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.
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.
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'.
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.