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2013 |
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Commissioning guide:
Body contouring surgery |
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Sponsoring Organisation: British Association of Plastic, Reconstructive and Aesthetic Surgeons Date of evidence search: March 2013 Date of publication: [month, year] Date of Review: [month, year]
NICE has accredited the process used by Surgical Speciality Associations and Royal College of Surgeons to produce its Commissioning guidance. Accreditation is valid for 5 years from September 2012. More information on accreditation can be viewed at www.nice.org.uk/accreditation
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Contents
Glossary.............................................................................................................. 2
Introduction......................................................................................................... 2
Variation of provision..................................................................................... 3
Access to body contouring surgery............................................................... 3
Why is this surgery a priority?....................................................................... 3
1 High value care pathway for body contouring surgery................................. 5
Referral pathway........................................................................................... 5
General criteria for body contouring surgery................................................ 5
Exceptions to general criteria........................................................................ 5
Exclusion criteria........................................................................................... 5
Where should surgery be undertaken?......................................................... 6
2 Procedures explorer for body contouring surgery................................. 8
3 Quality dashboard for body contouring surgery.................................... 8
4 Levers for implementation......................................................................... 8
4.1 Audit and peer review measures............................................................... 8
4.2 Quality specification/CQUIN (Commissioning for Quality and Innovation) 9
6 Benefits and risks of implementing this guide...................................... 10
7 Further information................................................................................... 11
7.1 Research recommendations................................................................... 11
7.2 Other recommendations……………………………………………………………………………………………………………………………..11
7.3 Evidence base……………………………………………………………………………………………………………………………………………..11
7.4 Guide development group for Body contouring surgery......................... 13
7.5 Funding statement………………………………………………………………………………………………………………………………………13
7.6 Conflict of Interest Statement.................................................................. 13
The Royal College of Surgeons of England, 35-43 Lincoln’s Inn Fields, London WC2A 3PE
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Term |
Definition |
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Body mass index (BMI) |
A measure for human body shape based on an individual’s weight and height. BMI = body weight in kilograms / height in meters squared |
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Excess body weight |
Calculation of change of BMI relative to a maximum normal BMI of 25kg/m2 |
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Massive weight loss |
Loss of 50% or more excess body weight |
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SF-36v2® |
QualityMetric’s SF-36v2® health survey asks 36 questions to measure functional health and wellbeing from the patient’s point of view. It is a practical, reliable and valid measure of physical and mental health that can be completed in five to ten minutes. For more information visit: http://www.qualitymetric.com/WhatWeDo/SFHealthSurveys/SF36v2HealthSurvey/tabid/185/Default.aspx |
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Significant functional disturbance |
This includes infections, disability, time in hospital, smell, excoriation, severe intertrigo, evidence of significant interference with activities of daily life, ulceration and psychological disturbance (eg depression) |
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Weight stability |
Weight stability described in this document allows for a maximum of 5kg increase or a 5kg decrease in weight. |
Body contouring surgery is reconstructive surgery following massive weight loss.
In 2010, 65.1% of all adults aged 16 years and over were overweight or obese. Morbid obesity rates (body mass index (BMI) ≥40kg/m2) increased from 1.2% in 1995 to 2.7% in 2003, and fluctuated between 2.2% and 2.7% between 2008 and 2010.
Weight loss surgery or bariatric surgery is commissioned nationally across England. In adults with a BMI of more than 40kg/m2 (or more than 35kg/m2 with co-morbidities) in whom surgical intervention is considered appropriate, bariatric surgery is recommended as a treatment option in the National Institute for Health and Clinical Excellence (NICE) guidelines.1
As a result of the drive to tackle obesity, there are increasing numbers of patients with massive weight loss and skin redundancy. This has led to post-weight loss deformities of loose, ptotic skin envelopes and residual adiposities with resultant contour irregularities.2 The resultant redundant skin presents new quality of life concerns in a range of areas such as mobility, decreased activity, body image dissatisfaction3 and depression.4 The excess skin causing physical discomfort, psychosocial problems, lost work days/productivity and concern about quality of life5 in general has led to an increasing uptake of body contouring surgery,6 to manage the complex problems7 that span multiple parts of the body after massive weight loss.
