Tier 3 weight management

[Cowsontheloose]

I was referred to tier 3 weight management last year. I've had my first appointment today and they say they don't offer weight loss jabs. Is this normal? I've opted for bariatric surgery for my preferred option. How would they prefer for surgery over the jabs?

First thought is surgery is permanent where as the weight loss jabs depend on the person changing their diet and lifestyle to lose weight and especially to maintain, as studies show many people regain once stopping, as they simply eat less rather than change diet, so when stopping they eat more of what they used to again, essentially back to the habits that made them put the weight on in the first place.

I though it was because weight loss jabs on the NHS haven't been rolled out yet. It was on tv just a few days ago, that the first tranche will start being offered jabs shortly. You need a BMI over 40 and 4 or more co morbidities to qualify. This was for Mounjaro.

@Cowsontheloosewhat were the other options if WLI were not on offer?

I saw this, buy i thought ot was different for the tier 3 weight loss. The new roll.ouy is for GPs to be able to prescribe

I've seen posts of wegovy being offered through tier 3 weight management but it may be only with diabetes, I don't know the criteria. The new roll out is via GPs, tier 3 weight management is a separate referral scheme.

Is there any chance you can self fund Mounjaro privately?

Tier 3 here leading into tier 4 (bariatric surgery) is using exactly the same criteria - 40bmi and 4 comorbidities for mounjaro. I thought that was NHS wide it's just how it's delivered.

Google says gps or community clinic.

But yes the criteria wouldn't be any different as I was a lot over 40bmi and was looking it it and felt frustrated I could access surgery but not mounjaro.

I've ended up paying and best thing I've ever done but genuinely worried about affordability of it as in having some money issues.

@Cowsonthelooseit’s a ridiculous system isn’t it.

I requested a referral to Tier 4 weight management service when my BMI was over 50. As I had no co-morbidities they wouldn’t prescribe WLI but I could have had bariatric surgery. The weight management service was worst than useless, an absolutely pathetic offering, so I didn’t waste my time returning to the sessions. Instead I self funded WLI which stopped my food noise enabling me to put in place many lifestyle changes and now my BMI is a healthy 23.

Oh wow that's fab! Very similar story here although I'm only down to 39 bmi. I can't imagine 23!! How is it? Will you stay on MJ long term?

Dietitians, orlistat and thereapy

I must admit im a bit worried about what dietitians can offer, I've seen more than a few in the past. Well done on your amazing achievement

Personally if you can self fund, the injections are life changing and probably less risky than the surgery.

Yes I've gone from bmi 50 to just under 40 in 6 months and I've already regained mobility. I have fatty liver and knew I needed to do something. It's working and I am sure I will get down to a healthy weight.

My fear with surgery is that although it works long term people seem to put on (or even move over to injections) and it has lifelong effects.

I did wli as a last chance befire surgery. I read it's likely 12 years before NHS roll out the programme to all eligible (as in 30bmi+/27 with a condition) which made the decision for me!

I have another few lbs to lose and then I will start reducing the amount of Wegovy I take to see how little I can get away with taking. But I suspect I’ll have to stay on a small dose for the rest of my life (or as long as I can afford it!).

How would they prefer for surgery over the jabs?

Surgery option, experienced staff for pre/post op support is there in place all ready to go.

WLI is still very new and resources are not fully skilled up and experienced to provide all the support the NHS does with these things. NHS are not like a pharmacy that just prescribes and lets you get on with it they will have multiple HCP overseeing the treatment, making decisions on dose changes, supporting side effects, educating on diet changes etc, that all need skilled up and experience and this needs repeated throughout the uk.

I've just posted this in the June 25 WLI thread as I am taking Mounjaro but also on the wait list for tier 3.

Went to a seminar today as a precursor to the programme.
So:-
*There were approx 25 attendees around 10 were on a private WLI.
*Consultant (endocrinologist /bariatric surgeon) said this was becoming more and more common
*They would not / could not offer WLI as they had no funding for this at present ( but had for bariatric?!). And until the purchasing group prioritised this they could no offer it. He did see WLI as part of the holistic weight loss solution.
*BMI needed to be >40 (or 35 for certain ethnicities etc). Because it's basically a 12 month wait for accessing the program it would be up to the clinicians if they take on someone who has a BMI of less than 35 (but more than 30). - they acknowledged this was likely if taking WLI. Previous to WLI it was rare to see people with a significantly lower BMI. On referral they require >40 BMI.
*They see those taking WLI as needing the multidisciplinary support of the WL prog to change habits/ make better choices etc so have no problem if people are taking WLI.
There's a 4 HR ISH initial consultation, and then 2 in person sessions of around 4 hrs per week for 12 weeks.
*There is an online option but take up for that is low/non existent.
*But those at the seminar now won't get their first session until October.
*Follow up in person at 9 months.
*Resources available for 12 months minimum.

And just to add in this thread the consultant said that they would take a clinic decision 9 months into the 12 month programme and it would be a full clinic team who would make the decision and not the patient. There was no opting in/out. You would think that someone would be working out how much bariatric surgery costs v WLIs.