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Table 1 A comparison of Scotland’s tier 4 pathways by bariatric centre

From: Variations in bariatric surgical care pathways: a national costing study on the variability of services and impact on costs

Pre-surgery targets Centre 1 Centre 2 Centre 3 Centre 4 Centre 5 Centre 6 Centre 7 Centre 8 Centre 9 Centre 10
Pre-surgery targets – weight loss, glycaemic control
(targets not specified by NICE).
Most boards stated other factors such as attendance rates at clinics and lifestyle changes.
5% weight loss, Hba1c < 64 mmol/mol 5–10% weight loss. Hba1c – control but no target. Smoking cessation. Remittance binge eating. 10% weight loss, Hba1c < 69 mmol/mol 5% weight loss in tier 3, further 5% weight loss tier 4. Hba1c – control but no target. Weight loss > 5 kg in 6 months 5–10% weight loss. If < 50 BMI, must reach target. Hba1c < 64 mmol/mol Weight loss > 5 kg, Hba1c < 75 mmol/mol Weight loss > = 5 kg Weight loss > 5%, HbA1c < 75 mmol/mol 10% weight loss. Glycaemic control < 75 mmol/mol Hb1c. Smoking cessation. Sleep apnoea 3 months treatment.
Pre-operative assessment a
 Assessment of any psychological or clinical factors that may affect adherence to postoperative care requirements (such as changes to diet). MDT including clinical psychologist Dietician, clinical psychologist Dietician only Dietician, clinical psychologist Dietician, clinical psychologist MDT including clinical psychologist MDT including clinical psychologist MDT includes diabetologist MDT including clinical psychologist MDT including clinical psychologist
 Psychological support Yes Yes No Yes If required Yes Yes No Yes Yes
 Format of sessions (Group or 1:1) Group 1:1 Either Both 1:1 Both Both 1:1 Both Both
Post-operative assessment:
 Regular postoperative assessment, including specialist dietetic and surgical follow-up Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
 Psychological support As required Not stated Not stated Yes If required Yes Yes No As required Not stated
 Format of sessions (Group or 1:1) 1:1 1:1 1:1 Both 1:1 1:1 Both 1:1 1:1 1:1
  1. ain addition to a risk–benefit analysis by the hospital specialist and/or bariatric surgeon