NICE guidelines state that surgery for obesity should only be undertaken by a multidisciplinary team that can provide expertise including psychological support before and after surgery as well as information on or access to plastic surgery where indicated.1 According to the 2004 review of bariatric surgical services in Scotland:8
Plastic surgery is an integral part of an overall bariatric surgical service.
Criteria for patients undergoing plastic surgery must be clearly defined.
The number of patients being referred for this type of surgery is small at present but is likely to increase in the foreseeable future. This will have implications for waiting lists.
Variation of provision
In England there is no standardised guidance for provision of body contouring following massive weight loss. In a recent study carried out by Mukherjee et al, out of the 67 respondents of 147 of the primary care trusts in England, only 54 had referral guidelines for plastic surgery and 23 excluded all post-bariatric surgery body contouring procedures.9 According to a study carried out by Butler, 95.1% of plastic surgery units in the country offer some form of reconstructive surgery following massive weight loss, with a large variation of what is available between each unit, and 4.9% of units do not offer any surgery owing to lack of primary care trust funding.10,11 Butler found that 56% of units do not offer psychology or psychiatry screening, for 14% this information was unknown and only 24% of all the plastic surgery units in the UK offer it routinely.
A recent study 12 showed that 37.7% of patients who were approved in Scotland for post-bariatric body contouring would not have fulfilled the Leeds criteria,13 which set out the funding request policy for low volume services or treatments that are not routinely commissioned. This is another example of the postcode lottery that exists for the commissioning of plastic surgery services.14, 15
Access to body contouring surgery
According to a cohort study published in 2013, of 34 patients who had not yet applied for plastic surgery, 13 had been told by their general practitioners (GPs) that they would not qualify for plastic surgery on the National Health Service despite losing more than 75% of their excess body weight.16
Why is this surgery a priority?
Research demonstrates significant improvements in patients’ physical function, emotional wellbeing, body image satisfaction, identity shifts, sexual vitality, greater wellbeing and quality of life once they have undergone body contouring surgery following massive weight loss.17,18 Highton et al found that 92% of 86 surgeon members of the British Obesity and Metabolic Surgery Society felt that patients face functional problems relating to skin redundancy after massive weight loss and a high percentage of patients complain about this problem.19
One series of 122 patients (2000–2005) were reviewed for patient satisfaction and quality of life.20 Another retrospective case series (12 years) involving 151 central body lifts revealed both patient and physician satisfaction.21 Neither of these studies had comment on the methods or instruments used for quality of life measures. Klassen et al demonstrated an improvement in quality adjusted life years following massive weight loss body contouring.22
Al-Hadithy et al demonstrated that the QualityMetric SF-36® health survey parameters for physical function, bodily pain, general health, vitality and overall physical health are significantly better in bariplastic surgery patients than in those who only had bariatric surgery. Previous studies have shown that physical dimensions of the SF-36® improve after bariatric surgery23 and other studies have demonstrated that body image and quality of life improves following abdominoplasty in non-bariatric24 and bariatric patients.25, 26 Early data demonstrate a greater change in physical health and functional outcome over psychological outcome for the patients who had received body contouring surgery. Following plastic surgery in the bariatric population patients had more active lifestyles, improved self-confidence and greater career progression.27, 28
1 High value care pathway for body contouring surgery
Referral pathway
Referral to plastic surgery should be encouraged through the primary care sector if the patient fulfils the criteria, using the referral tool (Appendix 1).
Psychological assessment should be included as part of the patient pathway. If patients have been referred through a bariatric multidisciplinary team, then the psychological assessment is unlikely to need repeating but if no previous psychological assessment has been performed, this will need to be arranged prior to referral to plastic surgery.
