Brief opportunistic health promotion regarding weight loss in primary care is evidence based and strongly encouraged

Resources to support patients to lose weight are all together on MyHealth Devon

Tier 2 referral pathways in Devon (by area) are outlined below

Tier 1 Adult Weight Management should be encouraged as part of health promotion and self-care in primary care. Opportunistic motivation and appropriate signposting is encouraged.

Patient facing information and links to other resources are available on the MyHealth Devon website:

Weight Management - My health Devon (myhealth-devon.nhs.uk)

Tier 2 services available nationally and locally are as follows:

National

1) NHS Digital Tier 2 Weight Management Programme (DWMP)

The new NHS Digital Weight Management Programme (DWMP) offers online access to tier 2 weight management services for those living with obesity plus diabetes or hypertension or both.

It is designed to offer service users a personalised level of intervention to support them to manage their weight, improve quality of life and improve longer term health outcomes.

Inclusion criteria

Patients who:

a) are aged 18 years and over AND

b) have a BMI greater than 30kg/m² (adjusted to 27.5kg/m² for people from Black, Asian, and ethnic minority backgrounds) recorded within the last 24 months AND

c) have a diagnosis of diabetes or hypertension or both

OR

a) NHS staff with a BMI over 30 (27.5 for BAME groups)

Exclusion criteria

• Pregnant women
• Patients with an active eating disorder
• Patients who have had bariatric surgery in the last two years
• Patients whom the referring practitioner feels a weight management programme is considered to pose greater risk of harm than benefit are not eligible for the programme.

Information on the NHS Digital Tier 2 Weight Management Programme, including how to refer, can be found on the below link:

• NHS Digital Weight Management Programme – North & East (devonformularyguidance.nhs.uk)

2) NHS Tier 2 Diabetes Pathway to Remission (T2DR) Programme

Consider referral to the NHS Type 2 Diabetes Remission (T2DR) Programme for patients with newly diagnosed Type 2 Diabetes.

Eligibility criteria include:

• be aged 18 – 65 years (inclusive),
• have a diagnosis of type 2 diabetes within the last 6 years, and
• have a BMI over 27 kg/m2 (where individuals are from White ethnic groups) or over 25 kg/m2 (where individuals are from Black, Asian and other ethnic groups)

Information on the NHS Type 2 Diabetes Remission (T2DR) Programme, including who to refer and how, can be found on the below link:

• NHS Tier 2 Diabetes Pathway to Remission (T2DR) Programme – North & East (devonformularyguidance.nhs.uk)

The provider, Oviva, is offering meeting/training for referrers at PCN/GP practice level. Please contact Caroline Taylor of Oviva to organise this: caroline.taylor@oviva.com

Local

NORTH AND EAST DEVON

• There is currently no local Tier 2 service for patients registered with a North or East Devon GP.
• Please note the NHS Digital Weight Management Programme (DWMP), detailed above, that offers national online access to tier 2 weight management services for those living with obesity plus diabetes or hypertension or both.
• Patient facing information and links to other resources are available on the MyHealth Devon website:

Weight Management - My health Devon (myhealth-devon.nhs.uk)

The MyHealth Devon page is designed to have all the trusted patient information and links to support available in Devon and nationally in one place - including:

a) BestYou App (provided by ICE Creates)

Best-You

Patients should be signposted to the ICE Creates’ app, ‘BestYou’. The BestYou app will support wider health and wellbeing goals including increasing activity levels, stopping smoking, managing weight and reducing alcohol consumption. The app is free to download and use for Devon residents.

b) Healthier You NHS Diabetes Prevention Programme

Healthier You NHS Diabetes Prevention Programme - Devon

Held face-to-face at locations in Devon or digital online group sessions. Designed to help prevent diabetes through healthier eating, physical activity, problem-solving, stress reduction and coping skills. Please see information on eligibility criteria.

c) NHS Better Health Programme

NHS Better Health Programme - lose weight

Information and links to healthier eating habits, getting more active and losing weight. Includes access to the NHS Weight Loss Plan, a 12-week plan supporting individuals to set weight loss goals, plan meals, make healthier food choices, be more active and record activity/progress (available on the App Store or Google Play).

History and Examination

• Clarify with the patient that they are ready to make behaviour change.
• BMI

(please reduce BMI thresholds by 2.5 kg/m2 for people from South Asian, Chinese, and Black African or Caribbean family backgrounds. This is NICE guidance and relates to a greater propensity in these ethnic groups to develop diabetes and its complications).

• Blood pressure (BP) – please use appropriately sized cuff.
• Check for signs of weight-related comorbidities and consider primary causes of Obesity (see ‘Investigations’).

Prior to referral to a tier two weight management service it is recommended that the following are checked:

• HbA1c to screen for Type 2 Diabetes Mellitus.
• Thyroid function tests to screen for hypothyroidism, a primary cause of Obesity.

Identify and manage weight-related comorbidities

• Please screen for comorbidities in primary care and manage as appropriate. For example:
  • Binge Eating Disorder (BED)
  • Obstructive Sleep Apnoea (OSA)
  • Type 2 Diabetes (prioritise drugs that promote weight loss)
  • Hypothyroidism

Review of medications known to cause weight gain

Some common medications known to cause substantial weight gain:

• Steroid hormones e.g. prednisolone, HRT and contraception
• Antidiabetic drugs e.g. pioglitazone
• Antidepressants e.g. amitriptyline, mirtazapine
• Antiepileptic drugs e.g. levetiracetam, valproic acid, carbamazepine
• Antipsychotics e.g. olanzapine, quetiapine, clozapine

Consider prescribing alternatives where clinically appropriate, and seek specialist advice if required.

Optimise medical management of Type 2 Diabetes Mellitus, prioritising medications that help to promote weight loss.

Consider referral to the NHS Type 2 Diabetes Remission (T2DR) pathway for patients with newly diagnosed (within the last 6 years) Type 2 Diabetes.

Pathway Group

This guideline has been signed off on behalf of NHS Devon.

Publication date: December 2024