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New commissioning guide for weight-loss programmes

20 Mar 2014

The launch of a clinical commissioning guide on weight loss services (today Thursday, 20 March), developed following a NICE accredited process has been welcomed by experts across several disciplines.

The guide is intended to assist clinical commissioning groups in commissioning these services and reduce variation in access to weight-loss clinics across the country.  It has the backing of five Royal Colleges, the British Obesity and Metabolic Surgery Society (BOMSS), the Faculty of Public Health, the National Obesity Forum (NOF), the British Dietetic Association (BDA) and the British Psychological Society.

Mr Richard Welbourn, Consultant Surgeon and President of the British Obesity and Metabolic Surgery Society (BOMSS) and Professor John Wass, academic vice-president at the Royal College of Physicians (RCP) led the project, joining forces with other experts to compile the guide - and to press for better joined-up clinical pathways for obesity services.

Along with surgeons, physicians and other health professionals they have been concerned that access to Tier 3 weight management clinics is restricted in some parts of the country.

Tier 3 obesity services offer support from clinicians, specialist dietician, psychologist and exercise specialists and are a prerequisite for patients seeking Tier 4 services such as bariatric surgery.

A lack of provision of Tier 3 obesity services in some parts of the country was highlighted by the Royal College of Surgeons in January pointing out that it risked leaving obese patients unable to access vital services they need to help control their weight.

Last week Public Health England and NHS England published a report which sought to clarify responsibility for providing Tier 3 obesity services and recommended that they should be commissioned by Clinical Commissioing Groups (CCGs). The new guide sets out how those services should be commissioned.

In a joint statement, Mr Welbourn and Prof Wass say: “The Royal College of Surgeons and BOMMS have developed a commissioning guide for Tier 3 services which covers weight assessment and management which takes into account the views of 10 sponsoring organisations.

“The guide includes input from patients, pathologists, bariatric physicians, general practitioners, public health experts, dieticians, psychologists and healthcare commissioners.

“It deals with the roles of the weight management clinic, the multidisciplinary team, the role of general practitioners, the role of the clinic itself, referral to bariatric surgery and peri- and post-operative care.

“We hope that this guidance will clarify the role of Tier 3 services in helping patients with weight problems.

“We are aware that Tier 3 services need to be developed in a number of areas in the UK.  We believe that the service model set out in this guide should be adopted as quickly as possible across the country to ensure that a consistent service is provided to those who need it. ”

Hospital Episodes Statistics data shows there has been a fall of 10% in the number of bariatric surgical procedures being performed between April 2012 and March 2013, even though the most recently available statistics show obesity rates in England continuing to rise.

Notes to editors

Read the full Commissioning Guide: Weight assessment and management clinics (Tier 3).

The Royal College of Surgeons of England is committed to enabling surgeons to achieve and maintain the highest standards of surgical practice and patient care. Registered charity number: 212808. For more information please visit

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