NHS Tier 4 Pre-Op Question

[Bari_Hopeful 4]

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…?

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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!

Edit: typo

Edited May 27 by Bari_Hopeful

[WendyJane 48]

I can tell you that my nutrition consults were easy, more educational than not. I have no idea what an NHS Tier appointment even is, let along the difference between a 1, 2, 3 or 4. How many tiers are there and what is NHS mean?

[summerseeker 2,361]

6 hours ago, WendyJane said:

NHS

Its our much loved National Health Service. I paid for my op so I cant help with this

[SpartanMaker 1,264]

@Bari_Hopeful Sorry you're not getting much in the way of responses. We don't have a lot of UK members to begin with, and so the likelihood of having one that's still active here and then also had their surgery at Queen Victoria Hospital is probably pretty low.

Just a thought, but you might try checking with the Tier 4 team at Queen Victoria to see if they have a post-surgery support group? A lot of Hospitals (at least in the US), have their own local support groups, so they would be worth seeking out.

Alternatively, if you have more general questions that might apply regardless of where the surgery is done, please feel free to post and hopefully we'll better be able to assist.

[NeonRaven8919 578]

I'm a London, UK based NHS patient. I've only just found your post, but I've added some hopefully helpful waffle to your original post.

I don't have experience of Portsmouth hospitals (only their seaside touristy spots) but in general, I've had only good experiences with the NHS treatment I got.

The psychologist visit is usually just a formality because I don't think a ten minute phone call is a really good gauge of someone's preparedness for a life altering surgery. If they NHS has already gotten you past the referral stage, I would imagine, you'll just need to wait until they can find a surgery slot.

I was approved in July of 2024 and told that "unless the moons and planets all align, you will likely get your surgery Spring 2025" I guess the moons aligned because two weeks later, they called to tell me it was time to start the 12 week milk pre-op diet and I was scheduled for October 2024. You will probably not have a 12 week pre-op diet. I was told this was a test group trial for University College London Hospital and because I had NAFLD.

Don't be too nervous (easier said than done, I'm sure) and congratulations! You've made it this far! You can do this!

We're all here to support you!

Edited Friday at 12:19 PM by NeonRaven8919

[Bari_Hopeful 4]

On 5/28/2025 at 12:39 AM, WendyJane said:

I can tell you that my nutrition consults were easy, more educational than not. I have no idea what an NHS Tier appointment even is, let along the difference between a 1, 2, 3 or 4. How many tiers are there and what is NHS mean?

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:

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The NHS weight management program uses a tiered approach, offering different levels of support based on individual needs and circumstances.

Tier 1 focuses on early prevention and self-care, while Tier 2 provides lifestyle interventions like dietary and exercise guidance, and may include free Weight Watchers or Slimming World subscriptions.

Tiers 3 and 4 offer more intensive support, including specialist services for complex obesity and, in some cases, bariatric surgery

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. ☺️

Edited Saturday at 01:21 PM by Bari_Hopeful

[Bari_Hopeful 4]

On 5/30/2025 at 1:18 PM, NeonRaven8919 said:

I'm a London, UK based NHS patient. I've only just found your post, but I've added some hopefully helpful waffle to your original post.

I don't have experience of Portsmouth hospitals (only their seaside touristy spots) but in general, I've had only good experiences with the NHS treatment I got.

The psychologist visit is usually just a formality because I don't think a ten minute phone call is a really good gauge of someone's preparedness for a life altering surgery. If they NHS has already gotten you past the referral stage, I would imagine, you'll just need to wait until they can find a surgery slot.

I was approved in July of 2024 and told that "unless the moons and planets all align, you will likely get your surgery Spring 2025" I guess the moons aligned because two weeks later, they called to tell me it was time to start the 12 week milk pre-op diet and I was scheduled for October 2024. You will probably not have a 12 week pre-op diet. I was told this was a test group trial for University College London Hospital and because I had NAFLD.

Don't be too nervous (easier said than done, I'm sure) and congratulations! You've made it this far! You can do this!

We're all here to support you!

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.

💗

[WendyJane 48]

@BariHopeful

Thank you for the education on the NHS. That is a wealth of information. Let me digest a little bit.

Regarding the initial question, and the path of information I have read, I can only send you good vibes and to prayers that things go well, keep us posted!!