Tier 3 Weight Management Service - Second Nature
Accessing the service
Referral guidelines
Eligibility criteria
Your patient must meet one of the following
Route 1
BMI 50 kg/m² or above
An adjustment of 2.5 kg/m² applies to people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean backgrounds, including people of mixed race with one of these backgrounds.
Route 2
Meets the NHS England tirzepatide cohort
As set out in the NHS England interim commissioning guidance on NICE TA1026 and the funding variation for tirzepatide.
Route 3
On weight loss medical therapies
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Despite maximum tolerated doses, has ongoing weight-related complications
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Would benefit from evaluation for an alternative weight loss intervention
Route 4
Any BMI, transitioning from CEW services
Transition of care for young people from Complications of Excess Weight services.
Additional requirements
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Aged 18 or over and registered with a South Yorkshire ICB general practice
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Understands the requirements and demonstrates a commitment to actively participating
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Can engage fully with the requirements
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Has engaged in a supported attempt to modify diet and exercise levels within 24 months of referral, through one or more of:
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A locally commissioned Tier 2 weight management service
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An equivalent NHS nationally commissioned Tier 2 service
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A commercial weight loss service
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Primary care or local authority health coaching
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Dietetic or practice nursing support
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The 12-week free NHS Weight Loss Plan app
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Updated: Aug 2026
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Clinical support group
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Gastroenterology
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Clinical support area
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Email address
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Website
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