Evidence Hub

Evaluation of the delivery of expanded local ‘Tier 2’ weight management services in England

Quick-read summary

The UK government announced a new grant in 2021/22, which included £30 million to provide more local ‘Tier 2’ weight management services for adults in England.

Tier 2 services are commissioned by local authorities and delivered in communities.

They help people lose weight by providing education on and support for healthy eating, exercise, and behaviour change.

The grant was announced during a period when local authorities were also facing challenges presented by the Covid-19 pandemic. This was a one-off grant and was not renewed, so was only available for a year.

We wanted to find out what types of services were funded through the grant, who could access these services, and providers’ experiences of delivering their services in this unique context.

Who is this evidence useful for?

Policy makers involved with public health and weight management, Tier 2 weight management service commissioners (such as local authorities) and providers; GPs and other health care professionals who have a role in supporting people’s weight management.

What is the issue?

• Around 1 in 3 people have obesity in the UK; rates are higher in people from Black, Asian and Minoritised Ethnic groups, men, people with serious mental illness, people living in areas of greater disadvantage, and people living with a physical or learning disability.
• Tier 2 weight management services are the first line of treatment for people living with excess weight.
• The UK government announced a new grant in 2021/22, which included £30 million to provide more local tier 2 weight management services for adults in England.
• At the same time the new grant was announced, local authorities were also dealing with Covid-19. Local authorities were told that the grant was not going to be renewed the following year.
• Understanding the types of services that were delivered, who could access them, and factors that helped or hindered service delivery in this unique context can help inform future service delivery.

Research summary

We surveyed Tier 2 weight management service providers and asked them about what their service involved, how it was delivered, the duration of the service, costs to participants, and who could access the service.

We also asked them what made service delivery successful, and what made it challenging.

We received 52 responses that provided information about Tier 2 services being delivered in 89 local authorities across England.

Research findings

What types of services were provided?

• Most services were delivered by the local authorities themselves (i.e., in-house services); other services were mainly delivered by commercial or voluntary organisations.
• Most services were 12-weeks long, group-based, mainly delivered in-person, and free to participants.
• Five services centred around participation in football.
• Five provided support for other health and wellbeing issues e.g., smoking, alcohol, mental health, sleep, debt/housing.
• Most services accepted self-referrals, and referrals from GPs and other health care professionals e.g., nurses.
• Services were usually advertised on websites, social media and in community bulletins.

Who could access the services?

• Both men and women could access most services.
• A minimum age of 18 years was common. The most common minimum BMI criteria was 25, followed by BMI 28.
• Around a quarter of services specifically provided support for higher-risk groups i.e., either Black, Asian, and Minoritised Ethnic groups, people with a serious mental illness, men, people living in disadvantaged areas, and people living with disability.
• However, it should be noted that this contrasts to data collected by the Office for Health Improvement and Disparities (OHID), which found that around 60% of services provided support for higher-risk groups.

What made service delivery successful?

• Working in partnership with other organisations.
• Working with community groups to ensure the service was accessible and appropriate.
• Having programmes that could be easily adapted to meet cultural needs.
• Recruiting and training high-quality staff to deliver the programme.
• Engaging with GP practices.

What made service delivery difficult?

• Receiving many referrals that were not always appropriate.
• Participants being unaware of what the service involved.
• Having programmes that were difficult to adapt for service users with additional or cultural needs.
• Lack of funding, time, and other resources (e.g., staff); higher costs to deliver a service for higher-risk groups.
• Excessive data collection i.e., collecting data from participants to report to OHID.

Why is this important?

This study provides a snapshot of how the grant was used to deliver Tier 2 weight management services for adults in England, and factors that helped or hindered service delivery.

The findings of this study can be used by policy makers, service commissioners, and service providers to improve delivery of Tier 2 services in the future.

Recommendations for policy and practice

• Service providers need adequate time and resources (e.g., staff) to deliver a successful service.
• This time and resource can be used to engage in activities to benefit the service, for example working with communities and external organisations, adapting programmes, recruiting and training staff, promoting the service to the public and referrers e.g. GPs.
• Referral systems need to be straightforward and eligibility criteria should be clear to referrers such as GPs.
• Participants should be provided with basic information about the service at the point of referral.
• Strategies to manage excess referrals, including providing support to people on waiting lists, should be explored.

How were the public, community groups, or patients involved in this work?

We worked closely with public health stakeholders to design the survey. Several public advisors also reviewed the survey.

What’s next?

We are now carrying out a study to explore in-depth Tier 2 services that support people from higher-risk groups i.e., Black, Asian, and Minoritised Ethnic groups, people with a serious mental illness, men, people living in disadvantaged areas, and people living with disability.

We are doing this study with eight Tier 2 service providers across England. We have interviewed the providers and commissioners of these eight services to explore their experiences of delivering their service.

We are also preparing to interview people who have used these services to understand how they found the service, what worked well, and what could be improved.

Get in touch about this research

Dr Mackenzie Fong, Research Fellow in Prevention, Early Intervention and Behaviour Change, NIHR Applied Research Collaboration (ARC) North East and North Cumbria (NENC)

[email protected]

Twitter: @mcknz_fong

 Read the full research paper

A cross-sectional survey study exploring provision and delivery of expanded community tier 2 behavioural weight management services in England – Clinical Obesity, March 2024