Tayside Diabetes MCN Handbook
Diabetes and Obesity


Tayside Adult Weight Management Pathway 


Many people with diabetes have a significant problem with obesity, which may require focused attention.

NHS Tayside adult weight management services are delivered within the four-tiered model set out below. Please note that NHS Tayside is no longer delivering the Counterweight® intervention.




The following information pertains to Tiers 2, 3 & 4 and provides guidance on referral criteria and access to the service.

Referral Process and Criteria


The service will accept notifications via RMS from General Practice or via the paper referral form.  from the Specialist Diabetes Service for patients with a Body Mass Index (BMI) above 25. They will then be triaged by the adult weight management service according to the following criteria:


Tier 2

  •  16 – 18 years old – must have a BMI which places them on or above the 91st centile and below the 98th (UK-WHO Growth Charts 2-18 years)
  •  >18 years BMI ≥ 25 ≤ 34.9 with no co-morbidities

* Please note that South Asian, Chinese and Japanese individuals may be considered overweight at BMI>23kg/m².


– these patients will be signposted to Tier 2 services.(Currently Winning Weigh and limited access to Weightwatchers for women of child-bearing age)


Tier 3

  •  16 – 18 years old – must have a BMI which places them on or above 98th centile (UK-WHO Growth Charts 2-18 years)
  • >18 years BMI ≥ 35 irrespective of co-morbidities or BMI ≥ 30 with obesity-related co-morbidity (Diabetes, CHD, Hypertension, Sleep Apnoea or additional reason for intervention e.g. awaiting surgery, iatrogenic weight gain)

* Please note that South Asian, Chinese and Japanese individuals may be considered obese at BMI>27.5kg/m².


Tier 4


Any patients requesting or being referred for bariatric surgery must be referred via the Tayside Adult Weight Management Service and complete Tier 3 intervention


Further Referral Information 

  1. All patients meeting the criteria above can be referred. Please include any relevant information that may help us work with your patient.
  2. We are keen to get referrals, so, please raise the issue of weight and seek agreement to refer. We have attached a sample dialogue that may be helpful for staff running chronic disease management or other clinics (and may even have some useful talking points for doctors).
  3. Please only prescribe Orlistat (Xenical) under guidance from the Adult Weight Management Service. The evidence that medication alone results in significant long term weight loss is very limited, and we hope to use savings from prescribing to fund support for patients – so the prescriptions you do write will work more effectively.


Who are the Tayside Adult Weight Management Service?


Tier 2 is provided by a range of services including weight management support workers, community health nurses, community education staff, leisure staff – all supported by Tier 3 staff - and commercial organisations.


The Tier 3 service consists of medical and surgical consultants, specialist dietitians, clinical psychology, physiotherapy and administrative staff 


How the Tayside Adult Weight Management Service operates 

  • Notification received via RMS from General Practice or via paper Form from Specialist Diabetes Team.
  • Patient triaged by adult weight management service to Tier 2 or Tier 3
  • Information sent to patient either signposting to Tier 2 services or informing how to opt in to Tier 3


     Tier 3 

  •  If patient does not opt in general practice is informed (if SIMD 1 or 2 postcode, follow-up telephone first)
  •  Patient opts in and given an assessment appointment
  •  Following assessment, patient then given opportunity to opt in to group intervention
  •  Group interventions run over 3 phases providing at least 1 year's intervention
  •  One-to-one interventions available in exceptional circumstances
  •  Only patients completing phase 1 and 2 of the programme will be considered for bariatric surgery.


Benefits to patient


Patients are triaged to the most appropriate service for them and have access to support from physiotherapy and psychology. A patient leaflet about the service is available.



Tayside Adult Weight Management Service


Tel: 01382 424140/424141


Email: tawms.tayside@nhs.net