Weight Management Services

We are a friendly, approachable, and experienced team who specialise in weight management. Our team is specially designed to fully support you with all aspects of weight loss.

The service is made up of a team of male and female dietitians.

We deliver services in Worcestershire Royal Hospital, Redditch, Bromsgrove and Kidderminster.

Most appointments are now virtual. It is really important to let us know if you have limited access or ability to use a smartphone or the internet. We can make other arrangements.

How is the Tier 3 service different from the diets I have tried before?

We are a specialist service offering you support to achieve long-term, sustainable weight loss. We often find that people who access our service have tried many diets in the past which have not worked for them. Our role is not to tell you what to do but to guide you to make decisions that will suit you and your lifestyle and to help you understand what you need to do to manage your weight in the longer term.

We take a behavioural approach to weight management to help you to

• Explore current habits and factors that are impacting on your weight
• Identify and start to make changes to your eating, activity and thinking.
• See the links between mood and the food choices that you make.
• Develop skills and confidence to manage your weight in the longer term.
• Feel more in control.
• Support you with any gaps in your knowledge about what to eat.

Do I have to have bariatric surgery?

Not all patients referred to the service are interested in having bariatric surgery.  We help you to develop your skills and confidence so that you can manage your weight in the longer term. These skills will benefit you regardless of whether you choose to have bariatric surgery or not.

Why do I need to complete the Tier 3 program before I can have bariatric surgery?

The program will support you to make the necessary lifestyle changes that will enable you to manage your weight in the long term. In this time, you will be working towards non-scales victories which will be different for everyone e.g. making time for yourself, being a bit more active, signing up to start something new, stopping smoking. Losing a bit of weight before surgery will help lower the risk of complications.

What to expect on the Tier 3 program?

All patients will initially have an individual video appointment with a dietitian for a brief assessment.  Those who are suitable for the service will have access to online resources whilst waiting to be allocated to a dietitian in your locality; this will include workshops.

When allocated to a dietitian, you will be offered a place on the weight management group, one-to-one virtual appointments and/or face-to-face appointments.

You need to be willing to engage with the service and commit to attending these appointments. 

If I want to have surgery what happens after I have completed Tier 3?

Once you have completed the Tier 3 program you will need to attend the 2 pre-surgery group sessions. These sessions provide you with information about the 2 bariatric surgery options in our Trust; gastric sleeve and gastric bypass. This group is now being run virtually and you can find out more about the Bariatric service here.

Below you can read some Patient Information Leaflets we have produced on the following topics:

• Mental Wellbeing
• Activity
• Emotional Eating
• Healthier Takeaways / Convenience Foods
• Mindful Eating
• Sleep Hygiene
• Useful Links

Referrals to the Tier 3 weight management service can now only be made via E-referral by a GP using the weight management triage pathway. Referrals either by post or email are no longer accepted.

In order to be referred through to the Worcestershire Specialist Tier 3 Weight Management Team you need to fulfil the local Care Commissioners’ criteria.

• Aged at least 18 years
• Either have a BMI >40 Kg/m² with or without obesity-related co morbidities or a BMI >35 kg/m² with at least one of the following: diabetes, hypertension, sleep apnoea or intracranial hypertension.

What it is and how it works

Wegovy is a weight loss medication that works on receptors in your brain. It helps patients to lose weight by reducing appetite and increasing how full they feel following a meal. It is used along with diet and behavioural/lifestyle changes.

Wegovy is a once-weekly injection; patients are started on a low dose that is increased gradually to its recommended dose of 2.4mg.

Prescription is for a maximum of 2 years in line with NHS guidelines. Patients must lose 5% body weight within the first 6 months to be eligible for continued prescriptions.

Who is eligible for referral in the NHS

18 years or older. A body mass index (BMI) of at least 35kg/m2 AND a weight-related health issue:

• Type 2 diabetes or Prediabetes (defined as a haemoglobin A1c level of 42 mmol/mol to 47 mmol/mol [6.0% to 6.4%])
• High blood pressure (hypertension)
• Obstructive sleep apnoea (OSA) treated with CPAP
• Idiopathic intracranial hypertension
• NAFLD
• HDL <1.3 for women and <1.1 for men
• Cholesterol > 5
  
  BMI thresholds may be reduced by 2.5 kg/m² for ethnic groups; South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean family background

And one of the following urgent medical needs:

• Precancerous or cancerous conditions in which weight loss would improve outcomes or aid access to therapies
• Patients requiring urgent weight loss for organ transplant
• Idiopathic intracranial hypertension requiring frequent lumbar punctures.
• Patients undergoing planned time-sensitive surgery (including bariatric surgery) for life-limiting conditions (e.g. cardiac surgery) where high BMI is the primary barrier to surgery and weight loss would be beneficial
• Weight loss required for assisted conception in women under the care of a fertility service, in cases where weight loss would be beneficial
• Severe obstructive sleep apnoea, or obesity hypoventilation syndrome and severe asthma, where condition is life-limiting despite ongoing secondary care management with optimised treatment.
• Genetic obesity conditions, if not eligible for Setmelanotide (Imcivree®).

Next step

GPs will need to make an e-referral to the Tier 3 Specialist Weight Management Service for consideration of Wegovy. The waiting list currently is three years.

All referrals need to include the following blood tests so that the service can assess suitability for Wegovy. Referrals will be slowed down if these blood results are not included.

• Hba1c
• Fasting Lipid Profile
• Kidney function tests
• Liver function tests
• TSH

Wegovy is not suitable for the following patients:

• A personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2.
• Serious hypersensitivity reactions, including anaphylaxis and angioedema have been reported with Wegovy® in patients with a prior serious hypersensitivity reaction to semaglutide or to any of the ingredients in Wegovy®.
• Women who are pregnant or planning to get pregnant. Pregnant women concerned about their weight can discuss this with their midwife.
• Patients who have had severe pancreatitis in the past.
• Significant history or current eating disorders.
• Unstable mental health – mental health needs to be well managed.

More information on Wegovy can be found at: www.wegovy.co.uk

If you would like to contact the team please use the details below:

Specialist Weight Management Dietitians
Email: wah-tr.weight.managementservice@nhs.net
Telephone: 01905 760742 (answer phone)

The Tier 3 weight management dietitians work closely with the Bariatric Tier 4 Surgical team. For more information about the Bariatric Service, visit: https://www.worcsacute.nhs.uk/services/item/bariatric-surgery

The Tier 3 and 4 dietitians are part of the Worcestershire Nutrition and Dietetic Department. For more information about the Nutrition and Dietetic Service, visit:  https://www.worcsacute.nhs.uk/dietetics