General criteria for body contouring surgery
Age over 16 years
Starting BMI above 40kg/m2 or above 35kg/m2 with co-morbidities AND current BMI of less than or equal to 27.0kg/m2 AND weight stability of 12 months AND significant functional disturbance (physical and psychological)
Body contouring surgery creates large wounds. The current evidence favours this surgery when patients have 'fully deflated'. Performing BCS at higher BMI's is associated with higher risk of complications.29-44 After reviewing British Obesity & Metabolic Surgery Society (BOMSS) input the group decided to increase the BMI from 27 to 28 for reconstructive body contouring surgery. This BMI level is considered safe for surgery.
Exceptions to general criteria
Starting BMI above 40kg/m2 or above 35kg/m2 with co-morbidities and 75% excess body weight – should be eligible for apronectomy only. BMI of up to 40kg/m2 can be considered here.
Weight stability of 12 months
Exclusion criteria
Current smoker
Active psychiatric or psychological condition that would benefit from diagnosis and treatment prior to referral for body contouring surgery or that would contraindicate surgery including:25
patients who have had an episode of self-harm within the last two years;
patients with a previous diagnosis of body dysmorphic disorder;
patients with a disproportionate view of the problem following your examination;
patients who currently have on going alcohol or drug misuse problems.
NB: General health, social and lifestyle issues should also be taken into account before offering body contouring surgery to patients
If a patient meets the criteria for body contouring surgery, the GP may begin the pathway for surgery. If a patient is very deserving for surgery, but does not meet all the criteria, they can still be considered via the exceptional circumstances route. This will involve the completion of an IFR (individual funding request) form by the GP, and if approved the pathway may proceed to psychological and consultant plastic surgical assessment.
Where should surgery be undertaken?
Body contouring surgery should be undertaken at a centre where there is a bariatric multidisciplinary team or integrated links to a bariatric multidisciplinary team.
2 Procedures explorer for body contouring surgery
Users can access further procedure information based on the data available in the quality dashboard to see how individual providers are performing against the indicators. This will enable CCGs to start a conversation with providers who appear to be 'outliers' from the indicators of quality that have been selected.
The Procedures Explorer Tool is available via the Royal College of Surgeons website.
3 Quality dashboard for body contouring surgery
The quality dashboard provides an overview of activity commissioned by CCGs from the relevant pathways, and indicators of the quality of care provided by surgical units.
The quality dashboard is available via the Royal College of Surgeons website.
4.1 Audit and peer review measures
The following measures and standards are those expected at primary and secondary care. Evidence should be able to be made available to commissioners if requested.
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Measure |
Standard |
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BMI |
Provider demonstrates adherence to BMI eligibility criteria |
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Multidisciplinary team (MDT) status |
Provider has MDT in place or can demonstrate integrated links to MDT |
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Body contouring database |
Provider can demonstrate collection of data |
4.2 Quality specification/CQUIN (Commissioning for Quality and Innovation)
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Measure |
Description |
Data specification (if required) |
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Referral for bariatric surgery patients as well as for patients who have lost weight through diet and exercise |
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Hospital data |
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Readmission rates for complications |
Provider demonstrates a readmission rate of <X% |
Data available from Hospital Episode Statistics |
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Average of length of stay |
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Psychological evaluation in patient pathway |
Provider demonstrates access for patients to psychological evaluation |
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Aspirational: patient reported outcomes measures |
Provider can demonstrate collection of patient satisfaction and patient reported outcomes measures, for example by completing pages 2–4 of the referral tool at last plastic surgery clinic appointment |
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5.1 Patient information for body contouring surgery
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Name |
Publisher |
Link |
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Body reshaping – patient information guide |
BAPRAS |
5.2 Clinician information for body contouring surgery
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Name |
Publisher |
Link |
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Up-dated adult exceptional aesthetic referral protocol (June 2011) |
NHS Scotland |
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G43 Obesity: NICE guideline |
NICE |
5.3 NHS Evidence case studies for body contouring surgery
1. Hurwitz DJ, Rubin JP, Risin M et al. Correction of saddlebag deformity in the massive weight loss patient. Plast Reconstr Surg 2004; 114: 1,313–1,325.
