How can Tier 3 Weight Management services in the UK better support people living with obesity and trauma-related binge eating? A qualitative study of healthcare professionals' perspectives

Background: Obesity rates have risen significantly over the past three decades. Emerging research highlights strong links between obesity, binge eating disorder (BED), and trauma. Individuals experiencing these intersecting issues are often supported across separate services, Tier 3 Weight Management (WM) and Eating Disorder (ED) services. However, the literature suggests that these services are struggling to meet the complex needs of this client group, and current national guidelines remain insufficient and fragmented. Aim: This study aimed to explore how Tier 3 WM services can better support people living with obesity-related binge eating (O-BE) and trauma, and what challenges healthcare professionals (HCPs) face in delivering this support. Method: Fifteen semi-structured interviews were conducted with HCPs working across WM, ED, and general practice settings. Data were analysed using reflexive thematic analysis (RTA). Findings: Five themes were identified: (1) ED and obesity: Where does BED fit?; (2) Whack-a-mole’ service delivery is failing to meet the needs of the whole person; (3) The Obesity economy: commissioning, decommissioning and recommissioning services; (4) Feeling complicit in a system that sets people up to fail; (5) Expanding provision beyond short-term targets towards long-term change. Conclusion: A significant gap exists in the recognition and treatment of O-BE, compounded by fragmented service structures and poor cross-sector collaboration. National evaluation frameworks fail to capture these service inefficiencies, leading to a cycle of short-term commissioning and missed opportunities for integrated care. The emotional toll on HCPs, who often feel powerless, frustrated, and morally conflicted within these systems, is a key finding of this study. Addressing these structural and emotional challenges is essential for improving care and outcomes for individuals living with O-BE.