The potential of a remotely-delivered weight management service to support existing specialist weight management services in the UK National Health Service: Preliminary findings from a pilot service evaluation (Preprint)

Abstract

BACKGROUND
Specialist weight management services (SWMS) in the UK National Health Service (NHS) are faced with long waiting lists and limited resources. Remotely-delivered SWMSs have the potential to support existing NHS services to increase access to treatment for patients living with obesity, however evidence of remotely-delivered services working to support NHS SWMSs in practice remains limited.

OBJECTIVE
This service evaluation explored the potential effectiveness, feasibility and acceptability of Second Nature’s remotely-delivered SWMS for adults living with obesity referred from existing NHS SWMSs. Preliminary findings from the first phase (‘Preparing for weight loss’) of a three-phase remotely-delivered SWMS are presented.

METHODS
Participants were referred to Second Nature by NHS SWMS leads. Eligible participants were assessed by a multidisciplinary team and allocated to one of three 16-week interventions: 1) a psychologically informed app-based program, 2) a Dialectical behavioral Therapy (DBT)-based skills training group program and 3) one-to-one psychological support. Primary outcomes were weight change (kg) and percentage weight change following completion of the intervention. Secondary outcomes included psychological distress, emotional eating, health-related quality of life, physical activity, emotion regulation, intervention feasibility and acceptability.

RESULTS
At 16-weeks, there were significant differences in weight (p=.012), with an average weight change of -2.2kg (SD 5.16) (-1.6% body weight). Participants in the app-based program lost the most weight (-2.8kg), and participants in the one-to-one psychological support program lost the least weight (-1.3kg). Psychological distress reduced to below the clinical threshold (mean score 0.95, SD 0.62) (p<.001). Emotional eating behaviors and difficulties in emotion regulation also decreased (p=.027 and p<.001). Health-related quality of life saw improvements in self-care, usual activities and anxiety/depression (p=.044; p=.014; p=.029), while participants’ challenges with mobility and pain/discomfort remained unaffected (p>.05). Subjective ratings of health status improved by 17.4% (p=.003). There were no significant changes in physical activity levels (p=.264), with most participants remaining ‘Inactive’ or ‘Moderately inactive’. Engagement with intervention sessions was high (93.7%) and attrition rate was 27.4%. Participants rated their satisfaction with the program at 9/10, while also providing insightful suggestions for future service improvement, such as improved app-functionality and more accessible physical activity support.

CONCLUSIONS
This preliminary service evaluation suggests that a remotely delivered SWMS has the potential to be effective, feasible and acceptable for NHS-referred patients in the UK. A full evaluation of all three phases of this service with a larger sample size is required to support these early findings.