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. 2025 Jun;15(3):e12731.
doi: 10.1111/cob.12731. Epub 2025 Jan 19.

Variation in the commissioning of specialist weight management services and bariatric surgery across England: Results of a freedom of information-based mapping exercise across the 42 integrated Care Systems of England

Maiar Elhariry  1 , Pranav Iyer  1 , Nadya Isack  2 , Bernado Sousa  3 , Pushpa Singh  4   5 , Sally Abbott  6   7 , Tom Wiggins  8 , Krishnarajah Nirantharakumar  4   9 , Srikanth Bellary  5   10 , Stuart W Flint  11   12 , Dimitri J Pournaras  13 , Jonathan M Hazlehurst  4   5   14
Affiliations

Variation in the commissioning of specialist weight management services and bariatric surgery across England: Results of a freedom of information-based mapping exercise across the 42 integrated Care Systems of England

Maiar Elhariry et al. Clin Obes. 2025 Jun.

Abstract

Specialist weight management services including bariatric surgery are commissioned within regions of England called Integrated Care Systems (ICSs) with eligibility and treatment guidelines determined as part of the National Institute for Health and Care Excellence (NICE) guidance. Reported variation in commissioning and bariatric surgery eligibility criteria has not been previously mapped. Freedom of Information (FOI) requests provide a tool, supported by legislation, to ask questions of public authorities including ICSs such that they must respond accurately. FOIs were sent to all 42 ICSs in England asking 4 questions aiming to establish whether there is variation in the commissioning of specialist weight management services and the eligibility criteria for bariatric surgery across England. Responses were presented descriptively and mapped across England. Responses were received from 41 out of 42 ICSs, with 34 reporting that they provide commissioned medical weight management programmes and 38 funding bariatric surgery. Thirteen reported using criteria that were not compliant with NICE guidance. A large area of the country centred around the East of England does not have a bariatric unit reducing access to care. There is significant geographical variation in the availability of both bariatric and specialist medical weight management services across England, with large portions of the country without local access to a service or no service at all. Where services are available, there is significant inconsistency in eligibility for bariatric surgery despite nationally available guidance.

Keywords: bariatric surgery; commissioning; obesity; specialist weight management; tier 3; tier 4.

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Conflict of interest statement

ME and PI have no conflicts of interest. NI declares being a trustee of the Obesity Empowerment Network and an active patient advocate. BS declares being an active patient advocate. PS has no conflicts of interest. SA declares research support from Johnson & Johnson as well as the British Dietetic Association as well as consulting fees from AstraZeneca and Johnson & Johnson and ICE creates as well as support for attending educational meetings from Novo Nordisk and the British Dietetic Association as well as committee‐level membership of British Obesity and Metabolic Surgery Society and British Dietetic Association Obesity Specialist Group and Obesity Management Collaborative, UK. TW has no conflicts of interest. KN declares grants from NIHR, UKRI/MRC, Kennedy Trust for Rheumatology Research, Health Data Research UK, Wellcome Trust, European Regional Development Fund, Institute for Global Innovation, Boehringer Ingelheim, Action Against Macular Degeneration Charity, Midlands Neuroscience Teaching and Development Funds, South Asian Health Foundation, Vifor Pharma, College of Police, and CSL Behring as well as consultancy fees from BI, Sanofi, CEGEDIM and MSD and leadership roles within NICST, a charity and OpenClinical, a Social Enterprise. SB declares speaker fees and AstraZeneca, Boehringer Ingelheim, NovoNordisk and Eli Lilly and received research funds from AstraZeneca and Bayer. SWF declares grants from NIHR, Office of Health Improvement and Disparities, Doncaster Council and Novo Nordisk as well as support for attendance at meetings or travel from UK Parliament, Johnson and Johnson, Novo Nordisk, Devon NHS Integrate Care Service and Safefood. DJP declares consulting fees from Johnson & Johnson, Novo Nordisk, Pfizer, GSK, and Medtronic as well as honoraria from Johnson & Johnson, Medtronic, Sandoz and Novo Nordisk. JMH declares grant funding from NIHR and previous advisory feed and speaking honoraria from Novo Nordisk as well as support for attendance at meetings from Novo Nordisk and Eli Lilly as well as being a committee member of Obesity Management Collaborative UK.

Figures

FIGURE 1
FIGURE 1
Map of ICSs reporting eligibility for bariatric surgery and their concordance with NICE guidance.
FIGURE 2
FIGURE 2
Map of ICSs reporting locations of bariatric surgery centres in relation to their geographical ICS catchment.
FIGURE 3
FIGURE 3
Map of ICSs reporting whether they commission Tier 3 weight management centres in relation to their geographical ICS catchment.
See this image and copyright information in PMC

References

    1. NHS Digital . Health Survey for England. 2021. https://digital.nhs.uk/data‐and‐information/publications/statistical/hea...
    1. Public Health England . Health matters: obesity and the food environment. 2017.
    1. NICE . Obesity: identification, assessment and management Clinical guideline [CG189]. 2023. https://www.nice.org.uk/guidance/cg189/resources - PubMed
    1. British Obesity and Metabolic Surgery Sociey and The Royal College of Surgeons and partner organisations . Commissioning guide: Weight assessment and management clinics (tier 3). 2014. https://www.rcseng.ac.uk/library‐and‐publications/rcs‐publications/docs/...
    1. Welbourn R, Hopkins J, Dixon JB, et al. Commissioning guidance for weight assessment and management in adults and children with severe complex obesity. Obes Rev. 2018;19(1):14‐27. - PubMed

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