Obesity Abstracts

Provision of Tier 3 (T3) services as defined in NHS commissioning guidelines are integral to NICE obesity guidelines. Previous surveys have shown that people with obesity face a postcode lottery in accessing them. With the establishment of Integrated Care Boards (ICBs) now responsible for commissioning T3 services, we undertook a survey using Freedom of Information requests to all English ICBs in October 2023 asking for: a comprehensive outline of the T3 obesity care pathways; the names of providers involved in delivering T3 services during the April 1, 2022, and March 31, 2023; the total number of referrals made; and the number of patients who commenced Tier 3 obesity treatment during the same period of time. We received responses from 40 out of 42 ICBs, 85% of whom stated they had T3 services. Non-NHS treatments only were provided by 7%, and a blended service (combining NHS and non-NHS weight management) was provided by 17% of ICBs. Scrutiny of the services offered, in many cases suggested they did not fulfil the criteria for a T3 service (no multidisciplinary team, short duration intervention, no access to pharmacotherapy, gateway service for bariatric surgery). Over half of England’s ICBs services comprised both face-to-face and online appointments. Only 55% of ICBs could provide data on the number of referrals to their services (total April1 2022 to March31 2023 = 43,860); 20 of 40 ICBs had data on the number of PwOs starting treatment (total 13,912). Despite NICE guidelines, health technology assessments and clinical need, these data confirm an ongoing lack of obesity treatment services for PwO in England. They are similar to findings from Coulman et al, who used routinely collected primary care data in England from the Clinical Practice Research Datalink linked with Hospital Episode Statistics from 2007-2020 (56,783 of eligible patients referred to weight management)¹, and the recent GIRFT (Getting it Right First Time) Programme National Service Report findings (only around 44% of trusts in England have obesity services at T3 or above)².

1. Coulman et al. PLoS Med 20(9): e1004282. 2. Wass & Lansdown. Endocrinology GIRFT Programme National Specialty Report Feb 2021.