2. Sarwer DB, Fabricatore AN. Psychiatric considerations of the massive weight loss patient. Clin Plast Surg 2008; 35: 1–10.
3. Sarwer DB, Thompson JK, Mitchell JE, Rubin JP. Psychological considerations of the bariatric surgery patient undergoing body contouring surgery. Plast Reconstr Surg 2008; 121: 423e–434e.
4. Kitzinger HB, Abayev S, Pittermann A et al. After massive weight loss: patients’ expectations of body contouring surgery. Obes Surg 2012; 22: 544–548.
5. de Brito MJ, Nahas FX, Bussolaro RA et al. Effects of abdominoplasty on female sexuality: a pilot study. J Sex Med 2012; 9: 918–926.
6. Steffen KJ, Sarwer DB, Thompson JK et al. Predictors of satisfaction with excess skin and desire for body contouring after bariatric surgery. Surg Obes Relat Dis 2012; 8: 92–97.
7. Gilmartin J. A critical literature review: the impact of reconstructive surgery following massive weight loss on patient quality of life. J Nurs Healthc Chronic Illn 2011; 3: 209–221
8. Michaels JV, Coon D, Rubin PJ. Complications in postbariatric body contouring: strategies for assessment and prevention. Plast Reconstr Surg 2011; 127(3); 1352-7.
9. Arthurs ZM, Cuadrado D, Sohn V et al. Post-bariatric panniculectomy: pre-panniculectomy body mass index impacts the complication profile. Am J Surg 2007; 193: 567–570.
10. Nemerofsky RB, Oliak DA, Capella JF. Body lift: an account of 200 consecutive cases in the massive weight loss patient. Plast Reconstr Surg 2006; 117: 414–430.
11. Colwell AS, Borud LJ. Optimization of patient safety in postbariatric body contouring: a current review. Aesthet Surg J 2008; 28: 437–442.
12. Shermak MA, Chang D, Magnuson TH, Schweitzer MA. An outcomes analysis of patients undergoing body contouring surgery after massive weight loss. Plast Reconstr Surg 2006; 118: 1,026–1,031.
6 Benefits and risks of implementing this guide
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Consideration |
Benefit |
Risk |
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Patient outcome |
Ensure access to effective conservative, medical and surgical therapy. Reduce long-term follow-up for the chronic complications of skin redundancy (psychology, dermatology, clinical nurse specialist, physiotherapy). |
Unrecognised deterioration on conservative therapy |
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Patient safety |
Surgery will be undertaken in a specialist centre with appropriate support for the massive weight loss patient. |
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Patient experience |
Improve access to patient information, support groups and equitable access to body contouring service. |
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Equity of access |
Improve access to effective procedures. |
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Resource impact |
Reduce unnecessary referral and intervention. If referral pathway and tool use, streamline referral process, reduce consultant clinic time wastage and ensure audit of outcomes. |
Resource required to establish MDT |
7.1 Research recommendations
Research should be undertaken into the true cost of body contouring surgery. Cost varies across the UK and proper research is required to understand the average fee. Quality of life cannot be calculated without this information.
7.2 Other recommendations
Request for central funding for body contouring surgery
National use of referral document for GPs for body contouring surgery (Appendix 1)
Wide dissemination of useful information on body contouring surgery to primary care and public (cf patient information leaflet)
patient groups
professional organisations (BAPRAS media company)
GP surgeries?
7.3 Evidence base
1. National Institute for Health and Clinical Excellence. Obesity. London: NICE; 2006.
2. Hurwitz DJ, Rubin JP, Risin M et al. Correcting the saddlebag deformity in the massive weight loss patient. Plast Reconstr Surg 2004; 114: 1,313–1,325.
