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Specialist referral is recommended for patients with complex needs, including those with: BMI 40 kg/m BMI 35 kg/m with significant comorbidities requiring specialist management Suspected underlying endocrine causes of obesity Previous unsuccessful attempts at weight loss with standard interventions Consideration for bariatric surgery The NHS provides tiered weight management services, with Tier 3 (specialist multidisciplinary teams) and Tier 4 (surgical) services available for those meeting referral criteria

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