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The NHS Commissioning Board has recommended the introduction of medical, multidisciplinary, multicomponent weight management services (Tier 3 services) for obese patients requiring specialised management, including assessment for bariatric surgery. Unfortunately, these have not yet been commissioned in many areas. Barriers identified include obesity being a low commissioning priority, therapeutic nihilism, medical workload constraints, a lack of trained staff, financial barriers to developing new services, and challenges of evaluation. A particular challenge is the lack of long-term funding and the complex tendering processes used in some areas. However, patients value these services, and the sparse academic literature shows encouraging results. Nonetheless, more robust evaluation of these services, including additional outcome measures and longer follow-up after discharge, is required to demonstrate cost-effectiveness to the NHS.