Evidence
Alert

GP referrals to weight loss programmes are accepted by men and women alike; research finds referrals reduce the gender gap

Structured programmes help people to lose weight, but they are overwhelmingly used by women. New research suggests that GPs who offer referrals to these programmes to both men and women can overturn the gender imbalance. It found that men are almost as likely as women to accept their GP’s referral, and are similarly successful at losing weight when they attend.

Men and women have similar rates of obesity and overweight. Yet nine in ten referrals from GPs to weight management programmes are for women.

Researchers set up a large study to find out whether a 30 second intervention by a GP (opportunistically, in a consultation unrelated to weight), was as acceptable to men as to women. They wanted to know whether simply offering weight management support to all men with obesity would result in more men attending programmes, even if they were not tailored specifically for men. 

Slightly more women took up the offer of support than men, but the GPs’ intervention dramatically reduced the gender imbalance. The researchers say GPs should be reassured that they do not need to worry about whether weight management programmes will be acceptable to men, since most accept the referral.

The research concludes that GPs who offer weight management support to men and women equally are taking an important step to increasing the numbers of men receiving weight loss support. 

What’s the issue?

Almost two in three adults in the UK are living with obesity or are overweight. The latest figures from England estimated that slightly more men (67%) than women (60%) are above a healthy weight. But men are much less likely to attend weight management programmes, or to be referred to such programmes by their GPs, than women. There is evidence that men make up only one in twenty of the 1.3 million people attending weight management programmes. Other research found that men make up one in ten referrals from primary care to community weight loss programmes. 

This matters because people who have support are more likely to lose weight than those who try on their own. 

Community weight loss programmes like Weightwatchers and Slimming World have a feminised image, designed to appeal to women. Previous research has looked at whether men would be more likely to attend men-only programmes, but these are not widely available. There has been little research looking at whether it is possible to get more men to mixed-gender programmes. 

The researchers wanted to see whether more men would go to weight management programmes if they were offered the chance.

What’s new?

This research used data from a study which compared the effects of offering simple advice to lose weight, with offering referral to a weight management programme. GPs could deliver advice or referral in 30 seconds, in a consultation unrelated to weight.

The trial included 1,882 adults with obesity. They were randomly assigned to be offered advice or referral, meaning that men and women were equally likely to be offered referral. One year later, follow-up information was available for 1,560 people (675 men and 903 women). 

  • Seven in ten men accepted a referral to a weight loss programme; they were nearly as likely as women to do so.
  • With GP referral, 30% of men attended the programme, compared to 50% of women. This meant that for every 16 women attending the programme, there were 10 men (with usual practice, 90 women are referred to a programme for every 10 men).
  • Whether they received advice or referral, men were less likely than women to take effective action to manage their weight. When given advice only, 12% men compared with 18% women embarked on a weight loss programme. When referred to support, 42% men compared with 61% women enrolled on a weight loss programme. 
  • There was little gender difference in the effect of the intervention. Once enrolled in the programme, men attended a similar number of sessions to women, and lost a similar amount of weight. 
  • Average weight loss was 0.7kg for men offered advice and 2.4kg for men offered referral.

The study concluded that GP referrals offered to men reduced the gender imbalance at weight loss programmes. 

Why is this important?

Clinicians mainly offer referrals to women, perhaps because they share the widespread belief that weight management programmes are less suitable for men.  This research provides reassurance that GPs who endorse these programmes and offer them equally to men and women, counter this impression and remove most of the gender imbalance in referrals.

Gender-specific programmes might be useful for men who are not willing to attend existing programmes, but they are not widely available. It may therefore be more realistic, cheaper and quicker, to use these brief interventions to reach men, rather than waiting for bespoke weight loss programmes to be developed.

This research indicated that men found the existing programmes acceptable. Those who attended at least one session remained as engaged as women. They attended the same number of sessions overall and lost a similar amount of weight. 

Given the large numbers of men with obesity in the UK, even a small increase in the proportion who lose weight is likely to reduce the numbers with obesity-related illness such as cardiovascular disease and diabetes. 

What’s next?

A GP referral to weight management support can help people with obesity lose weight and is recommended by Public Health England. However, it is not being sufficiently used in practice since GPs refer nine times as many women as they do men. Clinicians may be concerned about starting a conversation about weight, and most are started by patients. Men are less likely to see their weight as a problem compared with women, and therefore less likely to start this conversation.

The research should encourage GPs to discuss the available support for weight loss with men and women alike. The researchers say GPs should be reassured that they do not need to worry about whether weight management programmes will be acceptable to men, since most men accept the referral after a 30 second conversation.

