Tier 3 Weight Management Programme - has anyone else got experience of this?

[MadamePeriwinkle]

Spoke to the GP this morning about a few issues and mentioned that weight was one and I’d self-referred to the ‘standard’ local weight management service although my BMI is higher than their upper limit.

She asked what I weigh and responded with ‘Wow!’ (obviously not in a good way!) and has referred me to Tier 3 support for 52 months with the possibility of bariatric surgery at the end of I don’t make sufficient progress.

Overall this is positive. My weight is out of hand despite the fact I know what I should be doing and don’t live solely on junk food by any stretch of the imagination.

That said, I have a history of anxiety and depression, possibly undiagnosed ADHD, underactive thyroid and am perimenopausal.

Ideally I need to lose 8.5 stone to take me to the top end of the healthy BMI range for my height.

I’d be really grateful if anyone can tell me what to expect from the programme and success stories would be incredible. I’ve put off dealing with it for so long for many reasons but one of the biggest is that I have zero faith that anything will work.

Hello. Marking my place. About to go to a meeting. Will reply later today.

@ChristmasLightsLover thank you!

I needed to lose ten stone and was referred to nutritionist and CBT this was online during COVID. It was useless, she knew nothing about nutrition for menopausal and older women. We were all over 50 they also used the eat well plate that is considered old fashioned these days.

I lost 5 stone last year doing fast 800 and Ryselbus and am still losing now. So it didn't work for me. By BMI has gone from 42 to 33 so I'm happy with my route.

@Doggymummar that’s great progress but sorry you had a false start.

I’ve heard great things about Fast 800 but just not how I could make it work for me. I do two 13hr days a week and the rest normal 9-5 and the thought of doing that on 800 cals isn’t great.

Also difficult to prep/cook on those days.

How strict with it were you? I’m wondering about doing it 5 days a week and just eating normal but healthy food/portions on the other two days.

Yes, I have been through tier 3 and then I had baratric surgery, which is stage 4.

stage 3 was really supportive I had support from specialist baratric dietitian's and psychologist's.

stage 3 was the stage I needed to go through to have baratric surgery. I had both 1.1 and small closed group sessions looking at the reasons behind my eating and being morbidly obese, new research around obesity and nutritional support - I did lose weight in tier 3 with a specific individual eating plan taking into account my life style and allowing for some treats. It also involved preparing for life after surgery.

surgery was the biggest decision I have made to date. It has been life changing for me and I have lost over 10 stone since having it done.

However, the emotional (head) hunger does not disappear- the physical symptoms of hunger do.

it can be tough sometimes knowing that I can never have a glass of fizzy drink or wine or that I can never eat a slice of white bread or have the odd chocolate bar, apart from 1-2 squares occasionally. If I have too much sugar I get sugar dumping, which is horrendous!

The surgery has transformed my life and health conditions and I would do it all again.

Good luck OP

I was pretty strict but on Ryselbus you have no hunger so it wouldn't be a problem. I only ate cos I had to to keep alive. Could happily not eat for days.

@bugaboo218 that’s phenomenal! Do you mind me asking how much you managed to lose during the Tier 3 phase? I assume you have to set targets with the practitioners you’re working with.

Also, did the appointments take up a lot of time and were they quite flexible? I work 55 hours a week term time and will be studying as week from October so not sure how I’ll fit it in.

I must admit - and there is no judgement here whatsoever - that I’d love to get to a healthy weight without drugs or surgery. I think some weight loss drugs are contraindicated for me due to thyroid issues and having no gall bladder anyway, and the permanence of bariatric surgery is pretty terrifying. At this stage I wouldn’t vehemently rule anything out though.

I think my issues around food are more psychological, time and energy based. I know what I should be eating, am a good cook and don’t have a sweet tooth or eat huge portions most of the time. It’s lots of little treats here and there, takeaways and comfort food because I’m miserable, stressed or knackered.

@MadamePeriwinkle

In my area the tier 3 groups and 1.1 sessions were weekly with a choice of day time or evening for 2 hours.
I chose evening, due to work commitments. The psychology sessions 1:1 were monthly for 1 hour face to face or on Zoom.

I managed to lose 4 .5 stone in a year. A lot of weight shifted, but I was still morbidly obese even losing 4.5 stone, so had surgery.

My eating plan was specifically tailored to me on tier 3. In my area in tier 3 they did blood tests, metabolic tests and only then is the diet plan created. It is much more in depth and individualised to you. it also takes into account working hours/shifts and life style factors.

I think if anyone is considering having weight loss surgery then doing tier 3 is vital because you need to understand why you eat what you currently do and how to deal with the emotional, mental and physical irreversible ( if you have a gastric by pass) changes that will impact and be with you for the rest of your life!

I found the physical changes the hardest to deal with. Suddenly people, who ignored me and were rude and disrespectful when I was fat started to attempt to treat me like a human being and notice me. Obviously I told them to fuck off!

The other thing that is difficult to deal with is the loose skin . I love being healthy and slim mostly, but I hate my saggy skin! I am still losing weight, but once done I will have the excess skin removed privately. The NHS will not usually remove the loose skin.

Good luck OP if you decide to go for tier 3 and eventually tier 4

My experience is not as positive.

The course was 12 months long. The first few weeks was weekly group sessions, then it went fortnightly until the 6 month mark. It was monthly from 6 months to a year and those sessions were a waste of time since all you did was weigh yourself and then sit and chat and the chat was just general chit chat a lot of the time. I missed getting onto tier 4 by a couple of kg.

It was run by a dietician and psychology assistant, there was one individual session with thwe pychologit half way through.

The first 6 months were positive with good content and support.

Thanks so much for replies and insight. It’s really helping me to get my head around taking this step.

Did you do much exercise whilst on the programme? My job can be quite active (and I’m really feeling it physically which is what’s prompted me to go back to the GP) but I don’t have a lot of spare time and tbh absolutely loathe exercise for it’s own sake. At the moment I don’t feel able for much either. The one thing I enjoy is swimming but it’s a drive away, nearly £10 a pop and I can’t go when when it’s busy as need to keep my contact lenses in to see!

Has anyone been referred surgery before 12 months on tier 3? they told me at first appointment only to lose 5% in 1st year which is about 16lbs or a stone and a bit. i feel like id lose more but will i be ineligible for surgery if BMI gets too low? Its over 41 at moment and was 44 earlier in year.

I was referred over a year ago and still haven’t heard anything, waiting lists in my area are insane.
In the mean time I have lost nearly 6 stone in 8 months with mounjaro. It has been life changing for me, virtually no negative side effects and it honestly feels like I used to be addicted to food and now I'm
just not. I’ve just come out of “obese” on bmi and I’m now into size 14 jeans which feels amazing to me from about a 22 in April!

@Downing4packsofharibo wow that's incredible!

I've still not got any further and am on the fence about meds so I'm going to apply the weight loss jabs principle of 500cals a day below BMR but see if I can do it without the jabs. It gives me about 1350 cals a day which I think
is manageable.

Just need to clear the freezer of extraneous Christmas stock first!