# Tier 3 Weight Management



## Lucyr (Dec 24, 2022)

Has anyone heard of or been referred to tier 3 weight services/management? Not exactly sure what they’re called but it seems like tier 4 is surgery and tier 3 is the level before that, tiers1/2 are more like the usual weight watchers etc. 

After the consultant appointment (with the new one I didn’t really gel with) a referral has been put in to this for me. I have no interest in qualifying for weight loss surgery whatsoever, unless an absolute last resort. I understand it helps some people, but it’s not for me at the moment and I’d be more motivated by the thought of avoiding it than qualifying for it. 

I’ve looked up the local programme name for tier 3 and it seems to be a 6 month programme of various sessions with different focuses (diet, psychology, exercise) and weigh ins to support you in losing weight. It does seem like it’s aimed at people who want to qualify for weight loss surgery but there wasn’t much info to be honest. 

I don’t know if my referral will be accepted but never really had a programme of support so willing to give it a go if it is accepted. I’ve also got the orlistat which I’ll start after Christmas and some iron supplements which I’ll start in the new year, so I’m all set for a weight loss kick start after Christmas. 

Has anyone else heard of this or have any experience to share? Or if not is it something worth sharing some notes on here when I find out more for future people? I didn’t even know it existed to be honest.


----------



## zuludog (Dec 24, 2022)

This is the first I've heard of the Tier System? for weight loss, but if you Search YouTube for 'tier 3 weight management' there are several videos which might help

Similarly if you Search t'Net for 'tier 3 weight management services' there are several references

Apologies if you know this already, but have you tried following the advice in these books -

The Fast 800 by Dr Michael Mosley
Life Without Diabetes by Prof Roy Taylor

Or commercial diet schemes such as Optifast, Kee, Exante, and possibly others


----------



## Lucyr (Dec 24, 2022)

zuludog said:


> The Fast 800 by Dr Michael Mosley
> Life Without Diabetes by Prof Roy Taylor
> 
> Or commercial diet schemes such as Optifast, Kee, Exante, and possibly others


None of those are reccomended for people using insulin, I have tried but had high ketones within the first day so stopped.


----------



## berryr99 (Dec 24, 2022)

Somehow got referred to a Tier 3 clinic although I am very far from obese - just a bit overweight. All the people there were very overweight, if not obese and the whole provcess was designed to prepare people to accept surgery. I refused to stay but got one important tip which put me on a carb counting course.


----------



## AndBreathe (Dec 24, 2022)

Lucyr said:


> None of those are reccomended for people using insulin, I have tried but had high ketones within the first day so stopped.


Lucy, ketones are generally a worry where the ketones accompany high blood sugars.  Ketones with lower/normal blood sugars more often indicate nutritional ketosis (which is harmless, and just indicates the person is fuelling on fat, as opposed to glucose) or starvation ketosis, which is more self-evident, but suggests the person is burning their own fat reserves.

Bearing in mind I have never used insulin or had anything other than ketones suggesting nutritional ketosis, they have no fear for me, but clearly you have to decide on your own way forward.

I know of someone on another forum who went through the tiers of weight loss management and eventually underwent a Rouy-en-Y procedure.  She seems happy with it, although it is a while since I have read any posts from her.

Like any treatment, weight reduction surgery can have unwanted side effects which can be lifelong, so like you express, I think it isn't something to go into lightly.

Good luck with whatever you decide.


----------



## Lucyr (Dec 24, 2022)

AndBreathe said:


> Lucy, ketones are generally a worry where the ketones accompany high blood sugars.  Ketones with lower/normal blood sugars more often indicate nutritional ketosis (which is harmless, and just indicates the person is fuelling on fat, as opposed to glucose) or starvation ketosis, which is more self-evident, but suggests the person is burning their own fat reserves.



Yes I know this about different types of ketones, but I can’t do a diet that means i always have ketones as then when I’m high I can’t tell if it’s dangerous ketones or  not.


----------



## Lucyr (Dec 24, 2022)

berryr99 said:


> Somehow got referred to a Tier 3 clinic although I am very far from obese - just a bit overweight. All the people there were very overweight, if not obese and the whole provcess was designed to prepare people to accept surgery. I refused to stay but got one important tip which put me on a carb counting course.


