Who Qualifies For Tier 4 Services According To NICE

Managing Obesity

Who Qualifies For Tier 4 Services According To NICE?

The NICE Clinical Guidance (CG189) published in 2014 and the NICE Quality Standards (QS127) published in 2016 set out who is eligible to receive Tier 4 services.

Tier 4 Services

Bariatric surgery is recommended as a treatment option for people with obesity if all of the following criteria are fulfilled:

  • They have a BMI of 40 kg/m2 or more, or between 35 and 40 kg/m2 and other significant disease (for example, type 2 diabetes or high blood pressure) that could be improved if they lost weight.
  • All appropriate non-surgical measures have been tried but the person has not achieved or maintained adequate, clinically beneficial weight loss.
  • The person has been receiving or will receive intensive management in a tier 3 service.
  • The person is generally fit for anaesthesia and surgery
  • The person commits to long-term follow-up

People with Type 2 Diabetes

  • Offer an expedited assessment for bariatric surgery to people with a BMI of 35 kg/m2 or over who have recent-onset type 2 diabetes (less than 10 years duration) as long as they are also receiving or will receive assessment in a tier 3 service (or equivalent).
  • Consider an assessment for bariatric surgery for people with a BMI of 30–34.9 kg/m2 who have recent-onset type 2 diabetes (less than 10 years duration) as long as they are also receiving or will receive assessment in a tier 3 service (or equivalent).
  • For Asian patients reduce BMI values by 2.5 kg/m2.

In practice what these guidelines mean is that a person with type 2 diabetes who fulfills the criteria above can be referred to a surgical centre (Tier 4) without going through a Tier 3 service as long as the Tier 4 team are able to offer a multi-disciplinary lifestyle programme to the person before they have surgery.

People with a BMI of 50 kg/m2 or More

Offer an assessment for bariatric surgery to people with a BMI of 50 kg/m2 or more as long as they are also receiving or will receive assessment in a tier 3 service.

 

https://www.nice.org.uk/guidance/cg189

https://www.nice.org.uk/guidance/qs127

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