions such as diabetes.
All of our surgical treatments are performed laparascopically (keyhole). Performing the operation in this way removes the need for a large incision and means less pain, less scarring, and a much quicker recovery time. At present we offer the following procedures:
- Roux – En- y / Gastric Bypass
- Sleeve Gastrectomy
The sleeve Gastrectomy removes part of the stomach to help with weight loss. The stomach is divided vertically from top to bottom, and the larger stomach section is then removed. This leaves a smaller gastric tube which is around 25-30% the size of your original stomach.
The Sleeve Gastrectomy encourages weight loss by reducing the amount of food you can eat and by reducing your appetite through complex hormonal mechanisms (not well understood). Your stomach will be around 70% smaller than before the surgery, meaning that the portion sizes that you are able to manage will be smaller. A Sleeve Gastrectomy is permanent and the alteration to your stomach is not reversible.
Unlike some other forms of bariatric surgery, a laparoscopic Sleeve Gastrectomy does not affect the valves or nerves in the stomach. This means that although the stomach is reduced, the stomach function largely remains intact.Gastric bypass (Roux – En - y)
The gastric bypass combines restrictive and Malabsorptive techniques to produce weight loss:
Restrictive – the upper portion of the stomach is stapled to create a small ‘upper stomach’, or pouch about the size of a golf ball.
Malabsorptive – Most of the stomach is bypassed along with at least 150 cm of proximal small intestine, necessitating vitamin and mineral supplementation.
Neuro-hormonal component – the intestine is cut or divided. The lower portion of this division (the long roux limb) is then lifted and joined to the new stomach pouch. The free end of the intestine (the biliopancreatic limb) is then joined to the remaining portion of the gut forming a ‘Y’ shape. Once the restrictive component of the bypass decreases, different mechanisms will kick in to maintain weight loss.
Food eaten passes into the pouch, which becomes full with small quantities of food, meaning that you will feel full quicker. Food then bypasses the remainder of the stomach and passes through the newly created opening into the long roux limb. This ‘replumbing’ of the intestine results as well in a degree of malabsorption of food and calories, aiding further weight loss.
The Weight management service
Who can access the service?
People who have a Body Mass Index (BMI) of more than 40kg/m2 or a BMI between 35 and 40 who have an obesity-related condition that would be improved by weight loss e.g. Diabetes and hypertension.
Can I self-refer?
Unfortunately we are unable to accept self-referrals. We require a referral letter from your GP. We cannot accept referrals from other hospital speciality consultants.
What happens in my first appointment with a Tier 3 dietitian?
Your first appointment will be with one of our dietitians, and will take approximately 50 minutes. The aim of the first appointment is to help us understand your weight history, lifestyle factors and events that may have led to weight changes. We would then invite you to further individual appointments to focus on your weight, or invite you to our group programme.
Will you give me a diet plan to follow to help me lose weight?
We often find that people who access our service have tried many diets in the past which have not worked for them, and so the aim of our service will be to help you understand what you need to do to manage your weight in the longer term. We will also explore any current habits and factors that are impacting on your weight.
If I see the psychologist for an assessment, will I be offered one to one therapy?
Unfortunately, our psychologist is unable to see anyone for individual therapy following an assessment.
Do I have to be interested in surgery to access the service?
No, many people attend the Tier 3 weight management service for dietetic support with weight management.
How long will have to I wait before I can have bariatric surgery?
Generally there will be 12 months between your 1st appointment in the service, and the date of your surgery, however this timeline can vary. If you have lost 5% of your body weight by 6 months in the Tier 3 service, then you will be assessed by the surgery team.
Why do I have to lose weight before bariatric surgery?
If you are able to lose 5% of your body weight before surgery, we find that the risk of complications from surgery is reduced. It also helps to show that you are able to lose weight and make lifestyle changes in order to get the most out of your surgery.
When I have had surgery, when will I have follow-up and how long does this last?
You will be reviewed on the ward after your surgery. You will be seen in clinic 3 weeks after the operation by a Nurse and Dietitian, and then every 3 months or so for 2 years. If you have a problem, you can be seen more often.
How much weight on average do people lose after surgery?
People who have a Sleeve Gastrectomy typically lose 60% of their excess weight (weight that they can above a Body Mass Index of 25kg/m2). People who have a Gastric Bypass usually lose about 70% of their excess weight. Weight loss varies from person to person, and will depend on their eating habits and the amount of activity that they do.
What are the risks of Bariatric Surgery?
Any operation has risks. A bleed, blood clot, wound infection or leak as a result of the surgery carries a risk of 1 in 50 people. In the long term, people might experience dumping syndrome (food entering the gut too quickly and causing symptoms such as shaking, sweating, fatigue and nausea), reflux, or stomach pain.
Will I need to take vitamins and minerals after the surgery?
Yes, after the surgery you will need to take multi-vitamins and minerals every day for the rest of your life, for which you will be advised. You will also have to have a Vitamin B12 injection every three months for the rest of your life.
I am writing after completion of a Gastric Sleeve procedure in late December 2017, as you are aware this procedure is for weight loss and within this letter I have to compliment the Trust on firstly offering this type of procedure but also for the standards of care given, I highlight the professionalism, compassion and friendliness from all the staff I came into contact with across the Trust.
I have been over weight since I was 15 years old and I have tried everything including different diets, over the counter Diet pills, and other “Fads” to try and lose weight, some with short term limited success. I really had nowhere to turn and and I was very despondent with my weight controlling my everyday life.
Once I met ******* she gave me a massive amount of information and encouragement. I was seen by ******** (Con surgeon) and everything explained thoroughly, after a short while a slot was given at short notice for surgery on the 29th December 2017. The pre surgery Liver shrinking Diet over Christmas was a Challenge but surgery went ahead and went reasonably smoothly. My weight loss has been an extraordinary part of my life since the procedure and I am convinced this will massively reduced my chances of getting diabetes and the associated risks plus many other serious longer term issues associated with Obesity. I have no hesitation in stating that this procedure will ultimately extend my life expectancy.
Weight Stats:Worst Weight before GP referral: 154kg (24.2 stone)
Day of surgery: 133kg (20.9 stone)
Today: 112kg (17.6 stone)
Height: 185.9cm (6ft 1)
The WRH staff are in my opinion outstanding from ****** and his team. I hope my gratitude to all concerned is covered. I am realistic that I still need to focus on my diet for the rest of my life and the surgery is a tool to help me do this along with support from the Trust. Next stop 100kg!!
Thank you all for the journey you have helped me embark and for being by my side as I continue on it’s path. Your knowledge and encouragement have really helped me get to where I am today. *****, thank you for recognising my desire and need to go forward with the operation as soon as possible and for helping this to happen. *****, You have been a reassurance and a wealth of knowledge of helping cure the side effects I was feeling. I look forward to continuing my journey with you all and know that with your guidance, and my desire, that I will succeed.
Referral information:Referrals to the Tier 3 weight management service can now only be made via E-referral using the weight management triage pathway. Referrals either by post or email are no longer able to be accepted. The CCG sent out a referral proforma to all GP surgeries in February 2019 to upload to the GP EMIS computer system.
In order to be referred through to the Worcestershire Specialist Tier 3 Weight Management Team you need to fulfil the local Care Commissioners’ criteria.
- Registered with a Worcestershire GP
- Aged at least 18 years
- BMI >40 kg/m2 with or without obesity related co morbidities
- BMI >35 kg/m2 with at least one obesity related co morbidity e.g. Diabetes/Hypertension)
If you would like to contact the team please use the details below.
Telephone: 01905 760742 (answer phone)