Tier 3 weight management clinics sit in the middle of the NHS obesity treatment hierarchy, offering intensive, multidisciplinary specialist care that falls between routine primary care advice and bariatric surgery. These programmes typically combine dietetic support, psychological input and physical activity guidance over an extended period, and they represent the last structured step before surgical options are considered. Yet the men who need these services most are conspicuously absent from them. The study’s authors note that men are under-represented both in weight management services and in the research that shapes those services, creating a double invisibility: clinicians know men are not showing up, but they have had little patient-generated evidence to explain why or what would change their minds.

To address that gap, the research team conducted semi-structured interviews with nine patients who had experienced the Tier 3 programme and three peer buddies, former service users who now support new participants by offering lived experience, encouragement, social connection and practical accountability. Including buddies was a deliberate methodological choice, since they occupy a dual position as people who have navigated the programme themselves and as informal guides who hear directly from men currently struggling with it. The interviews were analysed using Reflexive Thematic Analysis, an inductive approach that allows patterns to emerge from participants’ own words rather than testing pre-existing hypotheses. Four themes crystallised from the data, two describing psychological barriers and two describing drivers of engagement.

The first barrier is cultural. Participants reported that, in their experience, it is culturally more acceptable for men to be overweight or obese than for women, with a larger body size often associated with strength, solidity and male identity. A big frame can read as power rather than pathology, and this reframing of excess weight as a masculine attribute blunts the perceived urgency of the problem. Where women may face social pressure to address weight for aesthetic reasons, men can carry substantial extra weight without feeling that their identity is under threat. The researchers argue that this cultural permission slip means many men simply do not register their obesity as a problem requiring clinical intervention, which has profound implications for how and when services should attempt to reach them.

The second barrier cuts deeper into psychology: vulnerability is uncomfortable. The study found that a male identity built around self-reliance and guarded emotional expression discourages men from seeking help of any kind, and specialist weight management is no exception. Admitting that you cannot control your weight on your own means admitting that you need assistance, which collides directly with norms of masculine stoicism. Participants described the discomfort of exposing personal struggles to strangers, of being weighed and measured and asked to talk about eating behaviours that carry shame. This theme echoes a broader literature on men’s under-use of primary care and psychological services, but here it is mapped specifically onto the structures of an NHS weight management pathway, showing how the design of services can inadvertently amplify the very anxieties that keep men away.

Yet the study is not simply a catalogue of obstacles. The third theme, that men do need help when obesity becomes a health worry, identifies the moment when the calculus shifts. For the men interviewed, a concrete health scare or diagnosis, such as concerns raised by a doctor about diabetes, heart health or mobility, transformed obesity from an identity and appearance issue into a genuine medical threat. Once the problem was framed in terms of health rather than looks, seeking help became not only acceptable but necessary. This finding aligns with established health psychology models, including the Common Sense Model of Illness Recognition and the Health Belief Model, which hold that people act on health threats when they perceive them as serious, personally relevant and consequential. The practical implication is stark: the language used to engage men matters enormously, and health framing outperforms appearance framing.

The fourth theme offers what the authors describe as new insight for healthcare practitioners: being invited for specialist treatment is helpful for men. A direct, personal invitation from a healthcare professional gave men permission to accept help, externalising the decision in a way that sidestepped the admission of self-directed failure. Rather than having to conclude on their own that they needed specialist support, men could respond to an authoritative recommendation, preserving their sense of self-reliance while still entering treatment. For the authors, this suggests that primary care practitioners, who are often the first point of contact, hold a critical lever: the way they frame conversations about obesity and the explicitness with which they extend an invitation may determine whether a man ever engages with Tier 3 services at all.

The role of peer buddies adds another layer of practical insight. Because buddies have lived through the programme, they can normalise the experience for newcomers, reduce the fear of judgement and provide accountability that feels like camaraderie rather than surveillance. The study suggests that this lived-experience support model helps men make long-term lifestyle changes by embedding social connection into the treatment pathway, countering the isolation that self-reliant masculine norms can produce. For NHS weight management leads, the message is that services designed around peer support and delivered through personal invitation are more likely to reach the men who currently stay away.

Taken together, the four themes point toward what the researchers call a paradigm shift. Male obesity, they argue, needs to be understood not as an aesthetic or identity issue but as a threat to men’s health, and help-seeking behaviour needs to be normalised so that consulting a specialist weight management service carries no more stigma than consulting a cardiologist. That reframing has consequences for public health messaging, for clinical training and for service design. Campaigns that appeal to appearance are likely to miss men entirely, while campaigns that connect weight to the health outcomes men care about, staying active, staying alive for their families, avoiding chronic disease, are more likely to land. Meanwhile, clinicians need language and invitation strategies that work with, rather than against, masculine self-reliance.

The study, conducted as part of an unfunded MSc placement project with the support of practitioners running the Plymouth NHS Tier 3 Weight Management service, was approved by the Health Research Authority and the HRA Oxford Research Ethics Committee, with informed written consent obtained from all participants and data anonymised in line with protocol. Its sample size is modest, and qualitative work of this kind aims for depth of understanding rather than statistical generalisability, but its value lies precisely in giving voice to a population that research has largely ignored. As obesity rates continue to climb and men continue to die earlier than women from weight-related conditions, the MUSTO study provides something clinicians have lacked: a map, drawn by men themselves, of the psychological terrain they must cross to reach treatment, and a clear indication that a well-timed, well-framed invitation can make all the difference.

Subject of Research: Men's engagement with NHS specialist weight management services for obesity

Article Title: A qualitative exploration of Men’s Uptake of Specialist Treatment for Obesity (MUSTO) within the UK national health service: what men say about what helps and hinders them to engage

Article References: A qualitative exploration of Men’s Uptake of Specialist Treatment for Obesity (MUSTO) within the UK national health service: what men say about what helps and hinders them to engage. (n.d.). https://doi.org/10.1186/s12889-026-29673-3

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29673-3

Keywords: obesity, weight management, men's health, NHS, Tier 3 services, qualitative research, masculinity, help-seeking behaviour, peer support, health psychology, primary care, BMC Public Health