“Jumping through hoops”: accessing obesity treatment within the integrated tiered weight management pathway in England

Student thesis: Doctoral ThesisPhD by Publication


More than a quarter (25.9%) of adults in England are living with obesity. Obesity treatment funded by the NHS in England is delivered through an integrated tiered weight management system; comprised of Tier 1, Tier 2, Tier 3, and Tier 4 level interventions. The collection of works put forward for this thesis are eight papers published between 2018 and 2023. Each paper provides unique insights into the accessibility of obesity treatment in England across and between the four tiers. From the perspective of the agent-in-focus (the NHS Obesity Dietitian), Strong Structuration Theory has been utilised as a framework to analyse the macro-
, meso-, and micro-level structures that contribute barriers of access to obesity treatment in England according to the published works. The main body of the critical overview is focused around the three distinct treatment access ‘hoops’ that have been identified within the integrated tiered weight management pathway in England: weight-based discrimination, ambiguity of clinical guidelines and treatment settings. This critical overview concludes with recommendations of how barriers in accessing obesity treatment in England could be alleviated, with a focus on dissolving the three identified access ‘hoops’ through influencing politicians, policymakers, further research and action on the part of healthcare professionals and people living with obesity.
Date of Award2023
Original languageEnglish
Awarding Institution
  • Coventry University
SupervisorDeborah Lycett (Supervisor) & Bernice Tighe (Supervisor)

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