Tier 2 Weight Management Services

General Principals

Patients who have not been able to lose weight through advice and self care may be eligible for Tier 2 Weight Management Services.

These services currently vary across the BNSSG area but are summarised in the following BNSSG Policy (this policy is the CBA policy for tier 3 & 4 services but also summarises tier 1 - 4 services for Bristol, South Gloucestershire and North Somerset)

We have tried to summarise the local options below. Please be aware that local pathways may be subject to change.

Please also see the Digital Weight Management page on Remedy.

Patients should complete at Tier 2 Weight Management process before consideration of referral to Tier 3 & 4 Weight Management service unless BMI is 50 or over in which case direct referral to Tier 3 & 4 Service is allowable.

Referral Guidance - Bristol

NHS Digital Weight Management Programme

The NHS Digital Weight Management Programme supports adults living with obesity who also have a diagnosis of diabetes or hypertension or both, to manage their weight and improve their health. This 12-week online programme forms part of the Tier 2 Weight Management pathway for those patients who are eligible to access and who successfully complete this programme.

Beezee by Maximus - Tier 2

Maximus UK are currently running free healthy weight management services for adults and families across Bristol.

Beezee Adults

Beezee Adults is the name given to the adult weight management programmes offered by Maximus UK. It helps adults lose weight in a healthy way and keep it off for good. There are four options:

1) Adult online group sessions

Due to unprecedented demand there is a waiting list for this of up to 12 months. We are in the process of contacting everyone on this list to let them know this and check if they would still like the service. At this point they will be also offered the effective self-led Beezee Adults Academy through the online learning platform and also signposted to other community resources and local activities .

If the adult is part of a family with young children aged between 4-12years, they could be eligible to join Beezee Families. See info below, or link to Weight Management for children (tier 1 and 2) (Remedy BNSSG ICB)

 2) Men’s online course - Gutless

Gutless is a free online weight loss programme just for men.

Support includes:

• Online group sessions for one hour every week for 10 weeks.
• Support from a nutritionist who will check in throughout the programme.
• A casual, fun, laid-back atmosphere.

Eligibility criteria:

• BMI ≥25-40 (adjusted to 23 if of Black African, African-Caribbean and Asian origin).

Exclusion criteria:

• Having a significant health condition or illness (co-morbidity) in the same individual which has a substantial impact on the patient's health and their ability to take part in the programme. This would mean the Tier 2 intervention is unsuitable.
• Having a complex need which requires an elevated level of support or may rely on other services due to a significant health condition, disability or broader life circumstances. This may involve challenges around mental health, communication, behaviour, sensory input or cognitive ability. As the programme is designed for Tier 2, the individuals need to be able to have autonomy over their participation. 
• Having a diagnosed eating disorder
• Having had bariatric surgery in the last two years

How to refer - self referral

GP’s and other health professionals can recommend Gutless to relevant male patients, who then self-refer using the following methods: 

• Website – the patient follows the simple steps here: Gutless - Free Healthy Lifestyle Services | Bristol
• If preferred, health professionals can instigate the referral through the website using: Referrers - Free Healthy Lifestyle Services | Bristol 

Email can also be used for self-referrals or referrals made by a health professional:

Email  beezeebodies@nhs.net providing as much detail as possible including name, DOB, gender, home address (including post code), and BMI. A contact phone number for the patient/parent/carer is required as this is the key contact method. Consent is needed for us to contact them with this.

3) Beezee Adults Academy – Available for Bristol residents over 18years. Six months of free access to the online learning platform the ‘Academy’ where people can learn at their own pace. People can self-sign up through the online learning platform.

 4) Community resources and activities – people can explore free resources for adult, children and families on mental health and getting active in their area.

Community resources and activities - Free Healthy Lifestyle Services | Bristol

Beezee Families

Beezee Families is the name given to the child weight management programmes offered by Maximus UK. This is a fun, family-friendly approach to learning about how to lead happier and healthier lives.

There are two options:

 1) Beezee Families - online

Support includes:

• Online group sessions for one hour every week for 10 weeks.
• Two 1-1 check-in calls with a nutritionist.
• Includes fun online games and activities to keep children engaged.
• The whole family get involved.

