Weight and health (Guidelines)

Referral

Please encourage patients to self-refer to community-based activities directly; some helpful websites are listed below but this is not exhaustive.

See: NHS Highland webpages for further information on food, mood and health. 

Resources:

• Active Health — Velocity Café & Bicycle Workshop (velocitylove.co.uk)
  A free and confidential one-to-one advice service for people (aged 16+) living in the NHS Highland area who would like to become more active to help their physical and/or mental health. GPs or other healthcare professional can refer, or patients can self-refer
• A Local Information System for Scotland | ALISS
  A national digital programme enabling people and professionals to find and share information on resources, services, groups, and support in their local communities and online
• Think Health Think Nature
  A free resource to help you explore and enjoy your local green spaces: 
• Welcome to High Life Highland - High Life Highland
  Provides local leisure opportunities in culture, learning, sport, health and wellbeing across Highland: 

Referral

Referral is through SCI Gateway or your local Dietetic department via generic email: nhsh.northhighlandcommunitydietetics@nhs.scot

To ensure that we can assess/ triage and provide appropriate intervention, we require the following minimum information on ALL referrals to our service.

Essential referral information:

• Current weight, height, BMI
• Recent BP (within last 3 months)
• Baseline blood tests, including: HbA1c, blood lipid profile (within last 3 months)
• Weight history, disordered eating
• Other relevant info including co-morbidities, pregnancy, prescribed medication
• List of other professionals involved 

Tier 2 referral 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 well-being

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

Tier 2 service:

Delivered 1:1 

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

Referral

Through SCI Gateway or your local Dietetic department via generic email: nhsh.northhighlandcommunitydietetics@nhs.scot

Essential referral information:

• Current weight, height, BMI
• Recent BP (within last 3 months)
• Baseline blood tests, including: HbA1c, blood lipid profile (within last 3 months)
• Weight history, disordered eating
• Other relevant info including co-morbidities, pregnancy, prescribed medication
• List of other professionals involved

Tier 3 referral criteria:

• Aged 18 years or over
• Body Mass Index (BMI) greater or equal to 30kg/m²
• 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 patients who: Meet Scottish eligibility Criteria for bariatric surgery:
  • Age 18 to 44 years
  • BMI 35 to 50kg/m²
  • Type 2 diabetes diagnosis within the last 5 years)
• For ex-patients:
  • Over 1 year since discharged from Tier 3 (unless significant change, eg. co morbidity / pregnancy)

The Tier 3 specialist Dietetic-led Weight and Health service

Delivered 1:1.

It supports people with a Body Mass Index (BMI) greater or equal to 30kg/m² and complex needs, by working together to achieve better health and wellbeing. Patients can choose to opt in to work with the Specialist Dietitian in 8 appointments over 6 months, towards:

• improving the quality, variety and quantity of the food eaten
• better understand internal cues of hunger and fullness
• develop emotional resilience and reduce emotional eating
• achieve a level of social interaction which supports mental and physical wellbeing
• engage in physical activity
• building good self-worth, self-care and body respect

Statement about medications to support weight management in NHS Highland.

Currently GIP (glucose-dependent insulinotropic polypeptide) and GLP-1 (glucagon-like peptide-1) receptor agonists are NOT recommended to be prescribed in NHS Highland for weight management. Further information can be seen in the Pink One newsletter (NHS Highland intranet access required). 

We understand that there is significant interest in these medicines, and we are working to develop prescribing pathways that can meet the need of patients in NHS Highland as equitably as possible.

A national Short Life Working Group has produced a consensus statement with recommendations to support Scottish Health Boards develop local clinical pathways. This process is underway in NHS Highland.

• Consensus statement: national criteria for the prioritisation of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and GLP-1 RA/glucose-dependent insulinotropic polypeptide receptor agonists (GIP RAs) for the treatment of obesity in NHS Scotland

The following medications have been approved by the Scottish Medicines Consortium (SMC) to support weight management in NHS Scotland.

Liraglutide (Saxenda®)

• Due to national shortages, NHS Highland is unable to start anyone on this medication.
• Saxenda® is not recommended to be prescribed in NHS Highland for weight management.

Semaglutide (Wegovy®)

• NHS Highland has accepted a formulary submission for this medication and it will become available once local clinical pathways are in place. 
• Until these pathways have been developed, Wegovy® is not recommended to be prescribed in NHS Highland for weight management.

Tirzepatide (Mounjaro®)

• There has been no request to add this medication to the Highland Formulary at this time. Once a clinical pathway has been set up for prescribing these medications, this will enable a formulary submission to be submitted and assessed.
• Tirzepatide (Mounjaro®) is not recommended to be prescribed in NHS Highland for weight management.

• People often consider bariatric surgery because they feel it is the only option to manage their weight and health. 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.
• The Clinical Advisory Group (CAG) will only consider requests for bariatric surgery from GPs/Consultants for patients who have completed Tier 3 and meet the Scottish eligibility criteria. Patients who do not meet the criteria, and have exceptional circumstances, and have competed Tier 3 may be referred to CAG for consideration.

Referrals:

• To be made via the CAG Out of Area Process via: nhsh.safehaven@nhs.scot
• Please see detailed information under Bariatric Surgery guideline

• Introduction to the BOMSS GP Hub
• BOMSS post-bariatric surgery nutritional guidance for GPs
• Overview | Obesity: identification, assessment, and management | Guidance | NICE

Supporting resources:

Leaflets and videos, also on the NHS Highland webpages:

• Health and weight - food, mood and health.
• Specialist Weight and Health Service leaflet
• FAQ about Bariatric Surgery
• FAQ about Orlistat leaflet