More funding should be poured into “under-resourced” NHS weight management programmes, say researchers who found evidence they do work.
A study led by the University of Glasgow found an inexpensive, 16-week NHS lifestyle management programme for people with type 2 diabetes had made a clear difference to participants.
“The common assumption that the weight lost is quickly regained is not true”
Published in the journal Diabetes, Obesity and Metabolism, the study found the programme offered by NHS Greater Glasgow and Clyde’s weight management service had led to sustained weight loss and reduced the need for medication.
Researchers hope their findings will help make the case for more investment in such schemes, which currently suffer from a lack of funding and low levels of referrals from sceptical clinicians.
The study examined records from the structured educational programme, which consists of nine fortnightly classes with referrals made by GPs or hospital doctors.
Delivered in a range of community venues, it is free of charge to patients with type 2 diabetes and a body mass index of 30 or above and deploys cognitive behavioural therapy techniques, alongside a diet regime and advice on exercise.
After the first phase of the programme, patients could choose to stay on for further weight loss and maintenance classes.
Researchers defined “success” as losing 5kg within seven to nine sessions and compared outcomes for that group with those for people who attended and did not lose weight, those who did not complete the programme and those who were never referred.
“Staff in primary care report a lack of confidence in raising the issue of obesity and weight management”
They used electronic health records to follow more than 23,200 people in Glasgow with type 2 diabetes and obesity for up to three years between 2005 and 2014.
In all, 3,371 potentially eligible patients were referred to the weight management service and less than half attended. Of the 808 people who made it to seven to nine lifestyle sessions, just over 40% successfully completed the programme having lost 5kg.
Those who successfully completed the programme maintained greater weight loss over three years compared with those who did not complete the programme and those who were not referred.
Significantly, the successful candidates saw no increase in oral diabetes drugs and were half as likely to progress to insulin as those who did not complete the programme and those who lost no weight.
Meanwhile, patients who were not referred or did not successfully complete the programme needed increasing amounts of oral diabetes medication over the next three years.
Lead author Dr Jennifer Logue, from Glasgow University, said the findings showed the programme had made a real impact and challenged current assumptions often held by clinicians.
She warned that weight management programmes in the NHS were often under-resourced and there was a lack of belief in their effectiveness among clinicians, leading to low levels of referral, despite them being recommended by the National Institute for Health and Care Excellence.
“This is the first real-world study to show that the lifestyle weight management programmes that we deliver in the NHS can have a long lasting meaningful clinical effect on type 2 diabetes,” she said.
“This study shows that the common assumption that the weight lost is quickly regained is not true,” said Dr Logue.
Funding urged for weight loss schemes proven ‘clinically effective’
She added: “Our hope is that this study will convince patients, clinicians and NHS managers that these inexpensive programmes can make a clinically significant difference to patients with type 2 diabetes.”
Increased funding could help boost the accessibility of sessions so more people can attend regularly and achieve the weight loss target of 5kg, according to the researchers.
In addition, they suggested that efforts to boost the skills and confidence of nurses and others when it came to talking about weight could also help boost attendance and completion rates.
“Staff in primary care report a lack of confidence in raising the issue of obesity and weight management with their patients; the use of effective behaviour change techniques in this initial conversation may help improve attendance and completion rates,” stated the paper.
A review of the programme was also set to include training for clinicians about discussing obesity and making referrals and greater use of local rather than central venues where possible.