Specialist Weight Management Service
Second Nature is now available to your patients via NHS Right to Choose. Find your local eligibility criteria, referral forms, and everything you need to get started.
Eligibility criteria
*There is a tolerance unit of BMI 2.5 on each element of the criteria above in relation to at-risk groups that have higher obesity prevalence rates particularly those with black African or Caribbean and South Asian origin.
BMI ≥ 50kg/m²*
BMI ≥ 35 kg/m²* AND has a referral from either:
An assisted conception service for infertility in which weight is a barrier to assisted conception after assessment by the assisted conception service.
A secondary care service where weight loss is recommended by the specialist and evidence indicates that this will enable or significantly improve the outcome of a time-sensitive procedure/treatment, in cases where activities of daily life are severely restricted, including:
Total hip replacement
Total knee replacement
Incisional hernia repair (Subject to the patient meeting the other criteria within The specialist management of abdominal wall hernia in adult NHS Devon policy)
The referring specialist should include the clinical justification, target BMI and details of restrictions on activities of daily living in the referral.
BMI ≥ 35 kg/m²* AND requires specialist support to achieve weight loss, due to another complex medical need such as:
Type 1 diabetes mellitus (to provide support with insulin adjustment).
Suspicion of, or confirmed, rare monogenic or hypothalamic cause of obesity (to assess for an underlying condition).
BMI ≥ 35 kg/m² to 49.9kg/m²* AND has one weight-related co-morbidity that is likely to improve with weight loss:
Complete list of co-morbidities – please indicate relevant below:
Established T2DM (diagnosed ≥ 6 years ago)
Established diagnosis of OSA (sleep clinic confirmation via sleep study)
Heart failure NYHA Class III/IV that has required hospitalisation.
Metabolic dysfunction-associated steatotic liver disease (MASLD) with moderate/severe liver fibrosis diagnosed by hepatologist.
Chronic kidney disease stage 4 and 5, when referred by a nephrologist.
Idiopathic intracranial hypertension (IIH) with impending visual compromise, when referred by a neurologist.
Exclusion criteria
Patients under 18 years old.
Pregnant women - Women becoming pregnant during the programme will be able to pause the programme (‘time out policy’) and return to the service following the birth.
Previous engagement with a Specialist Weight Management Programme.
Bariatric surgery in the last two years (NHS or private).
Unable to make changes to eating behaviours e.g. in a care setting where meals are provided
Unable to engage with all aspects of the programme e.g. unstable mental health, uncontrolled hypertension prohibiting exercise.
Patients solely seeking injectable weight loss medications.
Patients over the age of 75 if clinically deemed that weight reduction poses greater risk of harm from a weight management programme e.g., frailty.
Patients with mental health issues, active eating disorders or active substance misuse where engagement with the service will lead to worsening of their issue or put themselves/others at risk.
Patients with learning disabilities or neurodiversity if reasonable adjustments cannot be made.
Two pathways, both consultant-led.
We assess each patient and personalise their care.
Our specialist team includes consultant physicians, specialist dietitians, health psychologists, pharmacists, nurses and exercise specialists.
Consultant-led MDT. GLP-1 prescribing (Wegovy) where clinically appropriate. Dietetic, psychological, and behavioural support for up to 24 months.
Consultant-led MDT. Dietetics, psychology, exercise support. Structured lifestyle programme for 12 months.
Refer to us
All Tier 3 weight management referrals in Devon must be routed through the SPoA
How to do this
Refer via the NHS e-Referral Service to the Devon Weight Management Single Point of Access.
Use the SPoA referral template, available on the Devon Formulary. The same template applies across Devon.
If your patient has expressed a preference for Second Nature, please state this explicitly on the form.
Referrals sent directly to a provider outside the SPoA will be returned, so please use the e-RS route in all cases.
If you have a question about the referral process, contact
Matt Reid (Partnerships Associate) at matthew.reid@secondnature.io or call 07540235288.
