Tier 3 Weight Management (Interim Complex Obesity Service Policy) [Suffolk]

Threshold

Norfolk and Suffolk ICB was formed on 1 April 2026. Until clinical policies are fully harmonised across the integrated system, any policies that have not yet been updated will be treated as legacy policies. These legacy policies will continue to apply to the populations they originally covered.

• If you live in Suffolk, the relevant Suffolk and North East Essex ICB legacy criteria will apply.
• If you live in Norfolk and Waveney, the relevant Norfolk and Waveney ICB legacy policy will apply.

This ensures continuity of care and clarity for patients while harmonisation work is ongoing.

Interventions covered by this policy

Referral to the Complex Obesity Service provides access to a comprehensive care pathway, including:

• Specialist dietary advice
• Multidisciplinary team (MDT) support
• Clinical assessment and preparation
• Access to both medical and surgical treatment options, where patients are eligible and prioritised.
  • Where these treatment options are initiated, patients will be enrolled in long-term outcome monitoring to evaluate effectiveness, ensure safety, and support ongoing care planning.

The pathway includes:

• Initial desktop triage to determine eligibility for entry into the service
• Assessment period involving tailored and specialist dietary support and MDT input
• Access to NICE-approved pharmacological treatments where clinically appropriate, including:
  • Wegovy® (semaglutide) (TA875)
  • Mounjaro® (tirzepatide) (TA1026)
  • Consideration for bariatric surgery, where clinically appropriate.

All professional and clinical weight management referrals for SNEE patients must be processed via the Weight Management and Complex Obesity Service Single Point of Access (WMCOS SPoA). There are no direct referral routes available into medical or surgical treatment options. NHS choice for access to bariatric surgery is incorporated into the pathway at the point of entry into the Complex Obesity Service and captured via the patient surveys as part of WMCOS SPoA. Agreeing entry into COS patient signs a disclaimer which indicates that they are aware that their choice under the NHS Choice Framework is exercised at the outset of the pathway and that they have opted for the ESNEFT COS.

Conditions to be considered for treatment under this policy

Obesity disease

Eligibility criteria for provision of the interventions

It’s important to note that a referral does not guarantee entry into the service, all patients must undergo clinical prioritisation via the WMCOS SPoA before accessing any obesity treatment options. Access is prioritised based primarily on clinical need, with those who have the greatest clinical need receiving priority for MDT assessment and treatment. This means that treatment is not necessarily given to the person who has waited the longest, but to the person who is clinically assessed as being most in need of that treatment.

The patient must meet the eligibility and prioritisation criteria of this access policy at the point of referral, triage and assessment to enter any service that treats obesity disease and be considered for any subsequent obesity treatments and service options. All referrals that meet the minimum entry requirement will be assessed for access via the WMCOS SPoA for all NHS funded obesity services.

The patient must meet the eligibility and prioritisation criteria at the point of referral, triage and assessment to enter the service and be considered for any subsequent complex obesity treatments options. All referrals that meet the minimum entry requirement will be assessed for access via the WMCOS SPoA.

All patients will undergo a clinical assessment prior to any obesity treatment options being considered. Patients must meet the treatment option eligibility criteria, and must be clinically suitable for treatment options, before they commence that treatment option.

Across all access criteria set out in this policy, please note a lower BMI threshold (reduced by 2.5 kg/m2) for people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean ethnic backgrounds and people with a Mixed ethnic background*.

Access to enter the Complex Obesity Service:

The Complex Obesity Service supports access to intensive behavioural interventions, bariatric surgery, specialist psychological and dietetic support and the higher strength GLP-1 RAs treatment options, including Saxenda® (liraglutide), Wegovy® (semaglutide), and Mounjaro® (tirzepatide).

For all people requesting referral, clinicians should use shared decision making to determine with the individual that they feel ready to engage with the programme and would like to be referred at this time.