Yeah I thought it would be about preparing for surgery which I don’t want and wasn’t part of the discussion with consultant at all. I do know that you have to prove you can lose weight before surgery though so hoping I can get something useful from it if they accept me anyway


----------



## AndBreathe (Dec 24, 2022)

Lucyr said:


> Yeah I thought it would be about preparing for surgery which I don’t want and wasn’t part of the discussion with consultant at all. I do know that you have to prove you can lose weight before surgery though so hoping I can get something useful from it if they accept me anyway



Good plan.


----------



## Sarahp (Jan 1, 2023)

I did tire 3 twice, you do not have to want surgery to be referred, had the surgery but had complications, did go into remission but developed other medical issues so now trying to resolve those. The peer and group support is amazing.


----------



## Lucyr (Jan 1, 2023)

Sarahp said:


> I did tire 3 twice, you do not have to want surgery to be referred, had the surgery but had complications, did go into remission but developed other medical issues so now trying to resolve those. The peer and group support is amazing.


Thanks for your reply, and hope you can resolve the issues. I’m waiting to hear back on whether I’ll be accepted on the tier 3 but calorie counting with nutracheck in the interim. What kind of time commitment did it involve for you in terms of appointments or sessions etc, say per week or month? I’ve not had any info on that to know whether I’d need to clear it with work etc.


----------



## Sarahp (Jan 1, 2023)

Hi, in my area it was really fluid, they run day and night sessions so can accommodate shift workers, they also now run virtual sessions, I did two years of classes, intially was weekly, then moved to fortnightly and then monthly after about six months. We covered all sorts of things and visiting professionals came to talk about surgery and what to do if we didn’t want surgery, the sessions were two hours and often we did social groups/chats afterwards and some went on to a optional meet up monthly (available for life) via a peer/buddy system and we have a closed optional Facebook page which we can access for life for peer support. 
The second time was a different structure over a year with similiar talks and content.
It’s not a nationally laid out format so will vary area to area, though there does seem to be a good peer support network in most areas in Devon and cornwall and they like you to link in with this if you decide to have surgery.
I wasn’t sure about the op but once you see the first person come back and the frantic weight loss it does make you think hard about it.
I only had to take time off work for the initial assessments clinics to see if I would be accepted on to the programme, unfortunately you’re not automatic even if a consultant or Gp referral is made. Only other appointments I took time off work for were for pre op tests and checks for medical conditions that might pose a risk during the op but nothing for the courses themselves. Hope this helps. Ask any questions you want, my hubby works shifts so sometimes online weird times.


----------



## Lucyr (Jan 1, 2023)

Thankyou that’s really helpful, it sounds like the format in your area was really good, wonder if my area will be anything like that. Yes the being accepted seems the hardest part as I don’t really have proof of what other things I’ve tried, the application form wanted evidence of trying for 2 years and asked for the dates and weights for all sorts of things, which were all left blank. So I imagine they’ll go back to my GP for more info before I hear anything.


----------



## Sarahp (Jan 1, 2023)

Lucyr said:


> Thankyou that’s really helpful, it sounds like the format in your area was really good, wonder if my area will be anything like that. Yes the being accepted seems the hardest part as I don’t really have proof of what other things I’ve tried, the application form wanted evidence of trying for 2 years and asked for the dates and weights for all sorts of things, which were all left blank. So I imagine they’ll go back to my GP for more info before I hear anything.


Glad it helps! They are recognised by awards for being a gold standard so lots of areas are following their approach including their buddy system as well.
Not heard of having to apply and fill forms in before as the patient, all that was done by my referring dr. Keep me posted on how you get on and I can always ask around with our buddies if I can’t help you myself!


----------



## Lucyr (Jan 1, 2023)

Sorry yes the Dr has filled in the forms not me, but I’ve looked at them and seen what has been filled in and what has been left blank


----------



## Sarahp (Jan 1, 2023)

Lucyr said:


> Sorry yes the Dr has filled in the forms not me, but I’ve looked at them and seen what has been filled in and what has been left blank


Then they need to discuss with dr as that info should be on your records if the nhs has helped you especially your weight history.
Would be a good idea to prepare notes for your assessment appointment, mine was very relaxed, it wasn’t an interview and was very kind and patient focused.


----------



## Lucyr (Jan 1, 2023)

Yea that’s where the problem may be as the NHS hasn’t helped with weight, other than seeing the dietician at the hospital but the GP will have no record of that. See what comes back.


----------



## Sarahp (Jan 3, 2023)

Lucyr said:


> Yea that’s where the problem may be as the NHS hasn’t helped with weight, other than seeing the dietician at the hospital but the GP will have no record of that. See what comes back.


Good luck and keep me up to date.


----------

