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What should I do now –  Eat less, move more, bring your weight towards normal

Being overweight or underweight increases your risk for an operation.
BMI more than 35 – Risk Factor increase is clear but the amount is uncertain

BMI less than 20 – Risk Factor increases 3-4 times

A BMI  over 35 might mean your operation is postponed

 BMI is the ratio of height to weight.  It is a simple guide to obesity and weight related health.  As a guide a healthy adult weight is a BMI between 18.5 to 25, with 25 to 30 being overweight and over 30 is obesity.
It has been shown that a high BMI (over 35) is often associated with more surgical risk (chest infections, wound infections) and more problems with successful outcomes in weight bearing joint surgery (this means hip, knee, foot and back surgery).
A low BMI (below 20) can signify poor nutrition and there are risks that this nutritional aspect means your ability to overcome the “surgical insult” and repair healing may be reduced.
Use the NHS calculator to work out your BMI, then see the specific operative guidelines depending on your result.

BMI Less than 20

If your BMI is less than 20  then this might indicate poor nutrition (you are not eating well), or underlying illness, but may also be normal for you. Discuss with the practice if this is the case so that action can be taken in time.

BMI 20-25

Congratulations it is likely you are of a generally healthy weight.  This should mean your surgical risk is not elevated.

BMI 25-35

This suggests you are overweight and we would recommend you aim to reduce your weight over time.  We are not aware however that this particularly causes surgical problems at this time.

BMI 36+

At this level it is likely your weight will play a part in increasing your risk during and after surgery.  Although you may not achieve a “normal” weight by the time you get to surgery it is sensible to make steps to reduce your weight and to increase your fitness.  It makes sense that every pound or kilo you can lose before surgery will improve your risks.  Short term, and longer term weight reduction will be beneficial but crash dieting and severe food restriction could lead to similar nutritional problems as seen in the people who are underweight and under-nourished i.e. poor healing.  Some conditions can be helped in themselves by weight loss (hip or knee pain, some breathing issues, back pain) and it is sometimes possible to delay or avoid surgery if this can be addressed.

What options are there

Many times people know the issue and avoid tackling it.  They often know what works for them and the run up to surgery can be a trigger to “seize the moment” and if this applies to you then please take this opportunity.

For those that appreciate help there are commercial offerings like independent slimming organisations in your area such as Slimming World, Rosemary Conley or Weight Watchers.

Bariatric surgery (“Stomach stapling” etc.) may be suitable where the problem is severe.  Sometimes this is recommended to occur before other surgery where someone is severely overweight and the risks are considered appropriate.

What is the evidence

Weight Evidence

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Herefordshire Weight Services

Public Health website Herefordshire


Search “weight” – walks with local church groups, ramblers, National England Walks and Guides, cycling, swimming, Fitness network – Herefordshire

Voluntary Sector


Search “weight” – walks with local church groups, ramblers, National England Walks and Guides, cycling, swimming, Fitness network – Herefordshire

GP Practice – your practice nurse or GP will offer you advice and guidance regarding weight management. Some practices offer weight loss support groups.

Self Funding Commercial Services

Slimming World
or call 0344 897 8000

Weight Watchers
www.weightwatchers.com/uk or call 0345 345 1500
Both services have On-line or app or face to face meetings – cost approx. £20/month

National Health Checks at GP practices or local pharmacy offered to people aged between 40- 74 years every 5 years. You should get a letter through the post inviting you for a health check.

The NHS Health Check is a free check-up of your overall health. It can tell you whether you are at risk of developing certain health problems, such as heart disease, diabetes, kidney disease and stroke over the next 10 years. The health professional doing the check will offer advice on what you can do to lower your risk.

It is a free service.

The support includes patients who would like to lose weight or quit smoking. 1:1 and group meetings.


or phone: 01432 278178

For more information about NHS Health Checks click on the hyperlink below.


Healthy Lifestyle Trainers

Public Health Funded Healthy Lifestyle Trainers – active in the community and promote a holistic approach to lifestyle improvement – target deprived areas.  For 16 years and above

Self-referral, secondary and primary care to Healthy Lifestyle Trainers.

Trainers are embedded/ live in the area they cover so promote the service locally and therefore receive the majority of self- referrals. They have an in-depth knowledge of services to sigh post people to support services.


Phone: 01432383567

Email: hlts@herefordshire.gov.uk

Active HERE Pathway for people who are currently not active.

It is a Sport England and Public Health funded project. It is designed to support you to get more active through motivational sessions and tailored signposting to activities to suit you.

Tel: 01432 358 232
Email: info@brightstripe.co.uk
www.brightstripe.co.ukTo book your initial appointment call 01432 383 567Healthy Lifestyle Trainers

Phone: 01432383567 or e-mail on hlts@herefordshire.gov.uk

Healthier You Programme – Diabetes Prevention (NDPP)

Healthier You is a nine month behavioural change programme that helps those at risk of developing type 2 Diabetes significantly reduces their chances of getting the disease.

Participants receive support to change their lifestyle in a friendly and supportive group environment, facilitated by specialist staff trained in behavioural change and diabetes prevention and recruited from the local community.

You GP can refer through the above weblink


Reed Momenta – sub-contracted to Healthy Lifestyle Trainers

Secondary Care Dietetic Outpatient Service.

This is a comprehensive behavioural and lifestyle assessment by a Dietician. The Dietician explore and understand what has contributed to the patient’s obesity – how it impacts on their life and how best they can change their eating and activity behaviours to improve their health and quality of life

Referral from your GP or secondary care doctor to Secondary Care Dietetic Outpatient Service

Hereford County Hospital

Secondary Care specialist weight management service

Pre-bariatric and bariatric weight loss surgery

Referral from Primary and secondary care request requires CCG approval – case by case. If criteria met funding will be provided.  Under Choice policy pts can go anywhere in the county but Herefordshire people tend to go to Gloucester Royal Hospital.

Other local Hospitals are Shrewsbury and Birmingham.

Southampton Weight Management Services


Leeds Weight Management Services


Whats happening near you

Berkshire Weight services

In Berkshire we have a number of options

Eat4Health (self referral for those with BMI 25-35) Click this link to go to their website

Barometer (Referral from your GP surgery for those with BMI over 35)

National Services - Weight

These are some national Services