Ability to adhere to weight loss programmes correlates with weight loss achieved. People living with obesity and medical conditions such as malabsorption syndrome or nutritional deficiencies from other causes should have access to dietary advice prior to weight management intervention to ensure that these are appropriately addressed prior to weight management intervention.

Currently, it is not possible to provide access to Complex Obesity Service for all eligible people in line with NG246. To address this, a joint position statement was developed by national clinical bodies, building on the 2023 guidance and incorporating more detailed prioritisation criteria and new therapies such as tirzepatide (Mounjaro®), approved under NICE TA1026. This policy supports a prioritisation framework approach to enabling prioritised access to Specialist Weight Management Services based on clinical need, in line with NHSE phased implementation guidance and the joint position statement ensuring those with the greatest need can access treatment first.

Inclusions:

Patients aged 18 and over who meet the criteria can be considered for referral to the Weight Management Complex Obesity Service (WMCOS).

Please note: Meeting the minimum criteria thresholds to be considered by the Complex Obesity Service does not guarantee treatment.

All referred patients will be assessed using the prioritisation framework outlined below. Only patients who are clinically prioritised through the scoring process will be approved to receive care via the Complex Obesity Service.

Key prioritisation factors include BMI, the impact of overweight and obesity on an individual’s daily life, the presence of obesity-related complications, the length of time someone has been waiting (with longer waits contributing to prioritisation), and any previous weight management interventions completed. An adjustment of 2.5 BMI units is applied for individuals from Black, Asian, and other ethnic minority backgrounds.

Patients can be considered for access to the Complex Obesity Service if they have:

• BMI of ≥35 kg/m2 (reduced by 2.5 kg/m2 for people from Black, Asian and ethnic minority backgrounds and people with a Mixed ethnic background)

  OR

• BMI between 30-34.9 kg/m2 (reduced by 2.5 kg/m2 for people from Black, Asian and ethnic minority backgrounds and people with a Mixed ethnic background) with at least 1 of the weight related complications listed below.

Prioritisation is based upon national policy and guidance, including ‘A joint position statement by the Society for Endocrinology and Obesity Management Collaborative UK’ and ‘Proposed referral criteria for Specialist Weight Management’ ; providing a nationally endorsed, multidisciplinary consensus on prioritisation criteria for specialist weight management referrals – aiming to reduce variation and improve equity in service access across the system.

Key Prioritisation Factors

• Body Mass Index
• Obesity-related comorbidities, weighted by clinical severity and impact on health outcomes.
• Waiting time, with longer waits contributing to a higher prioritisation.
  • If a patient doesn’t yet meet the threshold for COS, they are placed in a “Waiting Well” group – with ongoing monitoring until they are prioritised.
• Previous weight management interventions, recognising prior engagement and readiness.
• Ethnicity adjustment, with a BMI reduction of 2.5 points applied for individuals from Black, Asian, and other ethnic minority backgrounds to account for differential risk profiles.

Comorbidity Weighting Categories:

Priority 1 Conditions

• Type 2 Diabetes Mellitus (T2DM)
• T2DM with complications (e.g. retinopathy, neuropathy, diabetic foot)
• Obstructive Sleep Apnoea (OSA)
• Obesity Hypoventilation Syndrome (OHS)
• Heart Failure
• Ischaemic Heart Disease (IHD)
• Myocardial Infarction (MI)
• Stroke (CVA)
• Metabolic Steatohepatitis (MASH)
• Metabolic Cirrhosis
• Infertility (weight loss required for assisted conception in women only where under the care of a fertility service via a consultant-to-consultant referral).
• Obesity-related Cancer

Priority 2 Conditions

• Pre-diabetes
• Hypertension (HTN)
• Hyperlipidaemia
• Peripheral Vascular Disease (PVD)
• Metabolic Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)
• Chronic Kidney Disease (CKD stages 3–5)
• Lymphoedema
• Intracranial Hypertension (IIH)
• Abdominal wall failure / hernia (BMI-related)
• Surgery preclusion due to BMI >35

