Objectives: This research surveyed Tier 3 adult weight management services in England commissioned by integrated care boards (ICBs) across England in financial year 2022-2023. Design: Survey of public health services commissioned by ICBs gathered via freedom of information requests Setting and Participants All 42 ICBs in England Primary and secondary outcome measures The primary outcome measure was whether or not there was Tier 3 provision. Secondary outcome measures included the type of Tier 3 services provided and the estimated number of patients referred and treated. Results: We received responses from all 42 ICBs, a 100% response rate. Five reported that their ICB had no Tier 3 provision (NHS NW London, NC London, Lancashire and South Cumbria, Northeast and North Cumbria, and Northamptonshire). Deprivation is the major underlying inequality underpinning differences in obesity levels, so we explored the relationship with deprivation measured by the Index of Multiple Deprivation (IMD) for each ICB and referral rates to Tier 3 services. Including only data from those ICBs returning numbers of referrals identified there was no correlation between IMD and referral rates (R2 = 0.074; P=0.210). Since obesity prevalence data mapped to ICB level was not available we used regional data and estimated that 25% of people with obesity were likely to have a BMI≥35 kg/m2 and be eligible for referral to Tier 3 management. We then calculated the percentage receiving treatment. According to ICN reports the percentage of eligible patients treated ranged from 0 to 1.1%, the highest number was in the South East of England, a region with the lowest levels of deprivation. Lastly, we noted that, several ICBs were commissioning services that appear to not meet the definition of a Tier 3 service and were more in keeping with the criteria for a Tier 2 service. Accessing full details for these programmes is currently not readily available. However, treatment programmes exclusively online may fail to: be complete in their multidisciplinary team; provide clinical assessment and screening for obesity 3 related diseases; include access to pharmacotherapy or surgery or comply with NICE guidance. Conclusions: Provision of Tier 3 services in England is inadequate and variable and they currently fail to meet the needs of the population. Five ICBs provide no Tier 3 services at all. Areas with highest levels of deprivation provided the most limited access. Even where commissioned, services often do not meet commissioning guidelines. Action is required to implement Health Service Policy and to ensure obesity services conform with clinical need and national guidelines.