Consent Forms

Consent Forms

Consent Forms2024-06-07T01:04:55+08:00

OAGB Consent Form

Sleeve Gastrectomy Consent Form


Would weight loss surgery benefit you?


BMI is one of the leading ways of measuring obesity,
find out if you’re a candidate for surgery.

cm
kg
Your BMI is

  • UNDERWEIGHT
  • NORMAL
  • OVERWEIGHT
  • MORBIDLY OBESE
  • SUPER OBESE

YOUR CURRENT
WEIGHT

40kg

BMI 40.0

HEALTHY BMI
WEIGHT

88kg

BMI 24.9

WEIGHT LOSS NEEDED TO
ACHIEVE A HEALTHY BMI

24kg

or 28% of your overall body weight

Your Expected weight loss in 1 year

With the most common treatment options

3.5kg

or 3.2% of your overall body weight 1

Lifestyle Changes

3.2 - 6.7kg

or 5 - 10% of your overall body weight 2,3

Prescription Medication

22 - 37kg

or 20 - 33% of your overall body weight 4

Weight Loss Surgery


Percentages are based on the weight loss averages

1) Sumithran P and Proietto J. The defence of body weight: a physiological basis for weight regain after weight loss. Clin Sci 2103; 124: 231–41.RACGP. Obesity prevention and management position statement 2019. Available at https://www.racgp.org.au/FSDEDEV/media/documents/RACGP/Position%20statements/Obesity-prevention-and-management.pdf, accessed September 2022. 2) Pilitsi E, et al. Pharmacotherapy of obesity: Available medications and drugs under investigation. Metab Clin Exp 2019; 92: 170–92. 3) Lee PC, Dixon J. Pharmacotherapy for obesity.Aust Fam Phys. 2017; 46(7): 472–7. 4) NH&MRC (2013) Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia. Available at https://www.nhmrc.gov.au/about-us/publications/clinical-practice-guidelines-management-overweight-and-obesity, Accessed September 2022.

Your Expected weight loss in 1 year

With the most common treatment options


Percentages are based on the weight loss averages

1) Sumithran P and Proietto J. The defence of body weight: a physiological basis for weight regain after weight loss. Clin Sci 2103; 124: 231–41.RACGP. Obesity prevention and management position statement 2019. Available at https://www.racgp.org.au/FSDEDEV/media/documents/RACGP/Position%20statements/Obesity-prevention-and-management.pdf, accessed September 2022. 2) Pilitsi E, et al. Pharmacotherapy of obesity: Available medications and drugs under investigation. Metab Clin Exp 2019; 92: 170–92. 3) Lee PC, Dixon J. Pharmacotherapy for obesity.Aust Fam Phys. 2017; 46(7): 472–7. 4) NH&MRC (2013) Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia. Available at https://www.nhmrc.gov.au/about-us/publications/clinical-practice-guidelines-management-overweight-and-obesity, Accessed September 2022.

At your BMI, the Australian Obesity Guidelines(9) recommend my target weight loss should be:


No recommendation based on your BMI.

Answer the questions below, and we can contact you to discuss your treatment options

Tell us about any other health issues

If you do not meet the BMI or weight criteria, you still may be considered for surgery if your BMI is over 30 and you are suffering serious health problems related to obesity.

Do you have either of these serious health concerns?

Have you experienced any of the following Health Risks Associated with Obesity?

BMI is not the only criteria

Something here about lifestyle or how long you’ve been trying to lose weight and what you’ve tried.

Tell us if any of these apply to you

What is your outlook on weight loss?

Readiness to begin your weight loss journey is important.

How committed are you to your weight loss journey?

Fill in your details to have these results sent to you.

If you choose, we can share information about your health, medical history and lifestyle with our team who will determine whether you are a candidate for weight loss surgery.

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