Specialist weight-management (tier 3) services explained

Weight management is often described in tiers. Tier 3 sits between community behavioural programmes and bariatric surgery. It exists because some people have causes or complications of obesity that need coordinated specialist input, or because earlier approaches have not been enough. The NICE appraisal for semaglutide places use in specialist weight-management services, which is one reason these services have become more prominent.

• People meeting BMI and comorbidity criteria set by NICE and local commissioners.

• Those who have tried tier 2 programmes without sufficient benefit.

• People with complex needs, such as mental health conditions, medication-related weight gain or physical limitations.

• People being considered for bariatric surgery, who need a structured assessment first.

• Those with suspected underlying contributors, such as endocrine disease.

A specialist service may include a physician with an interest in obesity, a specialist nurse, a dietitian, a psychologist or therapist, and exercise or physiotherapy input. This allows treatment of physical, nutritional and emotional factors together. Many people find the psychological element useful because it addresses emotional eating, trauma, sleep and stress, which medicines alone do not.

Expect a detailed history, measurements, blood tests and a review of medicines that may promote weight gain. The team explores previous attempts, eating patterns, activity and mood, and agrees goals. They explain treatment options, which may include behavioural therapy, structured diet plans, medicines and, in some cases, referral for surgery.

Services often provide support for a defined period. At review points the team checks response and decides whether to continue, change or stop treatment. For medicines, there are usually criteria linking continuation to a meaningful response. Ask at the start how long support is expected to last and what happens afterwards, including whether the GP will take over monitoring.

Waiting for specialist services can be lengthy. While waiting, you can start tier 2 support, work with your GP on managing conditions such as blood pressure and diabetes and ask whether a dietitian is available. If you choose a private route in the meantime, tell the NHS service so your care is coordinated.

Attend appointments consistently, be open about difficulties such as binge eating, low mood or side effects, and ask for the plan in writing. Bring a list of your medicines because some prescribed drugs, including certain antidepressants, antipsychotics, steroids and diabetes medicines, can promote weight gain and the team may be able to suggest alternatives with your prescriber. If a particular professional is not helping, say so; teams can adapt.