Weight management services in BSW

The NHS has several different weight management resources that are freely available to everyone. If your BMI is below 28 your GP or other health care professional will recommend that you take a look at the NHS Better Health website in the first instance to access the support there to help you lose weight or maintain a healthy weight.

There are also free exercise guidelines and suggested workouts available from on the NHS Live Well website.

If your BMI is over 28, you can access free weight management support programmes run by our local councils. These services provide more intensive help over a fixed period of time, usually from specially trained health coaches who can help you set your own goals and support you to achieve them. The three services in BSW are:

• BaNES – Everyone Health
• Swindon – Live Well Hub
• Wiltshire – Healthy Us

You can usually self-refer to these programmes, or ask your GP to refer you.

If you have a BMI of over 30 (over 27.5 for people of Asian, Chinese, Middle Eastern, Black African or African-Caribbean origin) and you also have diabetes and/or high blood pressure, you can ask your GP or pharmacist to refer you to the NHS Digital Weight Management Programme. This is a 12-week online behavioural and lifestyle programme that people can access via a smartphone or computer with internet access.

Medicines may be recommended to help support weight loss and weight management if healthy lifestyle changes (such as eating healthily and exercising more) are not helping on their own.

The weight loss medications available are:

• orlistat
• tirzepatide (Mounjaro®)
• semaglutide (Wegovy®)

Orlistat helps you to lose weight by preventing you absorbing fat from the food you eat. 

Tirzepatide and semaglutide are all part of a group of medications known as GLP-1 agonists which work by imitating the action of the natural GLP-1 hormone, which is released in the gut after eating. They help reduce your appetite by making you feel full and slowing down the time it takes for your stomach to empty.

You can find out more about how these medications work on the NHS website. 

All weight loss medications can only be prescribed under specific circumstances, in line with national guidelines. 

In BSW, orlistat can be prescribed by GPs if you've made a significant effort to lose weight through diet, exercise or changing your lifestyle. Even then, orlistat is only prescribed if you have either:

• a body mass index (BMI) of 28 or more, and other weight-related conditions, such as high blood pressure or type 2 diabetes

Or

• a BMI of 30 or more.

Tirzepatide can be prescribed by GPs for people with a BMI of 40 or more (or 37.5 or more for people of Asian, Chinese, Middle Eastern, Black African or African-Caribbean origin) who also have at least four of the following conditions:

• type 2 diabetes
• high blood pressure (hypertension)
• heart disease (cardiovascular disease)
• abnormal blood fats (dyslipidaemia)
• obstructive sleep apnoea.

Semaglutide can be prescribed by Oviva or our specialist weight management service provided by hospitals, for people with a BMI of 40 or more (or 37.5 or more for people of Asian, Chinese, Middle Eastern, Black African or African-Caribbean origin) who also have four of the conditions listed above. Semaglutide can be prescribed for a maximum of two years.

Some people who lose a large amount of weight can be left with loose skin. At this time, the NHS does not offer skin removal surgery following weight loss. Patients who want to undergo surgery for loose skin will need to do so privately. 

If you decide to undergo skin removal surgery privately, you'll need to choose who will do it. They should have the right training, skills and insurance to safely carry out the procedure.

You can find out more about choosing where to have a cosmetic procedure on the NHS website here.

Specialist weight management services are led by consultant endocrinologist doctors, with teams of health professionals providing a range of more intensive and specialist support to patients. 

In BSW our specialist weight management services are provided by local hospitals and a company called Oviva.

Oviva provides an online specialist weight management service that is able to prescribe semaglutide. People who have a BMI of 40 or more (or 37.5 or more for people of Asian, Chinese, Middle Eastern, Black African or African-Caribbean origin), plus at least four of the following conditions can be referred to Oviva by their GP:

• type 2 diabetes
• high blood pressure (hypertension)
• heart disease (cardiovascular disease)
• abnormal blood fats (dyslipidaemia)
• obstructive sleep apnoea.

Our local hospitals provide face to face support from doctors, specialist dieticians and psychologists on an outpatient basis. The hospital-based specialist weight management service is also able to prescribe weight loss medication. Your GP can refer you to our specialist weight management services if you have a BMI of 40 or more (or 37.5 or more for people of Asian, Chinese, Middle Eastern, Black African or African-Caribbean origin), plus at least four the conditions listed above, and you and your GP consider that you need more intensive support (for example psychological support).

Your GP can also refer you to the specialist weight management service under ‘fast track’ referral criteria if you have a BMI of 35 or more (or 32.5 or more for people of Asian, Chinese, Middle Eastern, Black African or African-Caribbean origin) and you:

• Have a condition called idiopathic intracranial hypertension that is threatening your sight, so you need to have lumbar punctures and/or your sight is already being affected
• Are waiting for transplant surgery and you need to reduce your BMI to below 35
• Have a type of cancer that is made worse by obesity, for example endometrial cancer (cancer of the womb lining)
• Have a BMI of 50 or more (47.5 or more for people of Asian, Chinese, Middle Eastern, Black African or African-Caribbean origin) and might be suitable for weight loss surgery.

Weight loss surgery

The specialist weight management service provided by hospitals can also refer patients who meet eligibility criteria for weight loss surgery. For people living in BSW, this weight loss surgery is mainly carried out at Gloucester Royal Hospital or Southmead Hospital in Bristol.

Weight loss surgery, sometimes called bariatric surgery, is a treatment for people who are severely obese. It makes the stomach smaller, so people feel fuller sooner and less food is eaten.

The main types of weight loss surgery are gastric bypass, gastric band, gastric balloon and sleeve gastrectomy. You can find out more about weight loss surgery on the NHS website here.

Weight loss surgery is usually only available on the NHS to treat people with severe obesity who meet the following criteria:

• they have a BMI of 40 or more, or between 35 and 39.9 and have a serious health condition that could be improved with weight loss, such as type 2 diabetes or high blood pressure

Or

• for people from an Asian, Chinese, Middle Eastern, Black African or African-Caribbean origin, bariatric surgery may be considered for people with a BMI of 37.5 or more, or between 32.5 to 37.4 if they also have another health condition that could improve with weight loss

And all of the following are met:

• all appropriate non-surgical measures have been tried, but the person hasn't achieved or maintained adequate, clinically beneficial weight loss
• the person is fit enough to have anaesthesia and surgery
• the person has been receiving, or will receive, intensive management as part of their treatment
• the person commits to the need for long-term follow-up.

Skin removal surgery

Some people who lose a large amount of weight can be left with loose skin. At this time, the NHS does not offer skin removal surgery following weight loss.  Patients who want to undergo surgery for loose skin will need to do so privately. 

If you decide to undergo skin removal surgery privately, you'll need to choose who will do it. They should have the right training, skills and insurance to safely carry out the procedure.

You can find out more about choosing where to have a cosmetic procedure on the NHS website here.