Understanding the options

Weight-loss medications and surgery are generally not recommended as first line treatments for weight loss. They are usually considered after serious attempts at diet and lifestyle changes have been made, but your weight isn’t low enough to improve your health.

Medication

In order for you to be considered for weight-loss medication you will need to have a BMI of 28 kg/m2 or more.

Medication is limited to the use of orlistat (Xenical) currently in the UK.

You will need to make changes to your diet and lifestyle to ensure the medication works correctly and that you can maintain the weight loss once you stop taking the medication.

It is very important that you have adequate support in place from your healthcare team in order to lose weight effectively and safely whilst taking weight-loss medication. Your diabetes team will also need to be aware of the medication you are taking, as your diabetes medication may need adjusting.

Surgery

Surgery for weight loss can also be known as 'bariatric surgery'. Bariatric surgery refers to the different types of surgical procedures performed to treat obesity by modification of the gastrointestinal tract to reduce nutrient intake and/or absorption. It is very important not to confuse bariatric surgery with procedures for surgical removal of body fat such as liposuction or abdominoplasty.

Diabetes UK supports the use of bariatric surgery and recommends that it should be considered earlier to help reduce the risk of the serious complications that can result from diabetes. It can often help to normalise blood glucose levels and reduce the need for or avoid the need for diabetes medications.

Bariatric surgery can be a way of losing significant amounts of weight for people who have Type 2 diabetes and a BMI of 35kg/m2 or more (32.5 kg/m2 for ethnic minority groups). It may also be considered for people who have a BMI between 30 and 35kg/m2 when diabetes can’t be controlled and especially if that person has risk factors for cardiovascular disease.

However surgery does have serious associated risks and should only be considered if serious attempts to lose weight through diet and lifestyle have been unsuccessful.

Once the decision to have weight-loss surgery has been made, there are different types of surgery for you and the specialist surgical team to consider. They will help to ensure that you understand the expected weight loss and method of weight loss, the effect it will have on your diet for the rest of your life and any possible complications the surgery involves. You will have a psychological and physical assessment.

The surgeon also needs to provide support networks to ensure the weight-loss procedure is safe before and after surgery. The team should include a surgeon, nurse, dietitian and psychologist. A diabetes specialist team should be involved and give guidance on how the surgery may affect the individual's diabetes.

BOSPA (British Obesity Surgery Patient Association) is a charity for people who have had weight loss surgery. It is run by people who have had the surgery themselves and they may be helpful to contact for added support: www.bospa.org

Information updated June 2012