4 healthy weight Greenwich

4 healthy weight is the new specialist Tier 3 weight management service that commenced in 2015 commissioned by Greenwich Clinical Commissioning Group.

The service is part of The Borough of Greenwich obesity strategy and will offer specialist multi-disciplinary treatment to over 400 patients a year, presenting with severe and complex morbid obesity. Patients accepted onto the programme1 will be offered an intervention of up to 15 months, that will combine a three month intensive treatment phase, followed by a maintenance plan. During the maintenance phase, patients will be supported by 4 healthy weight and encouraged to participate in community weight management interventions.

The service is located in GP surgeries and community locations across The Borough of Greenwich, including the following locations:
• Eltham Community Hospital
• Gallions Reach
• Millennium Village Peninsula Practice
• Charlton Carers

This service has been designed as an alternative treatment to weight-loss surgery. Patients who meet the NICE guidelines2 and fulfil the NHS England Commissioning Guidelines, April 20133 for referral for bariatric surgery and wish to proceed on a surgical pathway, will have a thorough MDT assessment.
Any patient proceeding onto a surgical pathway will be thoroughly assessed and prepared before onward referral to a surgical provider.

Referral Criteria

Adults over 18 years of age who have a BMI ≥ 35 with related co-morbidities such as diabetes and/or cardiovascular disease or a BMI ≥ 30 with recent onset diabetes
Individuals who have experienced a weight problem for at least five years
Individuals who have complied with Tier 1 and 2 services for at least 6 months and have failed to achieve or maintain adequate weight-loss goals
Individuals who have undergone bariatric surgery and require specific post-operative support after 2 years
Individuals who may be referred to Tier 4 obesity services (bariatric surgery) and therefore require assessment and preparation.

Anticipated Outcome Measures

No weight gain in the first 12 weeks on the programme
Reduction in body weight by 5-10% in 6-12 months and/or a reduction in waist circumference.
Reduction in blood pressure (if elevated)
Reduction in HbA1c (if elevated)
Improved lipid profile
Increase activity on a weekly basis after 12 weeks
Improvement in emotional wellbeing
Improvement in self esteem
Reduction in low mood
Reduction in the number of people electing for bariatric surgery
Effective outcomes for patients that do elect for surgery

The Service

Core Components of 4 healthy weight
1. Multi-disciplinary Assessments
2. Intensive Treatment Phase (12 weeks) either group or one to one
3. Maintenance Treatment Phase
4. Discharge Plan
5. Tier 4 Assessment and Referral
6. Community Based Support Network

Psychologically led Service

The psychological sessions are structured to deliver a 12-week programme, which is focused on addressing a patient’s relationship to food and developing new coping strategies. The aim of these sessions is for patients to better understand their triggers to disordered eating. This will enable them to deal with life events and trauma without resorting to food, by developing alternative coping strategies.

The main focus of this work is:
Understanding how childhood patterns and injunctions impact on adult behaviour around food
Acknowledging childhood trauma such as school bullying and the impact it has on adult eating behaviour
Understanding current relationship to food and triggers to disordered eating
Acknowledging inner dialogue around food and negative thinking patterns
Setting goals to improve self-esteem and eating behaviour
Developing positive thinking and implementing change
Creating new coping strategies
Creating long-term strategies and learning to deal with setbacks

The expectation at the end of the intensive psychological intervention is that there is an improvement in mental health and self-esteem. Therefore, there will be less of a reliance on food and an improvement in eating behaviour.

Dietetic

The Dietetic team are trained in Cognitive Behavioural Therapy (CBT) and deliver behaviour change as part of the dietary programme. The Dietetic team provide psychological support to enhance the work of the psychological therapy team, when helping patients with food choices and eating behaviour. Patient’s weight and blood pressure will also be monitored during these contacts.

Exercise and Activity

Patients are assessed on a one to one basis. The exercise specialist discusses various exercise and physical activity options with the patient, in order to tailor a prescription to their personal goals and level of ability. Patients are encouraged to make gradual daily activity changes, such as walking further and taking stairs instead of lifts, to gain an increased level of physical activity and an increased level of energy expenditure. Following an initial assessment they are invited to participate in a specialist circuit programme of home exercise.

Group Programme

The group programme combines all the psychological and dietetic components of the multi-disciplinary service and will be used in the intensive treatment phase. Research suggests that weight management delivered in a group programme is more effective to achieve long-term weight maintenance and anecdotal evidence from past service users validates this. The group programme will consist of:

12 consecutive weekly sessions
12-15 participants in each group
Facilitated by two psychological clinicians and one dietician (in sessions with the dietetic component)
Psychological and dietary components are delivered together


1. Referrals are only accepted from GPs or other designated healthcare professionals via the Referral Management Booking Service (RMBS)

2. Commissioning Guide: Bariatric surgical service for the treatment of people with severe obesity, 2007

3. Clinical Commissioning Policy: Complex and Specialised Obesity Surgery, April 2013