NHS Tier 4 Dietitian Consultation

[Bari_Hopeful 4]

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!

[NeonRaven8919 578]

On 5/23/2025 at 4:16 PM, Bari_Hopeful said:

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!

Hi!

Sorry to have found your post so late! There's not a lot of NHS patients on here as this is mostly an American website.

I had my surgery in October 2024 on the NHS. I remember the dietician appointment was a video call with other patients before any surgeries were finalised.

I will admit that I don't feel like I got much out of it. The main message is eat slowly and prioritise Protein first when eating a meal.

The session with the psychologist (a ten minute phone call) was probably the least helpful as she just said I need to practice mindfulness and learn others ways to cope with stress other than eating. (Gee, thanks! Where was that advice when I was a fat 8 year old? 🙄)

I had a higher BMI than you currently do and the privilege of living in London, so I think I was bumped up a few tiers and fast tracked (I don't know if this true in general, but London seems to get the lion's share of the funding so hospitals are less strict. My Gloucester based friend has a BMI of 44, but because she has no comorbidities, she can't get any weight loss referrals because her BMI isn't 50+)

But I digress.

Once I had the surgery, it was a year and a half from the initial referral, it's mostly been smooth sailing. I had the gastric sleeve and had no problems. So far, I've lost 39 kg and more fatty liver has improved significantly.

My mother had the gastric bypass (also on the NHS). She had a complication, St Anthony's private hospital did the surgery, but the NHS covered it but once they operated again, she had no problems. She never shared exactly how much she weighed with me, but she went from a size 28-30 to a 22 and reversed her diabetes. She passed away in 2023, but if she hadn't, she would be much smaller I'm sure.

I've had a great experience so far with my procedure and weight loss. I really do recommend going the NHS route if you are able to do so.

Well done on making this decision to change your life! You've got this. Sometimes, just making the decision to get help is the hardest part!

[Bari_Hopeful 4]

22 hours ago, NeonRaven8919 said:

Hi!

Sorry to have found your post so late! There's not a lot of NHS patients on here as this is mostly an American website.

I had my surgery in October 2024 on the NHS. I remember the dietician appointment was a video call with other patients before any surgeries were finalised.

I will admit that I don't feel like I got much out of it. The main message is eat slowly and prioritise Protein first when eating a meal.

The session with the psychologist (a ten minute phone call) was probably the least helpful as she just said I need to practice mindfulness and learn others ways to cope with stress other than eating. (Gee, thanks! Where was that advice when I was a fat 8 year old? 🙄)

I had a higher BMI than you currently do and the privilege of living in London, so I think I was bumped up a few tiers and fast tracked (I don't know if this true in general, but London seems to get the lion's share of the funding so hospitals are less strict. My Gloucester based friend has a BMI of 44, but because she has no comorbidities, she can't get any weight loss referrals because her BMI isn't 50+)

But I digress.

Once I had the surgery, it was a year and a half from the initial referral, it's mostly been smooth sailing. I had the gastric sleeve and had no problems. So far, I've lost 39 kg and more fatty liver has improved significantly.

My mother had the gastric bypass (also on the NHS). She had a complication, St Anthony's private hospital did the surgery, but the NHS covered it but once they operated again, she had no problems. She never shared exactly how much she weighed with me, but she went from a size 28-30 to a 22 and reversed her diabetes. She passed away in 2023, but if she hadn't, she would be much smaller I'm sure.

I've had a great experience so far with my procedure and weight loss. I really do recommend going the NHS route if you are able to do so.

Well done on making this decision to change your life! You've got this. Sometimes, just making the decision to get help is the hardest part!

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?

Edited Saturday at 10:48 AM by Bari_Hopeful