Priority 3 Conditions

• Asthma
• Atrial Fibrillation (AF)
• Polycystic Ovary Syndrome (PCOS)
• Gastro-oesophageal Reflux Disease (GORD)
• Osteoarthritis (OA)

All eligible patients will undergo the process of clinical prioritisation to determine the level of clinical need and to ensure that those with the most urgent or complex needs are seen first. This is overarching of all clinical assessments and treatment options available under this policy. This approach ensures all nationally and internationally recognised obesity-related complications are considered, enabling clinically robust, equitable, and inclusive prioritisation for treatment.

Those who are prioritised into the service will all receive a clinical assessment, specialist dietary advice and MDT support, the maximum duration this is offered to a patient without onward triage into obesity management medications and/or surgical treatment is 12-months.

Obesity Management Medication access within Complex Obesity Service

Access to Wegovy® treatment option:

In line with NICE TA 875 Weogyv® can only be prescribed within specialist services wit
comprehensive management and oversight via an MDT. Therefore, patients can only be considered
for this treatment option if they satisfy all below eligibility criteria:

• Be prioritised for (in line with section Access to enter the Complex Obesity Service prioritisation framework) and actively engaged in the Complex Obesity Service, which includes:
  • A reduced-calorie diet
  • Increased physical activity
  • Behavioural support
  • MDT input and assessment
• Have a BMI of ≥30 kg/m² with at least one qualifying obesity disease complication, set out in section 3.1 of this policy
• Treatment must be discontinued if <5% weight loss is achieved after 6 months, following individual patient review
• Maximum treatment duration is 2 years, in line with NICE TA875.
• Each patient will undergo an individual assessment to determine the appropriate duration of Wegovy® treatment for overweight or obesity. Outcomes will be reviewed at 6 and 12 months to guide ongoing prescribing decisions.

Access to Mounjaro® treatment option:

In line with NICE TA 1026 Mounjaro® can only be prescribed by the Complex Obesity Service, either via the core service or via the primary care setting Community Outreach.

Mounjaro® cannot be initiated or prescribed by GPs in Suffolk and North East Essex for overweight and obesity. Mounjaro® will only be made available to those who meet the NHS England ‘priority cohort’ groups in Community Outreach settings, details set out in section Access to Bariatric Surgery section of the policy.

Patients can only access this treatment option within their core service if they satisfy all below eligibility criteria:

• Be prioritised for (in line with section Access to enter the Complex Obesity Service prioritisation framework) and actively engaged in the Complex Obesity Service, which includes:
  • A reduced-calorie diet
  • Increased physical activity
  • Behavioural support
  • MDT input and assessment
• Patients must have a BMI of ≥35 kg/m² with at least one qualifying obesity disease complication, set out in section 3.1 of this policy.
• Each patient will receive individual assessments to determine the appropriate duration of Mounjaro® treatment for overweight or obesity. Outcomes will be clinically reviewed, with the option to extend treatment based on ongoing assessments.

Access to bariatric surgery treatment option

Eligibility criteria for provision of the intervention bariatric surgery will only be considered as a treatment option for people with obesity disease if they meet all the following criteria:

• Be prioritised for (in line with section Access to enter the Complex Obesity Service prioritisation framework) and actively engaged in the Complex Obesity Service, which includes:
  • A reduced-calorie diet
  • Increased physical activity
  • Behavioural support
• MDT input and assessment
  AND
• BMI ≥40kg/m2
  OR
• BMI ≥35kg/m2 AND at least one obesity related complication that would be improved by weight loss (obesity related complications set out in section Access to enter the Complex Obesity Service)

The following two groups, may be expedited for assessment for bariatric surgery:

• BMI >50kg/m2
• BMI ≥30kg/m2 and have Type 2 diabetes diagnosed in the last ten years

Access to the Complex Obesity Service Community Outreach Service

To be considered for obesity management medications within primary care settings, patients must fall within NHS England’s defined priority cohorts and be prioritised for treatment within the Complex Obesity Service (in line with section Access to enter the Complex Obesity Service prioritisation framework). Access is enabled through this framework, with those identified as having the greatest clinical need receiving priority for treatment. Meeting the criteria does not guarantee immediate access nor a particular treatment option. All eligible patients will undergo a process of clinical prioritisation to determine the level of clinical need and to ensure that those with the most urgent or complex needs are seen first.

