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Tier 3 – Weight Management Programme

The information on this page has been produced to provide useful information to those either currently in our service or for those who might want to know more about what we offer.

The aim of our Tier 3 service is to provide compassionate and tailored care to support with a reduction in weight and improvement in quality of life. We will also aim to work alongside you to identify and reduce further risks to your health and empower you for lasting change. Our specialist team aims to provide you with the tools needed to make positive lifestyle changes.

What is a Tier 3 service?

Tier 3 is a specialist weight management service that offers support for people living with obesity. We work collaboratively with people who have struggled for a long time to lose weight, with a focus on long-term lifestyle changes, not diets. Our Tier 3 service supports lifestyle changes through:

  • Dietary advice and education
  • Behaviour change
  • Motivation techniques
  • Medical optimisation
  • Exercise advice
  • Psychology assessment & recommendations

Our Tier 3 service is delivered through a combination of face-to-face and virtual appointments.

Some areas have a local Tier 3 provider, please ask your GP for more information.

Am I eligible for Tier 3?

You can be referred to our service if your Body Mass Index (BMI) is increased to a certain level and you also have health problems related to your weight. We support patients that:

  • have a BMI of 35-39 with obesity related health problems [completion of a Tier 2 service is required)
  • have a BMI of over 40 without obesity related health problems [completion of a Tier 2 service is required)
  • have a BMI of over 50 [completion of a Tier 2 service is not required, however it is recommended)

You must also:

  • be aged 18 years or above
  • be motivated to make lifestyle changes and commit to the programme
  • have agreement from your referrer that this is the appropriate pathway for you (as exclusions may apply)

In some cases this is also subject to assessment by the multi-disciplinary team, even if meeting the above criteria to ensure our patients are on the appropriate support pathway.

Policies will be reviewed in light of new evidence or new national guidance.

What is a Tier 2 service?

Tier 2 Weight Management Services are for people with a BMI of 25 or above and are based within the community.  You can self-refer to a Tier 2 Weight Management service. We do not offer a Tier 2 service at Bedfordshire Hospitals. Please ask your GP for available Tier 2 services in your local area. Examples of Tier 2 services:

  • Weight Watchers
  • More Life
  • Slimming World
  • NHS Digital

How can I be referred to the service?

You cannot self-refer to our service. You can be referred by:

  • Your GP (preferred option due to access to wider medical and weight history)

Your specialty consultant can also recommend a referral via your GP.

You will need to meet the access criteria listed above.

Which clinicians will I see in Tier 3?

Our Tier 3 service offers expert support from a variety of clinicians depending on your care needs. We cannot guarantee that you will be seen by the same clinician during your treatment pathway. Our Tier 3 service includes:

  • Specialist nurses
  • Specialist dietitians
  • Consultant physician
  • Clinical psychologist
  • Exercise practitioner

You may see all of the above clinicians or a select few, each patient’s weight management journey is unique and requires different clinical expertise.

FAQs

In this section

For individuals who would like to pursue weight loss surgery, you will need to complete a Tier 3 programme (6 or 12 months) and be assessed as suitable by the Tier 4 MDT.

There are a number of areas that can be focused as part of the Tier 3 weight management programme that can support an individual to meet eligibility criteria for weight loss surgery, as well as support weight loss surgery to be safe and effective.

Psychological Wellbeing

Weight loss surgery can add additional demands to an individual’s life and reduce access to coping strategies such as use as food, alcohol and smoking as a coping strategy for challenges with emotional wellbeing. There is therefore a risk it can trigger a deterioration in mental health. Whilst it is not possible to determine with certainty whether psychological risks will realise themselves, the below presentations indicate a person may be a vulnerable candidate for weight loss surgery:

  • Self-harm in the past 12 months
  • Inpatient mental health admission in the past 12 months
  • Substance use disorder in the past 12 months
  • Eating disorder in the past 12 months

Our service therefore recommends individuals have stability in no presence of the above for 12 months. We would therefore encourage individuals to liaise with their mental health teams or GP to access support in this regard to facilitate progression to weight loss surgery.

We also recommend that any active mental health difficulties has undergone assessment and stabilisation. Other aspects of psychological wellbeing that can support safe and effective weight loss surgery alongside attending the tier three weight management programme includes support for managing emotionally-driven eating, needle phobia and a phobia of vomiting, anxiety around eating, body image, self-esteem, and exploring how mental health and/or previous experiences impact upon adherence to diet and lifestyle recommendations.

The body mass index (BMI) is a measure that uses your height and weight to work out if your weight is healthy. This calculation is based on the relationship between your height and weight. It is important to note that BMI does not give a full picture of health risk, we will support with a more detailed assessment. The ideal BMI for most adults is between 18.5 and 24.9.

Click here to test your BMI using the healthy weight calculator on the NHS website.

Your BMI will fit into one of 4 categories:

  • below 18.5 – you’re in the underweight range
  • between 18.5 and 24.9 – you’re in the healthy weight range
  • between 25 and 29.9 – you’re in the overweight range
  • 30 or over – you’re in the obese range

For individuals who would like to pursue weight loss surgery, your local commissioning criteria states that all patients must complete the Tier 3 programme. In some cases, expedition to Tier 4 can be done on exceptional clinical grounds. The role of Tier 3 in preparing for weight loss surgery is key. We aim to:

  • Support dietary changes which enable a smoother transition to post-surgery eating habits
  • Support with weight loss which reduces the risk of complications after surgery
  • Work to improve medical conditions which may be a barrier to progressing to surgery
  • Identify any risks to mental health and support with signposting to the relevant services

The service offers a minimum of 12 months of support, sometimes a minimum of 6 months for higher-risk patients where weight loss surgery is a more suitable option in line with commissioning criteria.

It is important that you:

  • engage with the team appropriately
  • agree to come to all appointments. This includes keeping your clinic appointment free and being in an appropriate environment at your planned appointment time (for telephone/virtual appointments)

We know that life can be busy and sometimes you may need to reschedule your appointment. If you do not attend your appointments and you do not let us know, you will be discharged from the service. Our patients will be treated with dignity and respect during their time with us and we expect the same for our staff at all times.

As a hospital we operate on a zero tolerance policy, therefore abuse in any form will result in discharge from the service.

We want to know you better so we can support you on your journey. Before you come to the service, we will send you some questionnaires. Please complete these to the best of your ability. If you need support for this, please let us know. Using this information and information from our discussion at your first appointment, we will aim to support with a personalised care plan which we will develop together. The following will be discussed:

  • Your medical and surgical history including family medical history
  • Your weight history, what has worked for you in the past, including current eating habits
  • Barriers that may hinder your progress and how we can support you with them
  • Realistic goals which consider your personal circumstances
  • Any adaptations you may need for your care
  • We will discuss how often you need to attend appointments
  • We will discuss what types of appointment suit you best
  • You will have chance to ask questions and discuss any concerns that you might have
  • If Tier 3 is right for you, you will be booked in to see a dietitian/nurse/practitioner

Once you have completed your Tier 3 programme we hope that you have gained the tools needed to lose weight and maintain weight loss through positive lifestyle changes. For individuals who would like to pursue weight loss surgery you may have the option of progressing into Tier 4 to be considered for surgical intervention, provided that you have demonstrated weight loss and positive lifestyle changes (and meet the access criteria). If you are not keen on surgical intervention then we will discharge you back to the care of your GP.