Healthy Weight: adults (Guidelines)


Weight management interventions in NHS Highland range from the simple, to the complex and multifactorial; they acknowledge that both life circumstances and lifestyle impact on weight and health.

The outcomes of the service are to provide inequalities sensitive interventions which support people to:

  • improve the quality, variety and quantity of the food eaten
  • eat in response to internal cues of hunger and fullness
  • to develop emotional resilience and reduce emotional eating
  • achieve a level of social interaction which supports mental and physical well being
  • engage in physical activity
  • build good self worth, self care and body respect

In order to meet these outcomes people will be offered different levels of support and intervention depending on their health, behaviours, circumstances and needs.


Self-referral to Tier 1 and 2 services are encouraged.
Other referrals are accepted through SCI Gateway or via your local dietetic department.

Healthy weight triage: adult

* People often consider bariatric surgery because they feel it is the only option to manage their weight, and they have tried all other methods – diets, meal replacements, drugs etc.
There are alternatives - Tier 3 supports people to manage their weight and improve their health without bariatric surgery, although the issues around this treatment option will be explored with patients.

Supporting resources:
FAQ about bariatric surgery 

The Clinical Advisory Group will only consider requests for bariatric surgery from GPs/Consultants for patients who have completed Tier 3 and meet the National Criteria. Patients who do not meet the criteria, and have exceptional circumstances, and have competed Tier 3 may be referred for consideration. Referrals should be made via the CAG Out of Area Process.

Tier 2 criteria

  • Aged 18 or over
  • People who are ready to engage
  • History of dieting/recent weight gain
  • Have a poor relationship with food e.g. diet quality/diet quantity/disordered eating
  • Weight has an adverse impact on physical and/or mental wellbeing

 In addition to the standard referral details, we would welcome any information on the client/patient’s:

  • Weight History
  • Previous weight loss interventions e.g. types of diets, surgery etc.
  • Impact of weight on health and social activities
  • Any unusual/disordered eating patterns

Please encourage patients to self refer to NHSH weight management courses directly on the NHS Highland webpages: Healthy weight - food, mood and health.

Supporting resources:

Tier 3 criteria

Meet NationalCriteria for bariatric surgery

  • Age 18 to 44 years; BMI 35 to 50kg/m2; Type 2 diabetes less than 5 years


  • Aged 18 yrs or over
  • High Body Mass Index (BMI)
  • Completed Tier 2 (within last 6 months)
  • Ready to engage
  • Plus one of:
    • Chronic dieting history
    • Weight cycling
    • Disordered eating
    • Social isolation due to weight issues

And for ex-patients:

  • Over 1 year since discharged from Tier 3 (unless significant change e.g. co morbidity / pregnancy)

Supporting resources: Specialist Weight Management leaflet

Last reviewed: 30/11/2020

Next review date: 30/11/2023

Author(s): Dietetics .

Version: 2

Approved By: TAM subgroup of ADTC

Reviewer name(s): Fiona Clarke, Senior Health Improvement Specialist , Mairi Wotherspoon, Senior Dietician.

Document Id: TAM200