Episode 2: Navigating the NHS Level 3 Weight Management Programme

🎙️ The Road to Transformation: My Journey to Weight Loss Surgery and Beyond

Episode 2: Navigating the NHS Level 3 Weight Management Programme

In this episode, I dive into my experience with the Level 3 Weight Management Programme on the NHS — a vital step in my journey to weight loss surgery.

💬 In this episode, I share:
✅ What the Level 3 Weight Management Programme involves
✅ The specialists I worked with — including a dietician, physiotherapist, and consultant
✅ Why maintaining your referral weight is important (and why small fluctuations are normal)
✅ The challenges I faced balancing my chronic illnesses with weight management
✅ The steps I took to improve my eating habits, including introducing breakfast and increasing my protein intake
✅ My decision-making process when choosing between surgery or weight loss injections

🩺 Key Takeaway: This process isn’t rushed — be prepared for long waits between appointments and ensure you’re committed to following the steps to give yourself the best chance of success.

💬 Extra Tips:
I also discuss exploring alternative exercise methods, like Tai Chi and integrating movement into daily activities, to help manage pain from fibromyalgia and rheumatoid arthritis.

🔍 Support Along the Way:
I share my experience joining the Obesity UK support group — a vital requirement for moving forward with surgery — where I gained valuable insights from others on similar journeys.

💜 Your Journey is Unique:
If you're exploring weight loss surgery, know that the path is different for everyone. This episode offers insights, tips, and reassurance to help you feel better prepared.

🫂 Join the Conversation

Join our supportive community on Facebook:
 👉 Our Road to Transformation: Our Weight Loss Journey

If you enjoyed this episode, please subscribe, review, and share with anyone who may find it helpful.

💪 Your journey is yours — embrace it at your own pace.

#WeightLossSurgery #TransformationJourney #RoadToTransformation #NHSWeightManagement

Transcript

Hello and welcome to the Road To Transformation, my journey to weight loss surgery and beyond. I am your host, Amy Mandelj, and this podcast series will walk you through my journey to weight loss surgery from deciding to ask the GP for help right the way through to my surgery date, and all the steps in between, and of course, the progress beyond surgery. 

Hello and welcome back to The Road to Transformation, my journey to weight loss surgery and beyond. In this episode, I want to discuss joining the Level three Weight Management program on the NHS. Now, I think a key thing to remember is nothing happens quickly. Be prepared for lengthy weights. 

Those of you that know the NHS system. Knows that this isn't just for the weight loss pathway, it follows suit across board. So having been to the doctors and them putting in a referral. I then waited a few months and had confirmation that I'd been accepted onto the level three weight management pathway. 

And within this, there was, I think I was told it'd be an 18 to 24 month program where I would be seen by a number of experts in their field. I had a specialised physiotherapist. I had a dietician and also the consultant that took me through what options were available, and you have three appointments, I believe, with the dietician and the physio before they will approve you to move on any further if that's the option that they want to go with you. You're not guaranteed to have surgery. There's a number of different options available, including the weight loss injection and diet and exercise. So it really does depend on your circumstances, so it's also important to remember that. At your first appointment, you'll be weighed and measured. 

They might have done this at your doctor's practice and given them that baseline of what you weighed the time when you were referred. They don't want you to go above this weight. Now that being said, the dietician fully understands and appreciates that your body fluctuates like. You might put on a pound or two and two days later that might be gone. 

So they do take all that into consideration. And I remember at the time panicking about whenever I got an appointment in case I'd put weight on because of the multiple illnesses that I was navigating, it wasn't as cut and dry as go away and diet because I could diet all day long and. Put weight on. So just because of the medications that I was on, I was prone to putting weight on. 

So it was something that I really panicked about because the initial dietician that I saw, I believe, was a locum, which I found out towards the end of the level three process, um, having literally had panic attacks and everything about. Putting weight on before an appointment and due to covid as well. A lot of the appointments will be done over the phone, but then you will get appointments to go and get weight so they can check in as to if you've lost any weight. 

If you've put any weight on, and they work with you like they fully want you to succeed. So in the initial dietician appointment. We went through what foods I was eating, if I had fizzy drinks, if I had takeaways, how many takeaways I'd have a week, a month, what was my go-to snacks, for example. And we'd put together a plan of how to move forward. 