Further research is needed to find additional ways of countering the idea that weight management programmes are best suited to women.

You may be interested to read

The full paper: Tudor K, and others. Gender differences in response to an opportunistic brief intervention for obesity in primary care: Data from the BWeL trial. Clinical Obesity 2021;11:e12418. 

The published results of the initial study: Aveyard P, and others. Screening and brief intervention for obesity in primary care: a parallel, two-arm, randomised trial. Lancet 2016;388:10059. 

A video by Oxford Primary Care offering clinicians information and advice on how to encourage referral to weight management, titled 'Supportive and effective conversations about weight management referrals'.

Funding

This research was co-funded by the NIHR Oxford Biomedical Research Centre and NIHR Oxford and Thames Valley Applied Research Collaboration. The original study was funded by the National Prevention Research Initiative under the auspices of the Medical Research Council.

Commentaries

Study author

We GPs are typically reluctant to engage with people about their weight. It’s a touchy subject and makes us anxious; it feels like we are criticising and might cause offence. So we rarely offer referrals to weight management programmes, and we should. That is true for both men and women – but particularly for men.

This research should reassure GPs that the intervention is suitable for men. On the whole, they will go if you offer them the choice. And it could make a big difference if more men were referred. If you prevent hypertension, heart disease or diabetes even if the weight goes back on – you have pushed these conditions back into the future and deferred substantial costs. These programmes are cheap and you end up with a net NHS benefit.

A modest difference to weight will make a modest difference to people’s likelihood of future ill-health. If we routinely offer referrals to lots of people, that would make a noticeable dent in obesity in this country. After all, almost all of us consult a GP at least once a year.

Paul Aveyard, Professor of Behavioural Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford

Lived experience

As someone who has suffered with a weight problem, as well as having read many hundreds of published papers on obesity research and applications for obesity research funding, I consider this study to be extremely worthwhile. The intervention is simple, straightforward, and eminently “rolloutable” with potential cost benefits to the NHS alongside health and wellbeing benefits for patients.

The findings could have an impact across a wide range of professions and individuals. They show that GPs, who are fully aware of the adverse effects of obesity, on the whole, do not opportunistically raise the issue of overweight. Neither, when the subject is broached, do they recommend interventional treatment to men as frequently as they do to women.

The general public could also benefit by knowing that this intervention could be available with the backing of the NHS.

Diane Munday, Public Contributor, St Albans

World Obesity Federation

Obesity is a chronic relapsing disease that affects men and women alike across the globe. It is also a risk factor for other diseases, including cardiovascular disease, diabetes and over 10 types of cancer. Currently obesity levels in the UK and across the globe are rising, if we are to halt and reverse current trends, we need to implement immediate action across the obesity spectrum from prevention to treatment. This will require the adoption of an integrated, equitable, comprehensive and person-centred approach to obesity. In conjunction with policies that address other drivers of obesity such as marketing and our food systems.

All people living with obesity should have access to evidence-based services and programmes that support them to live healthier lives. We know that for many people, primary care is a common – and often the first – point of contact in the health system. As routine interactions with patients are already in place, it is important to leverage this opportunity for interventions. Primary care professionals are in an advantageous position to support person-centred care and ensure adequate follow-up. Education in obesity treatment and management for healthcare professionals is often inadequate, going forward it is essential that all primary care professionals are equipped with specialised training to help them deliver interventions.

This new research demonstrates that if general practitioners endorse and offer weight management programmes to all their patients, it will reduce persistent gender differences in attendance. It would result in more men attending such programmes and they will benefit from achieving a healthier weight at similar rates to women when they do attend. It is significant that the research suggests that this could be done with 30-second interventions by general practitioners. The World Obesity Federation encourages primary care professionals in those countries where such services are available, to offer weight management support services to men and women equally, for the benefit of all.

Margot Neveux, Senior Policy Manager, World Obesity Federation 

This research should encourage GPs and other primary care clinicians to endorse weight management support and offer referrals. These referrals could remove most of the gender gap in uptake; it should therefore provide the impetus for them to actively target both men and women as they appear to benefit markedly and equally. Training on how best this can be done in short, time-pressured appointments is likely to be necessary.

Those running community weight loss programmes should be aware that referrals from primary care will help reduce the gender gap and are likely to counter the perception that these programmes are best-suited to women.

Jaynaide Powis, Data and Evidence Manager, World Obesity Federation 

Conflicts of Interest

None declared.