Dr Laura Stewart
Registered Dietitian and member of the British Dietetic Association’s Specialist Obesity Group Committee
People living with obesity need differing levels of support and nutritional advice.
Weight management is complex and people living with obesity need differing levels of support at varying times. In the UK, tiered classification of weight management support is used. Tier 3 is best described as a multifaceted specialist weight management service.
A 2014 Public Health England report described tier 3 as a multi-disciplinary team approach, potentially including a specialist dietitian, psychologist, physiotherapist, predominately delivered through the NHS.
What that will look like and how you get referred to your local tier 3 will vary across the UK. The majority of people will be referred via their GP or other health professional.
Specialist dietitian support leads to changing habits
An important member of this team is the specialist dietitian, who will predominately deliver the core weight management programme.
Dietitians working in tier 3 services will offer sound nutritional advice along with support in changing behaviours. They have expertise in guiding people living with obesity to consider why they want to change and how they might be able to make those changes in their daily living.
A psychologist will work with those requiring assessment and support for mental health concerns.
There is no quick fix to losing weight and our modern society makes it easy for people to gain weight through taking in excess calories and doing less physical activity.
The dietitian supports people to consider the changes they need to make to decrease overall calorie intake from food and drink, increase levels of physical activity and reduce time spent being inactive.
Typically, a tier 3 patient is someone has tried to manage their weight and needs more specialist support.
Criteria for tier 3 support varies depending on where you live
Eligibility criteria is one of the factors that varies across the UK. It is usually dependent on BMI, which will always be at least a BMI of 30 and above. In some areas, waist measurement or medical complications such as Type 2 diabetes or heart disease will be part of the criteria.
Clear guidance on nutrition to prevent obesity
With 27% of adults in the UK having a BMI of 30 or above, the importance of tier 3 services can easily be seen.
The level of obesity in the next generation is worrying. In England, at age 10/11 years, 20% of children are in the ‘higher unhealthy’ weight range.
The Government has recognised the importance of changes the food industry can make to give people guidance and support on healthier choices. Food labelling and the sugar tax on drinks are well-known attempts. Policies around calorie labelling on menus and restricting two-for-one offers on high fat and high sugar foods have been out for consultation.
Weight management in the UK has come a long way but more needs to be done through public health initiatives to prevent obesity and support those who are ready to manage their weight.