Public obesity services specialise in holistic multidisciplinary management for those living with the most severe forms of obesity. However, as demand for such services well exceeds supply with resulting long waiting times, entry criteria can be highly restrictive. While specialised, coordinated multidisciplinary management has the potential for life-changing positive outcomes, it is demanding on the individual. Patients with very severe obesity or other barriers to care who will qualify for such services may not benefit or have limited benefit. Meanwhile, patients with lesser severity of obesity who may benefit substantially may not qualify for entry, or may experience significant delays in accessing care, with the risk of disengagement and clinical deterioration. To ensure that limited resources are used where they will have greatest impact, public obesity services must have clear, efficient and transparent processes that are regularly reviewed and enforced by multidisciplinary team discussion and consensus, to ensure that they are targeting those who will benefit from the interventions provided. Alternative models of care are needed for those who are very sick, but who may not benefit from complex multidisciplinary care in specialist centres.