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
40 kg/m²*
35 kg/m²*
With four or more comorbidities from the list indicated below:
Idiopathic intracranial hypertension (IIH)
Essential surgery refused e.g. transplant, cancer treatment
Sleep apnoea
Diabetes and pre-diabetes
Hypertension (requiring treatment)
Hyperlipidaemia (requiring treatment)
Atrial Fibrillation
Ischaemic Heart Disease
PCOS
Fertility problems
NAFLD/NASH
MSK or significant osteoarthritis, where surgery is refused due to BMI
Other routine surgery or intervention refused due to BMI
*For people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean ethnic backgrounds, the qualifying BMIs are 2.5 kg/m² lower (e.g. 37.5 kg/m² instead of 40 kg/m²).
In addition to the route requirements above, the patient must meet the clinical criteria set out below:
All co-morbidities have been optimised in primary care as far as possible prior to referral.
Other appropriate measures to achieve or maintain clinically beneficial weight loss have been tried but have been unsuccessful (e.g. Tier 2 weight management support).
Exclusion criteria
Under the age of 18.
Patients who are currently successfully losing weight through dietetic support or a reputable, evidence-based weight management intervention.
Pregnant women. Women who become pregnant during the programme can pause their participation and return following the birth and completion of breastfeeding, if applicable.
Patients who have previously been referred to the service or an equivalent provider and left the pathway early or disengaged from the service within the past 24 months. This includes failure to adhere to or complete a primary care-based Tirzepatide weight management service within the past 24 months.
Uncontrolled hypertension/heart condition/medical condition preventing increase in activity level.
Unstable or severe mental illness beyond the expertise of primary care.
Active eating disorders.
Patients who have attempted suicide within the past 12 months.
Patients who have self-harmed within the past 3 months.
Patients who have made plans to commit suicide within the past 3 months.
Bariatric surgery within the past two years.
Unable to tolerate a healthy, balanced diet and still following a texture-modified diet (e.g. liquid or soft foods).
Currently under the care of a Tier 4/bariatric dietitian.
Current gastrointestinal (GI) pain, vomiting, nausea, recurrent loose stools, dumping syndrome or poor wound healing.
Symptoms of gut leakage or blockage.
Failure to access GP support for vitamin and mineral supplementation and medical monitoring of co-morbidities.
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
Referrals can be submitted via NHS e-RS or directly by NHS mail. Follow the steps below for your area.
1
If you can't import files into your clinical system, download the .docx referral form and complete it as a Word document.
Using Ardens, DXS or another local form management system?
Check there first; if we're not listed yet, ask your file management lead to add this form.
2
Need help identifying eligible patients in your practice?
Find potentially eligible patients faster
For EMIS users
Our search files are built around the specialist weight management criteria for your area, so your team doesn’t have to build the search from scratch. Import once using the EMIS step-by-step guide, then run it whenever you want an up to date list.
Download the EMIS search file
If you have a question about the referral process, contact
Matt Reid (Partnerships Associate) at matthew.reid@secondnature.io or call 07540235288.
