Tier 3 Weight Management

[Lucyr]

I was referred to tier 3 by the diabetes dr (well he asked my GP to do it) just over a year ago I think, and I started it earlier this month. My 1 month follow up appointment will be next week.

Before I started I couldn’t find much information about what to expect and as I hadn’t heard of it before, and they don’t give you any information, it was a bit of a step into the unknown.

i dont find long posts that accessible either to read (a lot of information to process) or to write (my phone keeps jumping about changing things). So I’ll keep this short to start with and ask you, what information would be useful for me to share about it so that other posters can understand what it offers (either for if they’re referred to it themselves, or for awareness of options to suggest to other posters)

 

[Lucyr]

What are the tiers?

Seemed a good place to start. The definitions probably vary locally but are something like this

Tier 1 = self help type advice, so maybe a leaflet or a website on dietary advice, or there’s the nhs self help weight loss app, things like that https://www.nhs.uk/better-health/lose-weight/

Tier 2 = lifestyle interventions. This could be things like seeing someone at the GP practice to talk about dieting or getting a voucher to cover 12 weeks at a structured weight loss programme like weight watchers or slimming world. The diets may need adapting for diabetes but some people really benefit from the accountability and group support of this type of programme

Tier 3 = This is a specialist weight loss service that includes both nutritionist advice and psychological support. You have to prove that you’ve engaged with tier 1&2 for a certain time beforehand (a couple of years here) and get a referal from the GP as well as meeting other criteria. In my area you only get one chance at this level, you can’t be referred back again in the future if you don’t succeed or want more support again in the future. In my area it currently doesn’t offer any medication or face to face appointments and isn’t a very low calorie diet.

Tier 4 = This is more specialised support still including bariatric surgery. In my area you have to complete tier 3, meeting the weight loss target set by it, and still having a BMI that meets the tier4 criteria at the end of tier 3.

 

[Lucyr]

How much support does it involve?
I’m not sure what I expected, but I think I expected it to be a bit more intense or structured perhaps? Lots of sessions to attend etc. In actual fact it’s a monthly appointment with a nutritionist, the first one was by video and the next is phone call. I think they alternate. There will be 2 or 3 appointments with a behavioural change therapist too, my first is in a week or so, about 6 weeks after the program starts. This probably works ok as most of the time is you following it by yourself with occasional check-ins, if it was more intense i guess less people would stick to it perhaps, or it wouldnt teach the skills to follow it yourself.

There are some written materials too, one booklet from the nutritionist and one from the behavioural change therapist. The main booklet is quite clear in explaining what to do and it has spaces to put in the goal weight which you are set and your weights and measurements for each appointment.

The food diary includes extra things like you’re supposed to rate your hunger every time you eat but I found this confusing and didn’t do it because one sheet says 1-10 where 10 is starving and the other sheet says 1-10 where 10 is stuffed full. You’re also supposed to put where and why you eat but I haven’t done this either because the answer would just mainly be at home because I’m hungry. I wasn't asked about this so far anyway.

The booklet from the behavioural change person you’re supposed to work through before the appointment. I haven’t done this and probably should have another look at it before my appointment, I found it quite hard to understand.

I may have more to add once I’ve had a follow-up appointment with the nutritionist this week and the behavioural change person the week after.

Any other questions?
I will probably explain what the diet involves, their diabetes advice, what happens after the course, and how my weight loss is going at some point.

 

[Lucyr]

Have been asked how well the program caters for other conditions so I can cover that from what I’ve found related to autism and ME/CFS

 

[Lucyr]

What food is involved?
The program i'm on uses the plate method, and no calorie or carb counting. I've always found calorie counting extremely effective for weight loss, but havent been able to stick to it long term and regain weight when i stop counting. So i was nervous to be told not to calorie count. It was a bit of a mixed message as then it told you to keep a food diary. There's the option of a paper or photo diary (using the free app foodview which you can use to share a link that has your photo diary.

The general principle is to think of food as medicine, and to ask yourself when making food choices, what is this food choice going to do for my body. It's geared at eating natural unprocessed food mainly and is lower carb, higher protein and veg, and low fat. Some fats are ok like a little olive oil, not things like cheese though, and saturated fats like sausage, bacon etc are advised to be reduced on this plan. There's a lot of "good and bad carb / slow digesting carb / natural sugars" type advice which i ignore as i find it completely inaccurate for diabetes. There are no set "allowed" and "not allowed" foods though other than the advice above, and the suggestion is eat well 80% of the time.

I previously was skipping breakfast to do intermittent fasting but this was advised against so that you don't end up really hungry later on. I'm not convinced on this but going with it anyway.

At lunch and dinner i aim for half a plate of veg, and the remaining half to be more protein than carb. This is a visual plate method not a carb counting method, but effectively it is reducing carbs and increasing protein and veg.

At breakfast i aim for more protein than carb - e.g. you wouldn't have 2 pieces of toast, but 2 eggs and 1 toast would be fine.

Snacks - the idea is to fill up on enough veg and protein at meals that you don't need snacks, if you do need them then either fruit is advised (they keep suggesting bananas to me but i hate wasting an injection on a banana outside of meal times), or something that is protein paired with carb (e.g. an oatcake with philadelphia light or low fat cottage cheese).

What do i think of the diet advice?
I've found i've had to do a bit of picking and choosing which advice to listen to and which not to, but i have found some pieces of advice useful. I've chosen not to keep a food diary other than the week before appointments as i feel i need to find a way of losing weight that doesn't involve any kind of logging things. My weight loss i feel is slower than it was with calorie counting, but if it lasts longer then that would work out better overall.

 

[Lucyr]

Something that I’ve found is missing from or not explained enough in this program is how to change your thinking to stick to the recommended choices.

I’m now almost at the end of month 2 so a third of the way through the program. So far I’ve had 1 videocall and 1 phone call with the nutritionist and 1 videocall with the behavioural therapist. I tried really hard and lost some weight in month 1, but my focus and choice haven’t been great in month 2 and I haven’t weighed yet but I’m sure I’ll have gained or at least not lost when I weigh in on Thursday.

Yes it’s been a hard month, there’s been time off sick, ME has been a pain, a week away staying with family where they’ve done the shopping, family in hospital and just generally having a difficult month. But, I haven’t actually yet learnt how to stick to good choices through that, it’s still the same old turn to rubbish food when times are hard.

I will be home this weekend and have done an online shop to come Wednesday night. I’ve got freezer food that will last until then and will try to stay on track.