Tier 2:

Programmes available are:

• 12-24 week exercise and lifestyle programmes provided by local councils, consisting of a variety of group sessions and occasionally 1:1 sessions as well. The first 12 weeks are the standard offer, with the second 12 weeks being dependent on a 5% weight loss. They are always free and have the criteria of 18+ and a BMI of over 30, or 25 where there are additional health risk factors present.

Tier 3:

Services available are:

• The Adult Tier 3 Weight Management Service, also referred to as the Specialist Weight Management Service (SWMS), is a multi-disciplinary, intensive, secondary-care based programme, designed to support adults with severe obesity and complex needs who require a more individualised approach than the Tier 2 service has previously been able to offer them.

• The programme is typically 6-12 months and will potentially include input from a physician (either consultant or GP with a specialist interest), specialist nurse, specialist dietitian, psychologist, psychiatrist and  physiotherapist. 

Tier 4:

Services available are:

• Surgery will only be considered as a treatment option for adults with morbid obesity providing all of the following criteria are fulfilled:

• The individual is considered morbidly obese – classified as adults with a BMI of 40kg/m2 or more; OR the individual is between 35 kg/m2 and 40kg/m2 in the presence of other significant diseases that would be improved by weight loss; AND there must be formalised MDT led processes for the screening of comorbidities and the detection of other significant diseases.

• These should include identification, diagnosis, severity / complexity assessment, risk stratification / scoring and appropriate specialist referral for medical management. Such medical evaluation is mandatory prior to entering a surgical pathway.

• AND the individual has recently received and complied with a specialist obesity service weight loss programme (non-surgical Tier 3 / 4), as described below.