So for example, I found personally I wasn't eating enough through the day. I wouldn't have breakfast because I woke up. I would wake up feeling sick or I'd have my medication, but I wouldn't necessarily have breakfast. And equally the ADHD side, I would drop Tyler off at school and then just not fancy eating or not realise what time it was. 

And the next thing I knew. I was picking Tyler up from school and it was time for tea. So I was open and honest about that with the dietician that some days, most days, Monday to Friday at least, I was only having an evening meal and I was very rarely snacking. So the first thing that. Was put into place for me was to eat more, um, have a healthy breakfast, be it wheat bake or overnight ups or fruit, anything like that, to actually open up the digestive system and get my body working. 

And then for lunch, getting to the process of having plenty of protein because whatever direction I was gonna go in. At that point, I needed to focus on keeping my protein levels to actually keep, keep my energy levels up on a day-to-day basis. And then the other two appointments was on the phone, I think, but basically checking in on what I'd managed to implement, how it was helping me, how it was affecting me, and what other steps I could take going forward. 

To progress the journey. We also had the conversations on where I wanted the journey to go, and from the research that I'd done, because I had 12 and a half done to lose as a minimum to get into that healthy weight range, I was either gonna go down the injection route or the. Surgery route. I wasn't sure at that point what surgery I wanted. 

I needed to do more research into the different success rate and how the different surgeries affected you and what the adverse effects could be. But I knew I had a lot of weight to lose and from experience knew that. It wouldn't happen, just exercise and diet alone. I think I entered the level three pathway in 2021. 

It might have been 2022, I'm sure it was 2021. And at that point, as much as I qualified for the weight loss injections, there was a real. Difficulty in England getting those into the country and getting them available. So because of that, I opted to wait for the surgery because there was no guarantee. 

Like I could have been on the injections for three months and then not have been able to get hold of them, and I didn't want that extra pressure if I put weight on after the injections had run out. I was in a bit of limbo, so it was agreed that because of the amount of weight I had to lose because of my conditions and overall mindset to improve my quality of life, that the dietician was happy to put me forward for surgery. 

But nevertheless, I still had to go through. The three appointments with the dietician, the three appointments with the physio, and meet the consultant. I believe I met the the consultant twice in level three, but that might have been three times as well. They're changing the process all the time to kind of make improvements, so it's important to bear that in mind as well with the physio. 

So my first appointment with the physio. Again, I think the first appointment was in person and then we had the follow-ups on the phone, but she very much took me through what I'd done previously in terms of exercise where I was at with my illnesses. Now I really struggled with. The mobility side because of the fibromyalgia, because of the rheumatoid arthritis, I was in pain and still am in pain a lot of the time. 

So I was trying to find ways around it and I was, I was open with her that, you know, I've lost the weight before I'd start going to the gym because of the fibromyalgia, I. Been put forward for physio at my local hospital, and I'd done various sessions in a gym on what I could and couldn't do, but with that as well. 

Became the difficulty of balancing how much is too much, because if I overdid it, I'd end up in bed laid up, and that didn't help me either. That had other impacts, which meant that I basically lost a week of my life because I was bedridden, because I'd pushed myself too far. So it was agreed and we went through different options like Pilates, yoga, and we settled on. 

Tai Chi, which they had seated options after the appointment, she emailed me with a load of links that I could try, that I could, if I had housework to do, for example, I could implement the movements into the housework so I wasn't having to do it twice. And I think overall, my mindset was just at that point of I need to change. 

I know I need to change. I'm ready for this. What do you need me to do? I'm happy to do it. I was also told by the dietician that to complete the tick box exercise of what to do to get approved for surgery, I needed to go and find the Obesity UK support group. And at the time, they were doing online sessions two a week, one of which was. 

Like a generalized obesity UK group, which wasn't focused on surgery, like you could be part of that group if you were doing swimming world or whatever else. And then they had another session on a Sunday evening, which was predominantly surgical people. And we needed to go to at least two of these meetings to get an idea to, to hear people's stories, to listen to their experiences before we would get put forward for surgery. 

So I went away and did that. I listened to a lot of different podcasts with other people's experiences and what they had been through, which really helped in researching the. Surgery that would be best for me because of my other conditions. It was important to kind of look at how things could affect me. 