3. Song AY, Rubin JP, Thomas V et al. Body image and quality of life in post massive weight loss body contouring patients. Obesity 2006; 14: 1,626–1,636.
4. Mitchell JE, Crosby RD, Ertlet TW et al. The desire for body contouring surgery after bariatric surgery. Obes Surg 2008; 18: 1,308–1,312.
5. Lazar CC, Clerc I, Deneuve S et al. Abdominoplasty after major weight loss: improvement of quality of life and psychological status. Obes Surg 2009; 19: 1,170–1,175.
6. Kitzinger HB, Abayev S, Pittermann A et al. After massive weight loss: patients’ expectations of body contouring surgery. Obes Surg 2012; 22: 544–548.
7. Migliori F, Rosati C, D’Alessandro G, Cervetti GG. Body contouring after bilopancreatic diversion. Obes Surg 2006; 16: 1,638–1,644.
8. NHS Scotland. Review of Bariatric Surgical Services in Scotland. Edinburgh: NHS Scotland; 2004.
9. Mukherjee S, Adegbola S, Kamat S, Agrawal S. Bariplastic (post bariatric body-contouring) surgery in England: a ‘postcode’ lottery. Presented at: 5th Congress of the International Federation for the Surgery of Obesity and Metabolic Disorders European Chapter; April 2012; Barcelona.
10. South Staffordshire Primary Care Trust. Policy Statement No. 10: Commissioning Policy/Referral Guidelines for Bariatric Surgery for Morbid Obesity. South Staffordshire PCT; 2009.
11. Butler PE. Addressing the Funding Issue in the UK. Presented at: Massive Weight Loss Body Contouring Symposium; May 2009; London.
12. Al-Hadithy N, Mennie J, Magos T, Stewart K. Desire for post bariatric body contouring in South East Scotland. J Plast Reconstr Aesthet Surg. 2013 Jan; 66(1):87-94. doi:10.1016/j.bjps.2012.08.041. Epub 2012 Oct 12.
13. NHS Leeds. Individual Funding Requests (IFR) Policy. Leeds: NHS Leeds: 2011.
14. Henderson J. The plastic surgery postcode lottery in England. Int J Surg 2009; 7: 550–558.
15. NHS Modernisation Agency. Information for Commissioners of Plastic Surgery Services. London: DH; 2005.
16. Al-Hadithy N, Mennie J, Magos T, Stewart K. Desire for post bariatric body contouring in South East Scotland. J Plast Reconstr Aesthet Surg 2013; 66: 87–94.
17. Soldin M. Body Contouring After Massive Weight Loss. Presented at: Winter Scientific Meeting of British Association of Plastic, Reconstructive and Aesthetic Surgeons; December 2011; London.
18. Gilmartin J, Long AF, Soldin M. Quality of Life Following Massive Weight Loss and Body Contouring Surgery: An Exploratory Study. Leeds: University of Leeds: 2013.
Highton L, Ekwobi C, Rose V. Post-bariatric surgery body contouring in the NHS: a survey of UK bariatric surgeons. J Plast Reconstr Aesthet Surg. 2012 Apr; 65(4): 426-32. Epub 2011 Oct 20.
1. Favre S, Egloff DV. Body contouring surgery after massive weight loss. Rev Med Suisse 2005; 1: 1,863–1,867.
2. Rohrich RJ, Gosman AA, Conard MH, Coleman J. Simplifying circumferential body contouring: the central body lift evolution. Plast Reconstr Surg 2006; 118, 525–535.
3. Klassen AF, Cano SJ, Scott A et al. Satisfaction and quality-of-life issues in body contouring surgery patients: a qualitative study. Obes Surg 2012; 22: 1,527–1,534.
4. McHorney CA, Ware JE, Raczek AE. The MOS 36-item short-form health survey (SF-36): II. Psychometrics and clinical tests of validity in measuring physical and mental health constructs. Med Care. 1993, 31: 247–263.
