Providing weight management programmes for people living with obesity 

Providing weight management programmes for people living with obesity 

Weight Management

What this section covers

This section covers NIHR funded research into the impact of weight management programmes in adults and children. Weight management programmes are for people living with overweight or obesity and aim to reduce a person’s energy intake and help them to be more physically active by changing their behaviour. Programmes should last for at least 12 weeks, with weekly or fortnightly sessions, including regular weigh-ins. People can self-refer, or be referred by a health or social care practitioner. Programmes, courses and clubs take place in the community, workplaces, primary care, online, and in other settings (NICE).

What’s the context?

  • NICE recommends weight management programmes with multiple components for adults living with overweight or obesity, as part of an integrated approach to preventing and managing obesity (NICE PH33). The programmes should include behaviour change strategies to increase physical activity levels or decrease inactivity, improve eating behaviour and the quality of diet, and reduce energy intake (NICE CG189).
  • NICE also recommends and provides guidance on how to deliver effective weight management programmes for children and young people (NICE PH47).
  • Government funding has prioritised weight management services, with the aim of helping people to adopt healthier behaviours, lose weight and improve their general wellbeing (Department of Health and Social Care). During the COVID-19 pandemic, more services were delivered remotely or online.
  • Most councils (98%) accepted additional funding to expand provision. This could be face to face, remotely or online (Department of Health and Social Care).
  • Further funding was allocated to 11 local authorities to help expand child weight management services and improve access for up to 6,000 children living with excess weight or obesity (Department of Health and Social Care).

What does NIHR research tell us?

Weight management programmes in adults can be effective for short-term weight loss

Weight management programmes can help adults to lose weight. This has been shown in men (1,2), those living in areas with above average deprivation, and from a range of ethnic backgrounds.(3) Benefits can extend beyond weight loss, to include improvements in diet and physical activity, self-esteem and mental health.(2) Weight management programmes are cost-effective compared to taking no action. (2,4) However, surgical treatments are more cost-effective than weight-management programmes.(4) During pregnancy, weight management programmes can reduce the amount of weight gained. (5–7) But, they are not cost-effective (6) and may do little to prevent gestational diabetes or reduce the risk of large-for-gestational-age babies.(8)

Evidence is mixed on the most effective components of weight management programmes

Very low-calorie diets and low energy total diet replacement (e.g., soups, shakes and bars) can lead to weight loss that lasts 1 to 3 years.(4,9,10) The evidence is mixed on the cost-effectiveness of these diets. (4,11) Total diet replacements are unacceptable to people in some ethnic groups, who prefer low-calorie food tailored to their culture.(12) Weight reduction for men has been shown to be best achieved and maintained with the combination of a reducing diet, physical activity advice or a physical activity programme, and behaviour change techniques.(13) Dietary interventions are the most effective approach for reducing weight gain in women during pregnancy.(5)

Group-based weight management programmes with a social element are more effective

Group interventions have been shown to be more effective in terms of weight loss at 12 months than one-to-one interventions.(14) (NIHR Alert) Men respond to programmes delivered in social settings (13) and enjoy group-based interactions and feeling part of a team.(1,2)

Evidence on sustaining weight loss is mixed

Weight loss following a weight management programme tends to be measured after 2 years or less.(15) Some research has shown weight loss can persist for 4 years or more,(2,10,13), but other research has shown that weight loss is not sustained at 4 years (16) or longer.(17) Greater initial weight loss from weight management programmes can lead to faster weight regain, but weight may still be reduced at 5 years or more.(15)

Support to maintain weight loss has not been effective

Programmes that aim to maintain weight loss have not been shown to reduce weight regain. However, keeping weight loss programmes available to participants after they have lost weight is associated with a slower regain in weight.(15) Telephone support (18) and SMS-text messaging support (19,20) were not effective at weight maintenance after a weight management programme ended.

