1. Nutrition Clinic Non Surgical Referral Criteria Non Surgical Referral Criteria –BMI >40 –Complex co-morbidities –All available primary care interventions exhausted e.g. Healthy Helpings, Counterweight, Commercial Organisations etc Healthy Helpings, Counterweight, Commercial Organisations etc19/09/11

2. Nutrition Clinic Treatment options Treatment options –Xenical –Protein Sparing Modified Fast –600kcal deficit diet –2-3 x 6 month reviews, then D/C back to primary care 19/09/11

3. Bariatric Surgery Referral thresholds Referral thresholds –BMI > 40 with Type 2 diabetes –BMI > 60 –NHS Grampian, 40 procedures in total/year –26 NHS Grampian –11 NHS Highland –1 NHS Shetland –1 NHS Orkney –1 NHS Western Isles 19/09/2011

4. Bariatric Surgery If eligible for assessment If eligible for assessment –2-3 year wait for possible surgery –Patients should NOT expect surgery as end point 19/09/11