5. Bolton MA, Pruzinsky T, Cash TF, Persing JA. Measuring outcomes in plastic surgery: body image and quality of life in abdominoplasty patients. Plast Reconstr Surg 2003; 112: 619–625.
6. Cano SJ, Browne JP, Lamping DL. Patient-based measures of outcome in plastic surgery: current approaches and future direction. Br J Plast Surg 2004; 57: 1–11.
7. van der Beek ES, Te Riele W, Specken TF et al. The impact of reconstructive procedures following bariatric surgery on patient well-being and quality of life. Obes Surg 2010; 20: 36–41.
8. Al-Hadithy N, Hosakere A, Stewart K. Functional and psychosocial improvement following body contouring procedures in bariatric patients – the evidence. J Plast Reconstr Aesthet Surg –publication pending.
9. Larsen F, Torgersen S. Personality changes after gastric banding surgery for morbid obesity. A prospective study. J Psychosom Res 1989; 33: 323–334.
10. Vastine VL, Morgan RF, Williams GS et al. Wound complications of abdominoplasty in obese patients. Ann Plast Surg. 1999; 42(1): 34–39.
11. van Uchelen JH, Werker PM, Kon M. Complications of abdominoplasty in 86 patients. Plast Reconstr Surg. 2001; 107: 1869-1873.
12. Duff CG, Aslam S, Griffiths RW. Fleur-de-Lys abdominoplasty--a consecutive case series. Br J Plast Surg. 2003; 56(6): 557-66.
13. Gmür RU, Banic A, Erni D. Is it safe to combine abdominoplasty with other dermolipectomy procedures to correct skin excess after weight loss? Ann Plast Surg 2003; 51(4):353-7.
14. Rogliani M, Silvi E, Labardi L et al.Obese and nonobese patients: complications of abdominoplasty. Ann Plast Surg. 2006; 57(3): 336-8.
15. Kim J and Stevenson TR. Abdominoplasty, liposuction of the flanks, and obesity: analyzing risk factors for seroma formation. Plast Reconstr Surg. 2006; 117(3): 773-9.
16. Arthurs ZM, Cuadrado D, Sohn V et al. Post-bariatric panniculectomy: pre-panniculectomy body mass index impacts the complication profile. Am J Surg 2007; 193(5): 567-570.
17. Neaman KC and Hansen JE. Analysis of complications from abdominoplasty: a review of 206 cases at a university hospital. Ann Plast Surg. 2007; 58(3) 292-8.
18. Shermak MA, Chang DC, Heller J. Factors impacting thromboembolism after bariatric body contouring surgery. Plast Reconst Surg 2007; 119(5): 1590-6.
19. Au K, Hazard SW 3rd, Dyer AM et al. Correlation of complications of body contouring surgery with increasing body mass index. Aesthet Surg J 2008; 28(4): 425-9.
20. Colwell AS, Borud LJ. Optimization of patient safety in postbariatric body contouring: a current review. Aesthet Surg J 2008; 28(4): 437-42.
21. Greco JA 3rd, Castaldo ET, Nanney LB et al. The effect of weight loss surgery and body mass index on wound complications after abdominal contouring operations. Ann Plast Surg. 2008; 61(3) 235-42.
22. Shermak MA, Rotellini-Coltvet LA, Chang D. Seroma development following body contouring surgery for massive weight loss: patient risk factors and treatment strategies. Plast Reconstr Surg. 2008; 122(1): 280-8.
23. de Kerviler S, Hüsler R, Banic A et al. Body contouring surgery following bariatric surgery and dietetically induced massive weight reduction: a risk analysis. Obes Surg 2009; 19(5): 553–559.
24. Momeni A, Heier M, Bannasch H et al. Complications in abdominoplasty: a risk factor analysis. J Plast Reconstr Aesthe Surg. 2009; 62(10): 1250-4.
