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We reveal how the NHS is abandoning the obese

For over 25 years we have helped hundreds of thousands of people to lose weight, and keep it off, by helping them get to the root cause of their emotional eating.

The eat less, move more messages broadcast by the government and practiced by the likes of Slimming World and Weight Watchers don’t work – with many of their clients experiencing weight gain within months of reaching their goal weight.

By highlighting talking therapy the government’s advisory body, NICE, has signalled a new direction for the UK’s weight loss strategy. They recommended that there should be four stages of treatment (more commonly known as Tiers) available to the obese in their locality. The four Tiers are:

  • Tier 1 – Public health initiatives and primary activity
  • Tier 2 – Community weight management programmes
  • Tier 3 – Network of dedicated centres, staffed with experts in weight loss, exercise, and talking therapies, to help obese patients reverse their weight gain, and avoid the need for surgery
  • Tier 4 – Bariatric surgery, for those found to need it

We filed 211 Freedom of Information requests to England’s Clinical Commissioning Groups (CCGs) and Scotland’s 14 Health Boards. This research was carried out to identify whether or not these services were readily available to obese people in the UK.

A whopping 31 UK areas admit they have no specialist centres to save patients from bariatric surgery. Support elsewhere is a postcode lottery.

Yet in the middle of an obesity crisis, a network of “lifeline” Tier 3 centres – staffed by experts in weight loss, physical activity, and talking therapies – should be everyone’s right, free of charge, say NICE guidelines.

Of the 161 who answered the replies were haphazard:

  • Thirty one said they had no services at all
  • Forty two referred patients to different geographical areas or shared facilities
  • Twenty one said they used centres within, or adjacent to, bariatric units
  • Some said they helped only specific groups (e.g. those with complex diabetes)

Our Medical Director, Dr Matt Capehorn, explains:

“The confusion among CCGs is concerning – more than 24 initially referred the question to NHS England, so were totally unaware it was the responsibility of the CCG.”

“There are far too many with no Tier 3 services at all. Without these there is no appropriate intensive medical help for patients with severe and complex obesity.”

“Of those who did claim to offer Tier 3, standards varied considerably; many shared centres with other CCGs with such massive populations it’s difficult to see how they could cope.”

“Firstly most surgical teams will lack the multidisciplinary skills to provide good medical management, in particular talking therapy (psychological) and behaviour change, to identify and address underlying emotional eating issues (comfort eating, habit eating, or binge eating), which is crucial to prevent future weight regain.”

“It is a myth to believe bariatric surgery will work for everyone.”

“Patients need real help to avoid expensive and invasive surgery, instead, very low calorie diets, combined with psychological support and behaviour change should be used before bariatric surgery is even considered as an option.”

“It makes financial sense for CCGs to invest in Tier 3. If the only option for severely obese is to give them bariatric surgery it will bankrupt CCGs, and will result in no weight management services at all.”

“The provision of Tier 3 obesity services needs to be mandatory to save money – and lives.”

We will be approaching NICE to outline how our programme would be an ideal fit for their new strategy.

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