NICE guidelines include an adult obesity care pathway for people with a BMI of 35+in the presence of significant co-morbid conditions or BMI 40+, some of whom have been referred for consideration of bariatric surgery, as being eligible for tier 3 specialist weight management support.

The aim is to deliver a specialised multi-disciplinary service is a community setting with an emphasis on psychological support for the increasing numbers of people who have failed to achieve a healthy weight through other weight loss services.

Tier 3 will motivate, empower and facilitate individuals to make sustainable healthy lifestyle changes in their eating and physical activity behaviour which results in weight loss and an increase in self-confidence and self-efficacy.

The service will provide better treatment and package of care for these individuals.

As defined by NICE, tier 3 SWAMS is to provide effective and appropriate therapeutic and educational interventions that enable people to develop coping strategies and make behaviour changes to successfully achieve sustained weight loss.

Key elements of a specialist service include: - • Being multi-component: involving interventions that address issues related to underpinning psychological issues, nutrition/dietary patterns and enabling individuals to become more physically active. • Working with individuals who have increasing levels and complex obesity with related co-morbidities (including those who have tried repeatedly to lose weight) and providing support for them to lose weight safely through sustainable lifestyle changes. • Providing assessment and support for individuals who have been referred to tier 4 specialist weight management services (bariatric surgery). • Preparation and referral of appropriate patients to an NHS commissioned bariatric surgical provider after a period of stabalisation, and pre-surgery preparation as appropriate for the service