Bari_Hopeful

Hello, hello! This is my first post here and after searching for this topic, not much came up for me, so here I am! 🙂 I was wondering if anyone here could share their experience going through the NHS Tier 4 appointments, particularly this first meeting with the bariatric dietitian? I'm assuming each trust probably has their own system of doing Tier 4, but for me, this is my first Tier 4 appointment and it’s a video call. After this appointment, if all goes well, I will (eventually 🤞) progress onwards to the in-person-at-the-hospital “one-stop clinic” to meet with the bariatric nurse, anaesthetist, psychologist, and surgeon. I was successfully discharged from Tier 3 in Dec 2023 and have since been waiting for a Tier 4 appointment - the time has finally come! 🥳 Needless to say, I’m both excited and nervous - and happy to receive any words of advice or wisdom anyone can offer. Also, for what it’s worth, I’m under the Portsmouth NHS trust (Queen Alexandra) and hoping for either the OAGB or RNY. Anyone have any experience with the QA bariatric team? Thanks in advance!

I posted this in the Pre-Op Q&A, but thought perhaps it might be helpful to post it here as well since maybe those post-op could help…? Edit: typo

Did you have any psychological input during your Tier 3? (I don’t know if you had to go through Tier 3?) I had about 4 sessions with an NHS bariatric psychologist, but I believe I’ll still be having a Tier 4 psychological consultation to sign me off 🤞 for the MDT. Also, two weeks post-approval for the LRD! That is AWESOME! I think my trust tends to do the two-week milk diet. Even though I currently eat fairly low calorie keto, I think the milk diet would help lose a bit of pre-surgery weight at least. 💗

Hello, Wendyjane! The NHS is the National Health Service - socialised tax-funded medical care provided in the United Kingdom. The tier system is basically various levels of care for varying conditions. For those seeking weight management help through the NHS. Google AI summarised it really well for me: Hospitals are grouped into governing bodies (trusts), and each trust, I believe, decides how to invest in the tiers, which in turn impacts just how much and what kind of support is given. For example, when I went through Tier 3 in my trust, I was given 1:1 virtual support (zoom meetings) once a month for a year with a nutritionist to help me implement healthier lifestyle changes, and during that time, I also met with an NhS psychologist for 3-4 months to work through any issues I may have regarding food and mental health. I really enjoyed the support I received from my Tier 3 programme (“Weigh Ahead”). I was also held accountable for my weight, blood pressure, and body measurements. Tier 3 aims to help you lose 5-10% of your total body weight in order to be referred to Tier 4. The current Tier 3 service in my trust now allows patients to receive prescriptions for Ozempic and Mounjaro to help with weight loss. (I’m sure you can imagine I was sorely sad to find out I missed that opportunity! Whereas I think the injectables will be available to me only in Tier 4 and from the bariatric surgeon?) Also, in Tier 4, if you so desire to go forward with bariatric surgery, then you have multiple appointments with various consultants: the bariatric dietitian, bariatric nurse, bariatric psychologist, the anaesthetist, and finally the surgeon. Once your appointments with each of these completes, then they meet together as a “Multi-Disciplinary Team” to discuss each case and decide if that patient is a good candidate to go forward with surgery. If yes, you’re then placed in another waiting list. According to my trust, I am not meant to gain any weight from the time of my Tier 3 referral until surgery. This has been really, really challenging… and at times, frankly speaking, exceedingly discouraging. I hope this helps as an explanation. ☺️

Hi, NeonRaven! Thank you so much for your reply and sharing your experience! I find it so helpful to hear how other NHsers have experienced the process since it seems so much more elongated from the U.S. process. And you make such a good point about the London privilege - now it makes more sense why I’ve seen more internet presence and response from London NHSers. (And quite a few from the far north of England as well!) About three or four years ago during my annual diabetic review, my nurse had suggested bariatric surgery and that gave me a lot of hope - she was able to refer me for Tier 3. I had my dietitian appointment yesterday and it went really well! It was about 30 minutes and went over the Tier 3 lifestyle changes, continued lifestyle changes (balanced meals, regular exercise, blood sugar monitoring, weight maintenance, etc), medications, and then any questions I might have. She was very positive and said she would be recommending me to go forward for surgery when the MDT meeting happens 🥲 (once I meet with the next consultants - psychologist, anaesthetist, bariatric nurse, and surgeon - how soon? No one knows.) Needless to say, I am so relieved, so happy, and so excited to be moving forward even if it’s one step. I’ve found out that my hospital trust now does their “one-stop” clinic as separate virtual appointments, rather than in-person. (So, perhaps it will be quite some time before that MDT meeting?) And then the endoscopy and ECG will be done at the pre-op assessment once a surgery date is confirmed. I am so glad to hear your NHS experience has been so good and positive. I am so sorry to hear about your mother's complication and her passing, but it is so hopeful to hear she was able to put her diabetes into remission (that’s one of my big hopes!) Congratulations on your weight loss and wishing all the health and success! 💕 PS - funny enough, I have not had any group sessions whatsoever in this process. I am wondering if I’ll have a group session with the bariatric nurse?

Your post gives me great hope of making it to a “normal” weight - with a sigh of relief that it’s really possible! I thought I’d also be settling for overweight.

I recently came across this expected weight loss calculator/predictor: SOPHIA Bariatric Weight Trajectory Prediction. Thought it was pretty neat! Sounds like you’re off to a great start!