Obesity is a chronic relapsing condition characterised by abnormal or excessive accumulation of adipose tissue that presents a risk to health. It is associated with an increased risk of other chronic conditions including type 2 diabetes (T2DM), cardiovascular disease, renal and liver disease, musculoskeletal problems, and cancer.1 It can impact a person’s quality of life, wellbeing, and lifespan. Obesity is a complex condition, with a multitude of biological, social, environmental, and commercial factors, as well as food production and consumption processes, contributing to its development.2 One in four adults in the UK is living with obesity with comparable figures seen in children, and recent decades have seen an increase in prevalence.3,4

The National institute for Health and Care Excellence (NICE) updated its guidelines on the management of obesity in 2023.5 Weight management services were previously offered in tiers according to severity and complexity of disease, with Tiers 1 and 2 addressing population-level public health measures and short-term primary care-based services focusing on dietary and lifestyle factors, respectively. Tier 3 services offered pharmacotherapy in addition to intensive behavioural interventions for those with complex, refractory, or severe disease, while bariatric surgery was delivered within Tier 4 services. Engagement with one tier was necessary before onward referral to the next.

Evidence does not support using bariatric surgery as a last resort and changes to NICE guidance removed the requirement for exhaustion of non-surgical measures prior to consideration of surgery.5 The update also considered Tiers 3 and 4 together as specialist obesity services composed of a multidisciplinary team (MDT) including physicians, specialist nurses, specialist dieticians, psychologists, psychiatrists, and physiotherapists. Access to these services is hugely variable across the UK, with only 21% of clinical commissioning groups in England offering these services in 2014–2015 and one devolved nation …