Variation in Tier 3 Specialist Weight Management Services Within the National Health Service ( <scp>NHS</scp> ): Insights From Four <scp>NHS</scp> Sites in England and Wales

There are significant regional disparities in NHS Tier 3 specialist weight management services (SWMS) across the UK. In the context of an ongoing policy shift from hospital to community-based care, a detailed examination of the components of Tier 3 services is needed to clarify the distribution of responsibilities across the weight management pathway. We conducted a comparative service mapping of SWMS across four NHS sites in England and Wales, with on-site observation, staff interviews and document review. While the core structure and service delivery at the four sites broadly aligned with the National Institute for Health and Care Excellence (NICE) guidance, substantial variations were identified in service accessibility and content, alongside widespread resource constraints and communication challenges. These findings suggest that the strategic shift of SWMS care from hospitals to community settings is proceeding without an infrastructure to meet anticipated demand. Clearer definitions of service requirements within SWMS, sustainable funding mechanisms and data-driven commissioning may help reduce regional variation and inequalities in service provision.