 Eligibility:

Families with children aged 4-12 with a BMI centile >95^th. Children must be accompanied by a parent or carer.

Exclusion criteria:

• Having a significant health condition or illness (co-morbidity) in the same individual which has a substantial impact on the patient's health and their ability to take part in the programme. This would mean the Tier 2 intervention is unsuitable.
• Having a complex need which requires an elevated level of support or may rely on other services due to a significant health condition, disability or broader life circumstances. This may involve challenges around mental health, communication, behaviour, sensory input or cognitive ability. As the programme is designed for Tier 2, the individuals need to be able to have autonomy over their participation. 
• Having a diagnosed eating disorder
• Having had bariatric surgery in the last two years

 How to join Beezee Families:

GP’s and other health professionals can recommend Beezee Families to families who then self-refer using the following methods: 

• Website – the patient follows the simple steps here: Beezee Families - Free Healthy Lifestyle Services | Bristol
• If preferred, the health professional can instigate the referral using website following the simple steps here: Referrers - Free Healthy Lifestyle Services | Bristol 

Email can also be used for self-referrals or referrals made by a health professional:

• Email beezeebodies@nhs.net, providing as much detail as possible including patient’s name, date of birth, gender, home address (including post code), and BMI. A contact phone number for the patient/parent/carer is required when self-referring or being referred by a professional as this is the key contact method. Consent is needed for us to contact them with this.

2) Beezee Families Academy - People can also learn at their own pace by signing up to our online learning platform, the Academy which is available for young people 4-15 years old.

Physical activity on referral 

Please see Exercise on Referral page in the self care section of Remedy

Referral Guidance - South Glos

Please consult the South Gloucestershire Healthy Weight Pathway below to determine the most appropriate service for the patient and follow the relevant referral process outlined.

Further information on the South Gloucestershire Tier 2 Healthy Weight Programme and how to refer is provided below.

Healthy Weight Programme (adults)

Eligible South Gloucestershire patients can access a free 14-week programme delivered by the Active Lifestyle Centres. This includes an in-person 1:1 consultation followed by 5 group support sessions and access to all leisure facilities throughout the 14-week period. 

Eligibility 

• Aged 18 years or more
• Has a BMI ≥30 with no co-morbidities (adjusted to BMI ≥28 with co-morbidities or BMI ≥27.5 in people of Black African, African-Caribbean, and Asian origin) 
• A South Gloucestershire resident or registered with a South Gloucestershire GP
• Is clinically stable
• Is not pregnant
• Does not have a history of or an ongoing eating disorder 

Referral  

To refer a patient to the South Gloucestershire Tier 2 Healthy Weight Programme please complete the ‘South Glos Weight Management on Referral Form’ via EMIS. A patient can also self-refer by completing the One You Contact Form.

An adult that meets the above criteria will also have the option to attend the Healthy Weight Programme for families, depending on their child's circumstances. Further information can be found on the Children's Remedy Weight Management page here 

If you have any questions relating to the Healthy Weight Programme (adults) please call 01454 865337 or email oneyou@southglos.gov.uk 

Also see: Exercise on Referral page of Remedy.

Referral Guidance - North Somerset

Also see the Better Health North Somerset page on Remedy.

The services currently commissioned are:

Slimming World – free 12 weeks via GP referral 

The GP prints/emails the North Somerset Slimming World Referral Letter and gives to patient (Available as an EMIS template). The patient calls telephone number on the letter or uses the link / QR code provided to complete online registration. When the patient registers with Slimming World they will double check their eligibility, book them on to their preferred group for the first 12 weeks free of charge.

Eligibility - patients referred to the service must fulfil the following criteria to enter the scheme:

Person aged 16 years or more and resident in North Somerset with the following:

• Has not attended a slimming club in the 12 months prior to referral (self-funded or referred by health professional)
• Person is ready to lose weight
• BMI equal to or greater than 30 or BMI equal to or greater than 28 with comorbidity, or from Black Caribbean, Black African and Asian ethnic group OR
• BMI > 91th centile on gender appropriate centile BMI charts, if aged 16-17. Those aged 16-17 will need to be accompanied by an adult when they attend

Those not suitable for referral include: person with diagnosed eating disorder, person with significant unmanaged co-morbidity / underlying medical cause for obesity which requires more intensive support, person is pregnant, person has severe/moderate frailty as recorded on a frailty register, person has had bariatric surgery in the last two years. Note: there is no upper BMI limit for the service as per Weight management: lifestyles services for overweight or obese adults NICE guidance

For further information about Slimming World patient referrals please contact the Slimming World referral team Tel: 01773 483247.

