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In November 2014 NICE released updated guidelines on the indications for bariatric surgery. These are summarised here:

Bariatric surgery is 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 kg/m2 and 40 kg/m2 and other significant diseases (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, cliniclally 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 the need for long term follow up.

The major new change in these guidelines involves those who have recent onset type 2 diabetes:

Offer an expedited assessment for bariatric surgery for people with a BMI of 35 kg/m2 or over who have recent onset type 2 diabetes as long as they are also receiving or will receive assessment in a tier 3 service.

Consider an expedited assessment for bariatric surgery for people with a BMI of 30- 34.9 kg/m2 who have recent onset type 2 diabetes as long as they are also receiving or will receive assessment in a tier 3 service.

Consider an assessment for bariatric surgery for people of Asian family origin who have recent-onset type 2 diabetes at a lower BMI than other populations as long as they are also receiving or will receive assessment in a tier 3 service.

These important changes reflect the growing evidence that bariatric surgery can be a very effective treatment for type 2 diabetes.