HNY Policy and Pathway Repository - North Yorkshire

Obesity

Referral to tier 3 weight management services must meet the clinical criteria set out below:

• 1. Be over 18 years and over and registered with a HNY GP and referred by a GP
• 2. Have a BMI ≥35kg/m2 with any one of the comorbidities listed:
  • Hypertension
  • Hyperinsulinaemia
  • Dyslipidaemia
  • Type 2 diabetes
  • Psychosocial dysfunction
  • Exacerbation of conditions such as asthma
    
    or a BMI ≥40kg/m2 without comorbidities
    
    These BMIs are reduced by 2.5kg/m2 for people from a South-Asian, Chinese, Black African or Caribbean family background.
• 3. Have demonstrated that they have maximised primary care and community conservative management which must as a minimum include:
  • Receipt of healthy weight and lifestyle advice in primary care AND
  • Evidence of active participation in modification to exercise AND diet, which is patient- or GP-led, or delivered by an independent commercial service or Tier 2 service.
• 4. Patients with a BMI ≥50kg/m2 may be referred directly without evidence of compliance with Tier 2 if they meet the other requirements and have been offered a trial of pharmacological interventions where there are no contra-indications.
• 5. Have an understanding of the commitment required for a Tier 3 programme. This should include nutritional advice, exercise and lifestyle support AND are willing and able to engage and participate in ALL of these aspects of a Tier 3 programme.
• 6. Weight loss goals must be met at 6 months to continue treatment into months 7 to 12.
   

Criteria for exclusion

Referrals should not be made for individuals who:

• Have a BMI less than that stated in the inclusion criteria.
• Have a diagnosed eating disorder, disordered eating, or complex mental health issues, for example suicidal ideation.
• Referred from an inpatient mental health unit · Patients who are unable to participate in ALL of the components of a tier 3 weight management programme including nutritional advice, exercise, and lifestyle support
• Require or request weight loss injections alone or require Very Low Calorie Diets.
• Are referred for other medical/pharmaceutical management of obesity which sit outside of agreed pathways agreed by the ICB.
• Have a greater nutrition risk, for example are receiving cancer treatment, or palliative care.
• Are pregnant.
• Have a diagnosis of active Inflammatory Bowel Disease
• Have had previous bariatric surgery
• Have previously been referred and accepted onto a tier 3 weight management service
• Patients consuming more than 20 units of alcohol per week
• Patients under investigation for cardiac disease

The criteria are supported by NICE Clinical Guidance 189 Obesity: identification, assessment and management.

People with South Asian, Chinese, other Asian, Middle Eastern, Black African or African Caribbean family backgrounds have an equivalent risk of complications of obesity at a lower BMI than people from a White ethnic family background. For this reason, the BMI levels are reduced by 2.5kg/m2 in accordance with NICE Clinical Guideline CG189.

Recommendations | Obesity: identification, assessment and management | Guidance | NICE

Report of the Working Group into Joined Up Clinical Pathways for Obesity: owg-join-clinc-path.pdf