Exclusions this policy does not cover:

All treatment options covered by this policy exclude:

• Children and young people (aged below 18 years)
• Patients not registered with a SNEE practice.
• Patients who do not meet the clinical access policy, unless proven clinically exceptional to the policy.
• Patients who have been previously referred into the service and have left the pathway early or have disengaged from the services, who are seeking to re-enter as a re-referral within a 12-month period.
• Pregnant women
• Those diagnosed with active substance abuse
• Self-harm/suicidal behaviours within the last 12 months.
• Severe cognitive impairment/uncontrolled mental health/personality disorders
• Diagnosed eating disorder – active and/or no previous interventions in eating disorder service.

Exclusions for Obesity Management Medications:

Exclusions for Wegovy®:

• Wegovy® will not be offered to patients with a BMI below 35 kg/m², even if they meet national criteria, as they do not meet the local access threshold for the Complex Obesity Service. Wegovy® cannot be prescribed without the Complex Obesity Service management and oversight in Suffolk and north east Essex.
• Wegovy® will not be offered to patients who meet or exceed the BMI threshold but do not have any qualifying obesity disease complications, as this group does not meet the eligibility requirements set out in NICE TA875.
• History of type 1 diabetes.
• Uncontrolled type 2 diabetes.
• History or presence of chronic pancreatitis or previous acute pancreatitis (unless MDT decision that cause of pancreatitis, e.g. gallstones, has been fully treated).
• History or presence of medullary thyroid cancer (unless MDT decision that benefits outweigh risks).
• History or presence of multiple endocrine neoplasia.
• Pregnant, attempting pregnancy or breastfeeding
• TSH >6.0 mlU l-1 or <0.4 mlU l-1

Exclusions for Mounjaro®:

• History or presence of chronic pancreatitis or previous acute pancreatitis (unless MDT decision that cause of pancreatitis, e.g. gallstones, has been fully treated).
• History or presence of medullary thyroid cancer (unless MDT decision that benefits outweigh risks).
• History or presence of multiple endocrine neoplasia.
• Pregnant, attempting pregnancy or breastfeeding
• TSH >6.0 mlU l-1 or <0.4 mlU l-1

Exclusions for surgical intervention:

• Those who have accessed bariatric surgery privately or abroad will not be supported by this service within 5 years of the date of surgery unless presenting as an emergency.

Additional Notes:

• All referrals for interventions which are primarily to improve the appearance should refer to Commissioning statement ‘Cosmetic interventions: general principles’.
• Please refer to the Policy within this document that covers body contouring procedures.
  • Body contouring procedures are not routinely funded by the NHS. Patients who experience significant weight loss may develop excess skin; however, such procedures to address this are generally considered non-essential and are therefore not typically commissioned.
• Referral may be made to the ECC Panel for patients who do not meet the policy criteria in whom there are considered to be exceptional circumstances supporting the need for complex obesity treatments – specialist dietary advice, MDT support, obesity management medications and bariatric surgery.
• The service is led by a professional with a specialist interest in obesity and includes bariatric surgeons, bariatric physicians, specialist bariatric dieticians, nurses, psychologists and physical exercise therapist, all of whom must also have a specialist interest in obesity.
• Infertility linked to weight-related issues is currently under consideration as an additional complication. The policy may be updated to reflect this in future.
• *The term ‘people with a Mixed ethnic background’ is the recommended wording according to the Writing about ethnicity – GOV.UK on writing about ethnicity.