Feasibility and benefits of implementing a Slimming on Referral service in primary care using a commercial weight management partner

Summary

Objectives

To assess participation in a costed Slimming on Referral service and identify factors associated with success.

Study design

Simple intervention offering participation in a new service to 100 eligible patients. The setting was two Derby general practices, one inner city and one suburban.

Participants

One hundred and seven patients (mean age 50 years) attending general practice for non-obesity reasons. Inclusion criteria: BMI≥30, age≥18 years, not pregnant, no recent commercial weight management group membership, willingness to attempt weight loss.

Methods

Patients were offered free attendance at a local Slimming World group for 12 consecutive weeks. Body weight and height were measured at baseline, and questionnaires established perceived health, motivation to lose weight, employment, concerns, responsibilities and well-being. Weight was measured at each group visit. The main outcome measures were: (1) changes in body weight at 12 and 24 weeks, (2) social and demographic factors associated with barriers to enrolment, continued attendance and successful weight loss.

Results

Ninety-one (85%) patients attended a group, with 62 completing 12 weeks. Average weight loss in participants was 5.4 kg (6.4% baseline weight). Forty-seven then chose to self-fund, with 34 (37% original group) completing a further 12 weeks. Average weight loss over the total 24 weeks was 11.1 kg (11.3% baseline weight). Regular attendance was affected by income, financial concerns (independent of actual income), age, perceived importance of weight loss and initial weight loss success. Well-being of patients significantly improved between baseline and both 12 and 24 weeks.

Conclusions

Collaboration with an appropriate commercial weight management organization offers a feasible weight management option that is either similar to, or better than, other options in terms of attrition, efficacy and cost.

Introduction

Obesity is a serious but preventable challenge to health. Currently more than 20% of adults are obese,¹ i.e. a body mass index (BMI) over 30, increasing their risk of cardiovascular disease, metabolic syndrome, some cancers, depression and poor mobility.² While the benefits of treating obesity are clear, not least as a way of helping to meet clinical targets for hypertension, hyperlipidaemia and type 2 diabetes, less is known about how to manage obesity within the resource and training constraints of primary care.

The most effective treatment for obesity is reported to be a combination of diet, exercise and behavioural therapy.² However, the availability of treatments varies across the UK. A survey of 340 Primary Care Organizations (PCOs) found that less than 50% of these offered an obesity service and, where one existed, patients from only 25% of GP clinics were able to access it.³ Reasons for this may include low prioritization of specialist obesity services or uncertainty about effectiveness.⁴ Inadequate provision of obesity services has also been highlighted by a UK Government White Paper (Choosing Health),⁵ which recently set out new policy ideas to address the deficit. The introduction of drugs for weight control, notably orlistat and sibutramine, has also advanced treatment options for primary care, although the costs of these remain a legitimate concern. In addition, these drugs are approved for use by the National Institute for Clinical Excellence (NICE) only as adjuncts to core lifestyle advice and not as stand-alone treatment.6, 7 Indeed, there is better standardization for the provision of drugs and surgery than for core advice, e.g. for dietary intake and physical activity. This needs to be addressed, particularly to support prescribing in line with the guidance of NICE.6, 7

Choosing Health⁵ recommended that obesity services be upgraded across England and Wales to include regular monitoring and personalized advice on diet, physical activity and behavioural strategies to tackle the causes of over-eating and under-exercising. Offering free or reduced cost attendance at commercial weight management groups was recognized in this document and others as a means of expanding PCO capacity.5, 8 There is evidence from the USA that regular slimming group attendance leads to clinically significant weight loss that is maintained in the long term. Two randomized controlled trials compared commercial weight management group attendance with a self-help programme at 4 weeks,⁹ 26 weeks¹⁰ and 2 years.¹¹ Weight loss for subjects attending the commercial programme was significantly greater than after the self-help programme (4.8 kg more at 26 weeks; 2.9 kg more at 2 years). Weight regain is a problem for all weight management methods, with reports that 30% of lost weight is regained within a year, and virtually all by 5 years.¹² However, people attending commercial weight management groups do better than predicted at 5 years,¹³ perhaps due to frequent contact and group support, both known to influence better outcomes.¹⁴

No UK studies have been carried out to assess the feasibility of building commercial weight management group referral into primary care. Nor has there been an assessment of potential barriers to enrolment and attendance—an important aspect since accessibility is a key factor for any new service. To remedy this, a collaboration was developed between public sector stakeholders in Southern Derbyshire and Slimming World (SW), generating the research reported here.