• Bariatric surgery is a component of the ongoing process of chronic disease management of Type 2 diabetes and obesity

• Bariatric surgery should be performed in high-volume centres with multidisciplinary teams that are experienced in the management of obesity and diabetes. Members of the team should have understanding across disciplines and work together with common expectations and goals. The team needs to integrate with primary care, diabetes management, nutritional and lifestyle support, and surgeon's teams with consistent messages and agreed policies

• The surgical team must have undertaken relevant supervized training and have specialist experience in types of bariatric surgery performed within the programme

• Pre-surgical assessment needs to be comprehensive, including assessment of metabolic, physical, psychological and nutritional health. Patients should have realistic expectations of the risks and benefits of surgery along with their lifelong role in lifestyle intervention, nutritional support and follow-up

• Management of diabetes and other co-morbidities should be optimized and short-term pre-operative weight loss considered to improve health and visibility at the time of surgery

• The multidisciplinary team need to understand and recognize early and long-term complications in a timely manner and know when to refer back to the surgeon or others for specific care

• Lifelong follow-up on at least an annual basis is needed for ongoing lifestyle support, and post-surgical and diabetes monitoring

• Teams should collect prospective data and measure diabetes outcomes in methods consistent with IDF recommendations

• Regular, post-operative nutritional monitoring is required, with attention to appropriate diet, monitoring of micronutrient status and individualized nutritional supplementation, support and guidance to achieve long-term weight loss and weight maintenance

• Follow-up should include a psychological evaluation, support and therapy if appropriate. Mental illness, especially depression, is common in diabetes and severe obesity

• In order to help sustain weight loss from bariatric surgery, patients must be committed to increased levels of ongoing daily physical activity

• All practices are encouraged to engage and promote national programmes of ‘centres of excellence’ or equivalent and collect prospective data through registries