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