25. Colwell AS. Current concepts in post-bariatric body contouring. Obes Surg 2010; 20(8): 1178-82.
45. van der Beek ES, van der Molen AM, van Ramshorst B. Complications after body contouring surgery in post-bariatric patients: the importance of a stable weight close to normal. Obes Facts 2011; 4(1): 61-6.
46. Iglesias M, Ortega-Rojo A, Garcia-Alvarez MN et al. Demographic factors, outcomes, and complications in abdominal contouring surgery after massive weight loss in a developing country. Ann Plast Surg 2012; 69: 54-58.
7.4 Guide development group for Body contouring surgery
A commissioning guide development group was established to review and advise on the content of the commissioning guide. This group met once, with additional interaction taking place via email.
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Name |
Job Title/Role |
Affiliation |
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Mark Soldin, Chair |
Consultant Plastic Surgeon |
BAPRAS |
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Fiona Hogg |
Consultant Plastic Surgeon |
BAPRAS |
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Jane Deville-Almond |
Patient Representative |
Chair, British Obesity Society |
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Ken Clare |
Patient Representative |
Chair, Weight Loss Surgery Info |
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Elaine Sassoon |
Consultant Plastic Surgeon |
BAPRAS |
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Isabel Teo |
Plastics Registrar |
BAPRAS |
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Nada Al-Hadithy |
Plastics Registrar |
BAPRAS |
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Maleeha Mughal |
Plastics Registrar |
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Jo Gilmartin |
Lecturer in Health and Psychology |
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Kiranmayi Penumaka |
GP |
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Nick Wilson-Jones |
Consultant Plastic Surgeon |
BAPRAS |
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Richard Welbourn |
Consultant Bariatric Surgeon |
British Obesity and Metabolic Surgery Society |
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Steve Lloyd |
Chair |
Hardwick CCG |
7.5 Funding statement
The development of this commissioning guidance has been funded by the following sources:
DH Right Care funded the costs of the guide development group, literature searches and contributed towards administrative costs.
The Royal College of Surgeons of England and the British Association of Urological Surgeons provided staff to support the guideline development.
7.6 Conflict of Interest Statement
Individuals involved in the development and formal peer review of commissioning guides are asked to complete a conflict of interest declaration. It is noted that declaring a conflict of interest does not imply that the individual has been influenced by his or her secondary interest. It is intended to make interests (financial or otherwise) more transparent and to allow others to have knowledge of the interest.
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Name |
Job title/role |
Declared interest |
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Miss Fiona Hogg |
Consultant Plastic Surgeon |
• Received fees from Ethicon to attend education events on massive weight loss body contouring surgery |
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Dr Jo Gilmartin |
Lecturer in health and psychology |
• Received pump priming funds for undertaking quality of life research which contributed to the commissioning guide |
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Mr Mark Soldin |
Consultant Plastic Surgeon |
• Received pump priming funds for undertaking quality of life research which contributed to the commissioning guide • Runs a private clinic in South West London |
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Miss Nada Al-Hadithy |
Plastic Registrar |
• Received funding from the William Rainey Foundation to undertake Doctor of Medicine (MD) study |
Appendix 1
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Page 1: For the Referrer to complete: |
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Patient Name:
Date of birth:
Height:
Referral Source: Address:
Phone Number: Email: |
Original weight:
Original BMI: |
Current weight:
Current BMI: |
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Weight lost: |
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Percentage excess weight loss: |
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Length of time maintained current weight: |
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Method of weight loss: please select from below: |
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Diet |
Bariatric Surgery |
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Gastric band |
Gastric sleeve |
Roux en Y
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Duodenal Switch |
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Operation: |
Open |
Closed |
Date of surgery |
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Complications: |
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Additional information: |
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Funding Secured? |
Plastic surgery procedure desired: 1. 2. |
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Yes |
No |
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Past Medical History: Please write:
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As a result of the excess skin: |
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Skin condition |
Intertrigo |
Hidradenitis |
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Infection |
Dermatitis |
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Lymphoedema |
Ulceration |
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Functional morbidity |
Yes |
No |
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Psychological morbidity |
Yes |
No |
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Psychiatric History: Please write: |
Please tick if there is any history of the following: |
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Active delusional or schizophrenic illness |
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Body dysmorphic disorder |
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Eating disorder |
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History of self-harm in last 2 years |
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Major depressive illness |
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Obsessive compulsive disorder |
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Substance abuse problem |
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If any of the others are ticked, please give dates of diagnosis and last acute episode. |
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Drug History:
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Any history of recreational drug use? Please give information |
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Allergies: |
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Page 2-4: For the patient to complete |
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Date of Completion: |
Patient Name |
Date of Birth |
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Have you ever smoked? |
`What was the most you ever smoked |
If you are smoking now, how much do you smoke |
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Yes |
Only occasionally |
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Only occasionally |