Healthy Lifestyles Advisors

This is a free service available those who are over 18, living in North Somerset or registered with a North Somerset GP practice.

The service provides tailored advice to help achieve health goals (weight loss, get active, eat well, liver health) including 1:1 and group support over a duration of 12 weeks.

Please see the www.betterhealthns.co.uk website for additional information including information about how patients can self refer via the Self Refer Form, there is also a Practitioner Referral Form

The team can also be contacted by email on healthylifestyles@n-somerset.gov.uk or telephone 01934 427661.

H.E.N (Health, Exercise, Nutrition in Pregnancy)

HEN takes place at Oldmixon Children’s Centre in Weston-super-Mare, and is delivered by Public Health Lifestyle Advisors and a Registered Midwife.

Eligibility criteria:

• Resident in North Somerset
• Pregnant
• Able to attend a minimum of four sessions

Please see https://www.betterhealthns.co.uk/healthy-families/healthy-pregnancy/h-e-n-in-pregnancy/ for further information.

H.E.N (Health, Exercise, Nutrition Post Natal)

HEN Postnatal is a free healthy lifestyles course for mums who have given birth in the last year.  The course offers weekly support for up to 12 weeks, to help mums feel better about themselves and focusses on:

• participation in physical activity (40 minutes of the session will include taking part in gentle exercise)
• eating well advice
• goal setting
• motivational support and tips to stay on track
• general wellbeing support and signposting
• individuals can also opt in/out of weight check in’s at some of the sessions if weight loss is a goal for them

The course is designed as a rolling programme so that mums can join at any time to start the 12 weeks of support, it is expected that participants attend at least 9 sessions within 12 weeks.

There is no body mass index (BMI) criteria to access the support but participants must live in North Somerset or be registered with a North Somerset GP practice and have a baby aged 0-12 months old.

To find out more email: healthylifestyles@n-somerset.gov.uk or call 01934 426349.

https://www.betterhealthns.co.uk/information/hen-postnatal/

Healthy You (previously called Choose 2 Lose)

12 weeks of free behaviour change support to improve healthy habits, focussed on healthy eating and exercise. Each session is interactive, lasts 90 minutes and covers different topics each week e.g. portion sizes, healthy food swaps, setting goals, taking part in physical activity, local support and signposting.  At each session participants will have the opportunity to take part in 45 minutes of physical activity which will vary each week.

Eligibility criteria

Our target cohort is adults aged 18 years and above, living in North Somerset (or registered with a North Somerset GP practice) with a BMI ≥28 (adjusted to ≥25 in people of Black African, African-Caribbean and Asian origin and those living with comorbidities).

To get the most out of the course it is expected that participants attend at least 9 sessions (to include week 6 and week 12), those attending at least 9 of the 12 sessions will be eligible for two months free Legacy Leisure gym membership worth £88.

The service will focus on reaching higher risk groups, including adults living in areas of deprivation, BME groups, those with a disability and/or long-term health conditions.

Exclusion criteria

• An individual who does not meet the eligibility criteria as defined above
• Severe/moderate frailty as recoded on a frailty register
• Has a diagnosed eating disorder
• Has a significant unmanaged co-morbidity e.g. chronic obstructive pulmonary disease, unmanaged meaning not on medication and/or not subject to regular clinical review or have not completed a current active management programme such as diabetes management or cardiac rehabilitation
• Has had bariatric surgery in the last two years

This programme is currently available at:

• Hutton Moor Leisure Centre, Weston-super-Mare
• Scotch Horn Leisure Centre, Nailsea

For further information visit: Healthy You 

The Lose Weight webpage lists all of the weight management support available in North Somerset, please feel free to share this link with patients. 

Resources

Additional Services

To find additional services within BNSSG please use your MiDoS Login: Login - MiDoS Admin - 2019 (midosweb.co.uk) If you need your password resent, or be issued with one, please contact: Dosteam.southwest@nhs.net

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.