Bariatric Consultation Letter

15 June 2026 Dr Sarah Mitchell Riverside Family Medical Centre 18 Hawthorne Street Parramatta NSW 2150 Dear Dr Mitchell, Re: Michael James Anderson, DOB 22 September 1982 74 Parkview Crescent, Castle Hill NSW 2154 Thank you for referring Michael, a 43-year-old gentleman, to discuss his options for bariatric surgery and weight management. I had the pleasure of meeting him today for an initial consultation. Weight Today: 162 kg BMI Today: 51.3 kg/m² Target Ideal Weight: 85 kg PMHx: Michael's past medical history is significant for morbid obesity and several associated co-morbidities. These include Type 2 Diabetes Mellitus diagnosed approximately seven years ago, hypertension, obstructive sleep apnoea for which he uses CPAP therapy nightly, gastro-oesophageal reflux disease, hypercholesterolaemia, and bilateral knee arthritis. He reports shortness of breath on exertion and reflux symptoms. His previous surgeries include a laparoscopic cholecystectomy in 2012 and a right knee arthroscopy in 2018. He is an ex-smoker, having quit over 20 years ago, and consumes 2-3 standard alcoholic drinks per week. His current medications include Metformin XR 1g twice daily, Jardiance 25mg daily, Telmisartan 80mg daily, Rosuvastatin 20mg at night, and Esomeprazole 40mg daily. He has no known drug allergies. Weight History: Michael reports a long-standing struggle with his weight, which has steadily increased since his late twenties after transitioning from an active job to a sedentary desk role as an operations manager. He has made several significant attempts at weight loss in the past. He lost 18 kg with Weight Watchers but regained this within a year. He also had success with Lite n' Easy, losing 12 kg. A course of Optifast led to a 30 kg weight loss, but this was subsequently all regained. He has trialled pharmacological agents, including Saxenda, where he lost 10 kg but found daily injections difficult, and Ozempic, which provided initial success before his weight plateaued. He has also previously engaged with a psychologist to address emotional and stress eating, learning useful strategies but finding long-term maintenance challenging. Diet: Michael's current dietary habits are suboptimal. He often skips breakfast, has takeaway for lunch, and his largest meal is dinner, which is frequently takeaway or a high-carbohydrate meal. He reports snacking on chocolate, biscuits, chips, and ice cream, especially in the evenings. His liquid calorie intake is high, consuming approximately three cans of soft drink daily and occasional energy drinks. His water intake is low. Exercise: His physical activity is significantly limited by pain from his bilateral knee arthritis and exertional dyspnoea. He currently manages a 15-minute walk approximately twice per week. I had a detailed discussion with Michael about the role of bariatric surgery as a tool to achieve significant and sustainable weight loss and to improve his obesity-related co-morbidities, including his diabetes, sleep apnoea, hypertension, reflux, and joint pain. We discussed several surgical options. Laparoscopically Inserted Adjustable Gastric Band: I explained that a gastric band involves placing a silicone band around the upper stomach to create a small pouch, thereby restricting food intake. I noted that while it can be effective for some, long-term results are often less robust compared to other procedures, and it is associated with complications such as slippage, erosion, and reflux. For these reasons, it is now performed much less commonly. Sleeve Gastrectomy: We discussed the sleeve gastrectomy, which involves removing 75-80% of the stomach to create a narrow gastric tube. I explained that this procedure works through restriction and also by reducing hunger hormones, leading to an average excess weight loss of 60-70%. We reviewed the potential risks, including staple line leaks, bleeding, nutritional deficiencies, and the potential for worsening reflux. Roux-en-Y Gastric Bypass: I also described the Roux-en-Y gastric bypass, explaining that it involves creating a small stomach pouch and bypassing a section of the small intestine. This procedure works through both restriction and metabolic changes. I highlighted its excellent long-term weight loss outcomes and high rates of diabetes remission. Given Michael's history of Type 2 Diabetes and reflux, I suggested this may ultimately be the most appropriate procedure for him, pending a full workup. We also discussed the risks, including the lifelong need for vitamin and mineral supplementation and the possibility of dumping syndrome. I emphasised that surgery is a tool, not a cure, and long-term success is contingent upon significant and sustained lifestyle changes, including diet and exercise, with the support of a multidisciplinary team. Pre-Surgical Assessment Plan: To proceed with a comprehensive pre-operative assessment, I have organised the following: - Blood tests: FBC, U&E, LFT, iron studies, ferritin, Vitamin B12, folate, Vitamin D, TFT, lipid profile, and HbA1c. - Upper gastrointestinal endoscopy to assess his reflux. - Cardiology review with an ECG. - Liver ultrasound. - Referral to our bariatric dietitian for pre-operative nutritional assessment. - Referral to our bariatric psychologist for a formal assessment. - A request for an updated review from his sleep physician regarding his CPAP therapy. I have provided Michael with information booklets on all three procedures to review. I plan to see him again in approximately six weeks to discuss the results of his investigations and the multidisciplinary team assessments, at which point we can finalise the most appropriate surgical plan. I will, of course, keep you informed of Michael's progress. Thank you again for your referral. Yours sincerely, Dr Phillip Wallaby MBBS FRACS Consultant Upper Gastrointestinal and Bariatric Surgeon