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Referral
Adult weight management pathway
Scope
This guidance covers referrals into weight management for Adults of 18 years or more and follows NICE guidance.
The Tier 3 service is not a bariatric surgery clinic.
All referrals to Tier 3 will have an initial assessment to ensure the service is the most appropriate placement for them.
Onward referral for bariatric surgery may be made for patients aged 18 or more who have engaged with the Tier 3 service to lose weight over an agreed period. All referrals for bariatric surgery will be assessed by the Joint Tier 3 and Bariatric Service Multi Disciplinary Team (MDT).
This is the only route for NHS funded surgery in Devon.
As there are major implications for both, it is important that the GP and the patient understand what is involved if referral to the Tier 3 and Tier 4 services is accepted.
This is particularly true for Tier 4 (bariatric surgery) treatment which has life long consequences for the patient and long term prescribing and monitoring responsibilities for the GP.
There is a wealth of patient focused information on the MyHealth website which will help support your patient to make the right decisions for them.
Please consider referring them to this MyHealth-Devon: Obesity
Obesity: Investigations and Monitoring
Out of scope
- Patients who are not registered with a Devon GP
- In Devon, there is currently no weight management service for people below 18
- For under 18s consider a referral to paediatrics or a dietician
- Pregnant women
- Patients who are unwilling or unable to engage with the complexities of the service e.g. active psychosis, suicidal ideation severe learning difficulties (please assess suitability of Mental Health and Learning Disability patients and contact a member of Weight Management team if required on 01752 434623)
History and Examination
- Ensure patient is ready to make behaviour change
- Assess patient's BMI
- (For patients who are South Asian, Chinese, Black African or Caribbean, lower BMI thresholds should be applied. For all BMI thresholds use 2.5kg/m2 less. E.g: BMI 35 equivalent to 32.5.) (This advice comes from NICE and relates to a greater propensity in these ethnic groups to develop diabetes and its complications)
- Blood pressure (BP) – use appropriate size cuff
- Heart rate and rhythm
- Check for signs of cardiovascular, abdominal, respiratory and endocrine disorders, e.g. hypothyroidism, steroid excess, acanthosis nigricans
- Oxygen saturation measurement
If BMI is more than 35kg/m2 consider the following
- Full blood count (FBC)
- Urea and electrolytes (U&Es)
- BP
- Fasting lipid profile
- HbA1C
- Thyroid function test including TSH
- Liver function test – including alanine transaminase (ALT)
The results of these investigations must be included in any referral to Tier 3.
As there are major implications for both, it is important that the GP and the patient understand what is involved if referral to the Tier 3 and Tier 4 services is accepted.
This is particularly true for Tier 4 (bariatric surgery) treatment which has lifelong consequences for the patient and long term prescribing and monitoring responsibilities for the GP.
There is a wealth of patient focused information on the MyHealth website which will help support your patient to make the right decisions for them.
Please consider referring your patient to MyHealth-Devon: Obesity
Referral Criteria
Tier 1&2
- South Devon and Torbay and North East and West Devon
- Patients requiring referral to Tier 1 and 2 services in South Devon and Torbay, North and East and West Devon who are 18 years of age and older, with a BMI of 25 – 40kg/m2 should be referred to the national NHS website ‘Better Health’
- Plymouth City
- For patients of 18 years or older, with BMI 26-39kg/m2 refer to One You (Livewell South West) who will discuss options with patients. This includes the offer of an evidence-based multi-component lifestyle programme, called Eatwell.
Eatwell is community and group-based 10 week weight loss programme, specifically commissioned to support those living in deprived neighbourhoods. The programme includes the offer of a four week group-based healthy cookery course and free, weekly exercise classes. Pregnancy and Type 1 diabetes constitute exclusion criteria.
- For patients of 18 years or older, with BMI 26-39kg/m2 refer to One You (Livewell South West) who will discuss options with patients. This includes the offer of an evidence-based multi-component lifestyle programme, called Eatwell.
Tier 3
- The following results must be included in any referral to Tier 3 or the referral will be returned to the practice:
- Full blood count (FBC)
- Urea and electrolytes (U&Es)
- BMI
- BP
- Fasting lipid profile
- HbA1C
- Thyroid function test including TSH
- Liver function test – including alanine transaminase (ALT)
- Oxygen saturation measurement
Patients 18 years or more with a BMI greater than 40kg/m
Patients aged 18 years or more with newly diagnosed type 2 diabetes and have a BMI greater than 30kg/m
Patients with BMI greater than 35kg/m and one or more of the following comorbidities:
- Established (over 4 years) Type 2 diabetes or previous gestational diabetes
- Hyperlipidaemia uncorrected by maximum tolerated doses of Statins
- Sleep apnoea
- Gastro-oesophageal reflux disease (GORD) after assessment by a GI surgeon
- Severe Osteoarthritis requiring listing for joint replacement
- Intracranial hypertension Infertility in which weight is a barrier to therapy
- Non-alcoholic steatohepatitis (NASH)
- Mental Health patients on Atypical Antipsychotics
Referral Instructions
For Plymouth City patients refer to Tier 1&2 Weight Management
Contact Livewell on livewell@nhs.net or 01752 437177 (patient may contact Livewell directly)
For Western Devon patients refer to Tier 1 and 2 refer to the national NHS website ‘Better Health’
For East Cornwall patients refer to Tier 1 and 2 Weight Management
Follow the link to complete the referral form on the Cornwall Healthy Weight page and submit electronically.
Referral to Tier 3 Weight Management
e-Referral service selection:
- Specialty – Health Promotion
- Clinic type – Weight Management
- Service - Weight Management Service-TAS- Livewell SW
Referral Forms
Patient Information
Evidence
Cornwall Healthy Weight
Tier 3
For further information on Tier 3 service please contact Sarah Hind, Weight Management Service Lead:
- Address: Cumberland Centre, Damerel Close, Plymouth
- Tel: 01752 434623
- Email: Sarah.hinds@nhs.net
Pathway Group
This guideline has been signed off by the Devon Weight Management Group on behalf of NHS Devon.
Publication date: May 2019.
