Scottish Intercollegiate Guidelines Network Guideline No 115, February 2010.
Bariatric surgery should be included as part of an overall clinical pathway for adult weight
Bariatric surgery should be part of a programme of care that is delivered by a multidisciplinary
team including, surgeons, dietitians, nurses, psychologists and physicians. There should be
close communication between health professionals for effective management of patients’
comorbidities as weight loss occurs.
Specialist psychological/psychiatric opinion should be sought as to which patients require
assessment/treatment prior to or following surgery.
Bariatric surgery should be considered on an individual case basis following assessment of
risk/benefit in patients who fulfil the following criteria:
sustained improvement in the comorbidities.
Binge-eating disorder, dysfunctional eating behaviour, past history of intervention for
substance misuse, psychological dysfunction or depression should not be considered
absolute contraindications for surgery.
Dietary counselling should be provided before and after surgery. A standard dose of a
multivitamin and micronutrient supplement could be considered post malabsorptive bariatric
Healthcare professionals should undertake the following in all patients post bariatric surgery:
Calcium and vitamin D supplements (800 IU per day cholecalciferol) should be considered for
all patients undergoing bariatric surgery. Baseline calcium and vitamin D should be measured
to avoid iatrogenic hypercalaemia.
Patients should be supported to increase their physical activity in a sustainable manner post
Policies on the criteria for receiving plastic surgery post bariatric surgery should be developed.
These should be based on both BMI and consideration of long term benefit balanced against
risks for the individual patient.
Patients should be made aware of these policies as part of their informed consent for bariatric
Plastic surgery should be delayed until weight loss post bariatric surgery has reached a plateau