The Weigh Ahead

Referrals are made via your local GP in Hampshire, Southampton City, Isle of Wight or Dorset. You'll need to contact your GP to start the process and they'll usually book you in for bloods and complete the referral form.

Patients need to have a BMI greater than 35 with obesity-related co-morbidity (eg Hypertension, type 2 diabetes, high cholesterol, severe arthritis) or a BMI greater than 40 without.

Patients also need to have completed a Tier 2 service/intervention in the past two years. This could any of the following:

• a locally-commissioned service (eg Slimming World, Weight Watchers)
• prescribed Orlistat by your GP
• referred to an ‘exercise on referral’ scheme

Our Tier 3 service offers specialist support that's tailored to the individual. There are no diet plans or groups! You'll be assigned a team that will see you either face to face or over Zoom and we offer telephone and email support between your appointments.

We offer 1-1 nutrition and activity advice and behaviour change therapy. We also have GP specialists that work in the service that are able to prescribe weight loss drugs to those eligible (please see below regarding weight loss injectables).

The programme is six months initially, to help you lose 5-10% of your start weight. Then followed by six months of weigh-ins to help you carry on losing weight or to maintain the changes you have made.

Current wait time is around 14 weeks between your GP sending us your completed referral and starting the Tier 3 programme. We contact patients initially to offer lots of information about the programme to see if this is the right time to start, and to discuss whether we need to adapt the programme in any way to best support you.

Once booked in, we'll post you a patient booklet to read and to help you become familiar with the programme. This helps patients to understand what we offer and also charts your journey with us.

Patients are expected to commit fully to the programme. This means attending all booked appointments, or providing plenty of notice to cancel so that another patient can use that space and clinic times are not wasted.

We expect patients to attend Zoom appointments in the same way to face to face. You'll need to be in a quiet room, undisturbed ready for your team member to call you.

You'll need to provide weight measurements (either from home scales or by getting weighed at the GP, pharmacy or leisure centre) and by measuring your hips and waist. Don’t worry, we have an easy-to-follow video on how to do this.

We also encourage patients to record food diaries, it doesn’t have to be one of ours, it could be in a little notebook or a food tracking App – these are really useful tools for ongoing weight management.

At your first appointment, your nutrition advisor will want to find out how best they can support you, and what has motivated you to start the programme. As mentioned previously, there are no diet plans or exercise regimes. Together you will agree a few small goals based on your current eating and activity to work on between each appointment.

Your Behaviour Change Therapist will support you to better understand your relationship with food, how to become more motivated to lose weight, how to deal with difficult times and feelings, and offer you tools and techniques for losing weight and keeping the weight off.

The goal from the start is to lose 5-10% weight, for most patients this is around 1-2 stone (1-2lb per week). This may not seem like much but the changes that patients make are not short term. These are small changes that we hope patients can stick to for the long term.

We know patients come to us to lose weight, but there are many other positive outcomes from attending the programme:

• Losing cm from waist and hips so clothes fit better
• Increasing enjoyable activity to become more mobile
• Increasing more fruit and veggies into simple easy-to-cook recipes
• Understanding and recognising ‘difficult times’ and reacting without using food as a comfort
• Having a healthier relationship with food and activity
• And an increased feeling of wellbeing and mental health

Some weight loss plans are effective at losing a lot of weight and fast. Which is great for the short term, but we all know these diets don’t last forever and often the weight goes back on and more, with a feeling of failure.

We support small changes that can last and become embedded in an everyday healthy lifestyle. We know our patients often feel guilt, shame and sometimes hopeless when they start with us. We understand this, and will work with you to become more compassionate to yourself. There’s a good reason 87% of our patients are ‘very satisfied’ with our programme.

We have a closed Facebook group for patients only. This helps to create some social support and the team post lots of helpful content including recipes and activities that you can interact with if you want to. There’s no pressure to join.

Some patients access our Tier 3 service so that they can then be referred onto Tier 4 bariatric surgery. Other patients are discharged back to their GP and can carry on with the lifestyle changes they have made for the long term.

For more information about Tier 4 bariatric surgery on the NHS, please visit www.nhs.uk/conditions/weight-loss-surgery/

We are currently working with our commissioners to finalise a pathway to prescribe Saxenda. This will be for pre-diabetic patients with hypertension or dyslipidaemia. As soon as we are able to prescribe we will communicate this to all GP's so they are fully aware and can support a referral if you are eligible.

We want to help you to best support your patients before, during and after they attend our Tier 3 service.

If you have any queries or questions regarding patient eligibility or would like to book a ‘lunch and learn’ Zoom session, please contact us on 02380 764 964 or email SPIRE.Tier3Soton-HantsWMS@nhs.net