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No (move onto the next question) |
Less than one pack per day |
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Less than one pack per day |
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About one pack per day |
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About one pack per day |
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One to two packs per day |
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One to two packs per day |
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About two packs per day |
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About two packs per day |
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More than two packs per day |
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More than two packs per day |
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If you have quit, when did you quit: |
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Marital status (please check one): |
Please tick |
Occupation: |
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Single |
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Full time employment |
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Married |
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Self employed |
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Divorced |
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Part time employment |
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Separated |
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Student |
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Widowed |
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Unemployed |
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Living with Significant Other |
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Other: |
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Have you had a pregnancy in the last 12 months? |
No |
Yes |
Please give details |
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Have you experienced the death of a close family member in last 12 months? |
No |
Yes |
Please give details |
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Please describe what you eat on a daily basis: |
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On the average, how many main meals do you eat each day? |
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Indicate your preferred ways of dieting (select all that apply) |
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Skip meals |
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On the average, how many snacks do you eat each day? |
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Completely fast for 24 hours + |
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Restrict carbohydrates |
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Restrict sweets/sugar |
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How many of the following meals do you eat a week? |
Reduce fats |
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Breakfast |
Days |
Reduce portion size |
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Lunch |
Days |
Exercise more |
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Dinner |
Days |
Reduce calories |
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Take diet supplements |
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How frequently do you exercise? |
If you exercise, how long do you exercise each time? |
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Not at all |
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Less than 15 minutes |
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Once per month or less |
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15 - 30 minutes |
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Several times per month |
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31 - 60 minutes |
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Once per week |
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61 - 120 minutes |
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Several times per week |
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More than 120 minutes |
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Once per day |
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Several times a day |
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If you exercise, please indicate the types of exercise you do (fill in all that apply). |
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Cycling |
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Stationary bike |
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Running |
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Walking |
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Swimming |
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In-line skating |
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Weight training |
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Stairmaster |
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Aerobics |
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Treadmill |
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Dancing |
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Other: _________________________ |
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Is there a part of your appearance that you are concerned with? Use the diagram to record where and why you are concerned:
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Please tick the box which best applies to you |
Not at all |
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Neutral |
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Extremely |
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Because of this body area: |
1 |
2 |
3 |
4 |
5 |
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I get distressed when I see myself in the mirror |
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I find it difficult to mobilise |
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I have problems finding clothes that fit |
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I am able to exercise as much as I would like to. |
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I avoid going out of the house |
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I feel uncomfortable getting undressed in front of my partner |
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I have physical pain |
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I am limited in what I can do |
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I get distressed when going to social events |
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Activities of daily living |
Please circle the choice that best suits you |
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In general my health is |
Excellent |
Good |
Fair |
Poor |
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I am able to work |
Not at all |
A little |
Often |
Very much |
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I have satisfactory social contacts |
Very many |
Satisfactory |
A few |
None |
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I get pleasure out of sexual intimacy |
Very much |
Often |
A little |
Not at all |
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Please select from the following scale, which image you think best represents your body size and shape. If you feel you are in between 2 images, mark in between.
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Consent for clinical photography for MDT
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