What is “Tier 3” support and why do you need it?
New weight loss medications, such as Wegovy, are finally providing “the answer” to those living with obesity and overweight - but they must be taken as part of a full weight management service. Or what the NHS describes as a “Tier 3 service”. But what is it and why do you need it?
Obesity - a global health problem
Obesity is a significant public health concern worldwide, with a prevalence of over 650 million adults in 2016, according to the World Health Organization (WHO). It is associated with several health problems such as type 2 diabetes, heart disease, high blood pressure, and strokes. And can also have significant psychological and social consequences.
New weight loss medications, such as Wegovy, are finally providing “the answer” to those living with obesity and overweight - but they must be taken as part of a full weight management service. Or what the NHS describes as a “Tier 3 service”.
Many companies cite the fact that Wegovy can result in 15% weight loss - but most also fail to mention that a full weight management programme was a core component of the global clinic trials which produced that number.
A "Tier 3" weight management service
Put simply, it is essential to deliver weight loss medication to patients as part of a full weight management service, which includes dietetic, physical activity, and psychological support. This approach has been shown to be more effective than medication alone in achieving and maintaining weight loss. A systematic review and meta-analysis of randomised controlled trials (RCTs) evaluating the effectiveness of weight loss medications combined with lifestyle interventions found that this approach resulted in greater weight loss than lifestyle interventions alone or medication alone.
The medication's effect is primarily to help patients feel full after consuming smaller portions of food or reduce the absorption of fat in the body. When used in conjunction with a comprehensive weight management service, the medication can help patients to develop healthier habits and behaviours, including portion control, healthier food choices, and regular physical activity.
The weight management service should include dietetic support, which involves personalised nutrition counselling and guidance to ensure that patients receive balanced, healthy diets that meet their individual needs. Physical activity support should be provided to encourage patients to engage in regular exercise, which is essential for weight loss and maintenance.
Psychological support should also be included, as weight loss can be emotionally challenging, and patients may need help to address the psychological factors that contribute to their obesity.
Several clinical trials have been undertaken to evaluate the effectiveness of weight loss medications when used in conjunction with a full weight management service. The SCALE Obesity and Prediabetes trial was a randomised, double-blind, placebo-controlled trial that evaluated the efficacy and safety of liraglutide 3.0 mg (Saxenda) for weight management in adults with obesity or overweight and at least one weight-related comorbidity. The trial found that patients who received liraglutide in addition to diet and exercise counselling lost significantly more weight than those who received placebo plus diet and exercise counselling.
Another trial, the CAMELLIA-TIMI 61 trial, evaluated the cardiovascular safety of lorcaserin, a weight loss medication, in overweight and obese patients with cardiovascular disease or multiple cardiovascular risk factors. The trial found that lorcaserin did not increase the risk of major cardiovascular events and was associated with modest but sustained weight loss.
The use of weight loss medications can also help to reduce the risk of developing weight-related comorbidities such as type 2 diabetes, heart disease, and stroke. In a clinical trial evaluating the efficacy and safety of semaglutide 2.4 mg for weight management in adults with obesity or overweight, the medication was found to significantly reduce the risk of developing type 2 diabetes compared to placebo.
The conclusion is clear: don’t go it alone. Your health is important and it’s worth investing in. So only take weight loss medication as part of a full weight management programme.
Published: 19 April 2023