So for example, I. The gastric sleeve is a really good surgery. It removes, I wanna say, 70 or 80% of your stomach and leaves you with kind of a sausage shaped stomach. The issue with this for people that struggle with heartburn is it's a straight tube so your stomach acids can go back up and can. Make heartburn a lot worse. 

This is the same principle with the mini bypass and at the time I hadn't actually heard of the mini bypass, but obviously a lot of research went in and I was really concerned that what if I struggle taking on nutrients? What if I have every adverse reaction going as a single mom? I don't particularly want to have to have. 

Revision surgery because any of the surgeries can be reverted into the full gastric bypass. But that would mean another night away from my son. It could mean a lot of issues with recovery, and I wasn't really down for that. Like I wanted to make things as easy and simple as possible, and if that meant having a surgery that was an hour and a half longer. 

But the side effects wouldn't necessarily be there in terms of the heartburn, then it was worth putting that argument across to the doctors. Um, and that's exactly what I did. I mean, in the first consultation discussion, my. Sur it wasn't a surgeon. I think he was a surgeon, but he wasn't. My surgeon went through the different options, so it'd said about the sleeve, it'd said about the gastric band. 

Obviously the issue with the gastric band is it can loosen over time, but that can be the same with anything like with the gastric bypass. Your stomach pouch can increase over time. It's all about knowing. Knowing how much to eat and what to do. So we, we discussed the potential pathways, he'd explained about the weight loss injection, but also why putting me forward for surgery could potentially be the best route because of the issues in, in getting the injection into the country. 

So again, just to remind you, there were mandatory appointments. To go to where you go in, you get weird and leave again, this is just so they have kind of a record. My physio also went through what helped my pain, so at one point, because my, my illnesses were playing up. I was really struggling with the chronic pain. 

She suggested going through adult social care to see if I could get a bath lift, which is another story in itself because. I didn't have a good experience. I don't deal well with, with authority figures and especially anyone labeled under social services. I freak out and I panic and I'd explained all this to the physio, but ultimately if it meant I could have a bath again, 'cause I struggled, I still do struggle getting out of the bath then it was worth. 

Having the conversation. So she put the referral through to adult social care on my behalf and on that document dated my starting work. So I had adult social care come out to see how they could, could help me, but knew what the physio ultimately wanted me to have. And. The lady sat there and told me I was too fat for a, a baff lift, which I knew my weight. 

I also knew the other things, the other baff lifts that are on the market that could handle my weight, but it was an outright nurse, so it seemed like a pointless exercise. That said, they came and installed a. Grab rail rather than it being a one that sticks to the wall. It was screwed into the wall. So I did get something out of it. 

But yeah, it wasn't a nice experience. Um, some people obviously don't have the same stresses and anxieties that I do, but I just found that it was a pointless exercise to me. So yeah, they go through and they. They try and get you into a routine. I bought, I think it's called Groove Dance or something. I, I bought a program where it was very much somatic movements dancing, so I'd already been doing things to, to get myself moving more, but they understood the level of pain that I was in and the importance to. 

Not overdo it as well. So I think that was really useful. And the dietician would go through different nutritional and dietician guidance, and they really wanted you to build healthy eating habits before going into the surgery. So yeah, that's pretty much my level three. Journey. It's just important to remember, like I said at the beginning, they don't rush. 

These appointments are split like every six months, and you're split between, like you don't have two appointments close together with the dietician and the physio, and you do have to see them three times, even if they've already said. Like, yeah, we agree. Going forward, surgery is the best option. You still have to do the steps and the process to be able to get put forward for the multi-discipline meeting. 

I hope this has helped, and if anyone does have any questions, please feel free to put them in the comments and I'll. Come back to you, but I hope this helped. Thank you for joining me for this week's episode of the Road to Transformation, my journey to Weight loss surgery and beyond. Please remember to subscribe and review if you have enjoyed what you have heard. 

Remember, all journeys are different. But I wanted to give you an insight into my journey through the NHS. Feel free to share with any of your friends and family members who are thinking about weight loss surgery. You can also join us in our Facebook group, the Road to Transformation, our Weight Loss Journey, where you can share your experiences too. 

The link is in the show notes. I hope. See you next time. Thank you.