Obesity Abstracts

Weight management services need to operate at scale if everyone one who might benefit is to have the opportunity to receive treatment. There is a large body of research developing and testing ‘boutique’ weight-loss interventions, usually involving highly trained professionals, with multiple contact points, putting them beyond the budget or workforce capacity of the NHS. For the few interventions that do make it into routine care, experience has shown that the effectiveness of the intervention usually wanes when the programme is delivered by generalists. Remote interventions, delivered using technology, are an attractive proposition but need to be maintained over time which is often beyond the capacity or remit of research teams. In recent years there has been a marked expansion in the NHS use of commercial providers to offer weight-loss programmes on an ‘industrial’ scale. Our research has shown that referral to commercial weight-loss groups in the community leads to weight losses of about 5 kg at 1 year, double that of programmes offered within a GP practice. A trial involving referral to a commercial provider offering a total diet replacement programme achieved 10 kg weight loss at 1 year, very similar to another trial offering the same diet but supported by practice nurses. In each case the commercial provider was more cost effective. Qualitative research shows that patients find these services acceptable and in some cases more convenient than treatment offered by health professionals. By working with commercial providers the National Diabetes Prevention programme has achieved universal coverage, with significant reductions in weight and HbA1c. While many of these services can be accessed directly by the public, well-managed partnerships with the NHS provide reassurance to patients of a credible service, increase motivation to attend and help to avoid widening health inequalities by providing access to those with the greatest need.