Quick-read summary
Local authorities commission Tier 2 weight management services (WMS) to help people lose weight by providing support for healthy eating and exercise. The UK Government announced a new (non-recurring) grant to fund more tier 2 WMS for adults in 2021/22.
We surveyed providers of Tier 2 WMS to find out what types of services were available through the new grant and who could access them. We also interviewed professionals who commission and provide Tier 2 WMS for high-risk groups to understand their experiences of delivering these services.
From 52 survey responses which represented 89 unique local authorities across England, we found that 28% specifically supported people from high-risk groups. This is lower than data collected by the Office for Health Improvement and Disparities (OHID) which estimates that this was around 60% (shared via personal communication).
Five services provided support for other health and wellbeing issues e.g., smoking. Very few services provided specific support for mental health.
We identified several enablers and barriers to service delivery.
Ultimately, service commissioners and providers need sufficient resource (time, staff, funding) for successful service delivery. Successful service delivery involves co-developing and adapting services in partnership with service users and relevant community groups, and actively promoting the service amongst communities and GP practices.
Who is this evidence useful for?
Professionals who are involved in the commissioning and provision of Tier 2 weight management services for adults, particularly those for high-risk groups.
What is the issue?
In the UK, 1 in 3 people have obesity. Rates of obesity are higher in people from Black, Asian and Minoritised Ethnic groups, men, people with serious mental illness, more deprived people, and people living with a physical or learning disability. These groups can also face more barriers to seeking support for their weight.
The UK Government announced a new (non-recurring) grant to fund more Tier 2 WMS for adults in 2021/22. We did a study to find out what types of services were being offered through the new grant, and how to enhance implementation of Tier 2 WMS for higher-risk groups.
Research summary.
We did our study in two parts:
Part one (survey)
- We sent a survey to providers of Tier 2 WMS for adults in England that were commissioned by a local authority and were funded by the new grant
- The survey asked questions about the format, structure and content of the service, service user eligibility criteria, support for high-risk groups, costs to service users and barriers and facilitators to delivering the service
Part two (case studies)
- We recruited eight Tier 2 service providers across England who supported high-risk groups
- We interviewed 35 professionals from these case studies that were involved in service commissioning or delivery
- Six case studies provided support for people with a disability; one for men, four for ethnic minority groups and two for people with serious mental illness
What did the research find?
Part 1 (survey)
- We received 52 survey responses (59% response rate) representing 89 unique local authorities across all nine England regions.
- Services were similar in format (90% group-based), duration (78% 12-weeks long) and mode of delivery (86% in-person) and most were completely free (90% no costs to service users)
- Education and content on healthy eating and exercise were varied
- 28% services specifically supported high-risk groups. This is lower than the 60% reported by the Office for Health Improvement and Disparities (OHID)
- Five services provided support for other health and wellbeing issues e.g., smoking; very few services provided specific support for mental health
You can read more about Part 1 of the study here
Read the corresponding research paper here
Part 2 (case studies)
Enablers to service implementation were:
- Having an established programme that could be adapted to a range of service users
- Multi-partnership working with community groups
- Having an easy referral process
- Working with communities and service users to shape programme
- Having high quality staff delivering the service
Barriers to service implementation were:
- Limited resources (staff, funding) and time pressures
- Not enough time to identify and work with high-risk groups to develop and adapt services
- Supporting and engaging with people with more complex or cultural needs
- Too many referrals and inappropriate referrals
- Inflexible programme and systems.
Why is this important?
Previous clinical trials have investigated how much weight people lose through Tier 2 WMS. Very few studies have explored how these services are delivered and experienced in the real world.
Our research has helped us form recommendations to enhance the delivery of Tier 2 WMS, with a focus on those for high-risk groups.
Read the research paper linked to phase two of this work
How were people/community groups/patients involved in this work?
A group of public advisors helped shape our research by:
- Providing feedback on our survey findings which informed the research interviews
- Reviewing and providing feedback on information sheets, flyers and research interview questions
- Reviewing and providing feedback on study outputs.
Recommendations for policy and practice
We recommend that commissioners and providers consider the following things when delivering Tier 2 WMS:
- Equity
Identify which groups in the community cannot access a weight management service. How can decision makers be convinced that this programme is needed?
- Partnerships
Identify who can provide expertise, be a champion or collaborate. Build partnerships with these individuals and stakeholders.
- Co-development
Co-develop and adapt the programme with relevant community groups and individuals from the target group. Dedicate at least three months to this.
- Staff
Have personable and passionate staff with continuity across the programme sessions. Contact service users before the initial session.
- Accessibility
Identify the accessibility needs of service users i.e., venue (will carers also be attending), materials (e.g., easy read materials) and ways to cater for these.
- Referral process
Make referral processes simple (self-referral not always appropriate e.g., for people with learning disabilities) and provide information about the service at the point of referral.
- Brand identify
Cultivate a ‘brand identity’ to promote programme visibility and trust among service users. Promote the service to GPs and relevant community groups.
What happens next?
We have shared our findings at several regional and national stakeholder meetings. We are now interviewing service users from the case studies to understand their experiences of engaging with these services.
Once we have all our findings, we plan to share them at a dissemination event.
We also want to use our findings to inform an update of the current guidelines on commissioning and delivering Tier 2 WMS.
How can people get in touch with you?
Dr Mackenzie Fong
mackenzie.fong@newcastle.ac.uk
How was this work was funded?
This project is funded by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) North East and North Cumbria (NENC) (NIHR200173). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. This project was also funded by North of England Commissioning Support (NECS) Research Capability Funding.