Family-based interventions for children with obesity have met with mixed results

Several family-based interventions for children who were living with overweight or obesity (aged 6 to 18 years) focused on parenting and lifestyle education. These interventions did not lead to weight loss or behaviour change. (21–23) Issues included: low uptake, the costs to families of participation (including higher quality food, time and transport costs), and little long-term change in weight or physical activity. (22) Another programme involved twice-weekly physical activity sessions (in sports centres and schools) as well as education. The 9-week programme was followed by a 12-week free family swimming pass. This programme reduced BMI z-score at 12 months, and had a positive effect on cardiovascular fitness, physical activity, sedentary behaviours and self-esteem. A key strength was the acceptability of this programme to families; average attendance was 86%. (24)

Weight management programmes for children have been more successful in schools than in community settings

Weight management programmes to treat obesity in children aged 4 to 16 were slightly but significantly more effective in schools than in community settings (e.g., leisure centres or community halls). The intervention comprised 10 weekly sessions on topics delivered by health coaches. In the school setting, there was a small but significant reduction in BMI z-score for participants above a healthy weight. There was no overall impact on weight in the community setting. Looking at sub-groups across both programmes, the programme had greater effect for children of Black (African/Carribean/Other) ethnicity, those over age 11 and those from the most deprived groups. All the children in schools completed the intervention, however, in community settings, only 33% did so. The school programme included participants regardless of weight and attendance was mandatory. The community programme only included children above a healthy weight and had a ‘drop-in’ design.(25)

Interventions in schools that are not targeted towards children with obesity, and focus instead on preventing obesity, are covered under ‘Encouraging healthy schools’.

Useful resources

  • The Department of Health and Social Care offers leaflets, posters and resource packs for adult weight management programmes run by local authorities.
  • Public Health England offers a range of tools and resources to support weight management programmes.
  • NHS Inform, Scotland’s national health information service, offers an online weight management programme, with online activity trackers, meal planners and weekly journals.
  • Livewell comprises 13 Essex local authorities and other partners, and provides details of adult and child weight management programmes.
  • Government guidance on evidence-based behaviour change techniques for family weight management services.

NIHR research in progress

  • Which weight management approaches are most effective in producing weight loss, and best suited to different groups of people? (26)
  • How weight management programmes can be scaled up, including the cost-effectiveness of using non-specialists (such as health trainers and community members) and technology (web and telephone).(27)
  • How can technology be harnessed to deliver weight management interventions?(28)

NIHR studies included in this section

  1. Wyke S, Hunt K, Gray CM, Fenwick E, Bunn C, Donnan PT, et al. Football Fans in Training (FFIT): a randomized controlled trial of a gender sensitised weight loss and healthy living programme delivered to men aged 35-65 by Scottish Premier League (SPL) football clubs. Public Health Res. 2015 Feb 11;3(2):1–130.
  2. Gray CM, Wyke S, Zhang R, Anderson AS, Barry S, Brennan G, et al. Long-term weight loss following a randomised controlled trial of a weight management programme for men delivered through professional football clubs: the Football Fans in Training follow-up study. Public Health Res. 2018 Jul 23;6(9):1–114.
  3. Smith JR, Greaves CJ, Thompson JL, Taylor RS, Jones M, Armstrong R, et al. The community-based prevention of diabetes (ComPoD) study: a randomised, waiting list controlled trial of a voluntary sector-led diabetes prevention programme. Int J Behav Nutr Phys Act. 2019 Nov 27;16(1):112.
  4. Avenell A, Robertson C, Skea Z, Jacobsen E, Boyers D, Cooper D, et al. Bariatric surgery, lifestyle interventions and orlistat for severe obesity: the REBALANCE mixed-methods systematic review and economic evaluation. Health Technol Assess. 2018 Dec 4;22(68):1–246.
  5. Thangaratinam S, Rogozińska E, Jolly K, Glinkowski S, Duda W, Borowiack E, et al. Interventions to reduce or prevent obesity in pregnant women: a systematic review. Health Technol Assess. 2012 Jul 23;16(31):1–191.
  6. Rogozińska E, Marlin N, Jackson L, Rayanagoudar G, Ruifrok AE, Dodds J, et al. Effects of antenatal diet and physical activity on maternal and fetal outcomes: individual patient data meta-analysis and health economic evaluation. Health Technol Assess. 2017 Aug 10;21(41):1–158.
  7. Smith A, Tommerup K, Croker H, Rhodes A, Llewellyn C. Systematic review of brief interventions aimed at promoting energy balance behaviours delivered during antenatal care. Obesity Abstracts. Bioscientifica; 2019. 10.1530/obabs.01.RFC2.5
  8. Poston L, Bell R, Croker H, Flynn AC, Godfrey KM, Goff L, et al. Effect of a behavioural intervention in obese pregnant women (the UPBEAT study): a multicentre, randomised controlled trial. Lancet Diabetes Endocrinol. 2015 Oct;3(10):767–77.
  9. Astbury NM, Aveyard P, Nickless A, Hood K, Corfield K, Lowe R, et al. Doctor Referral of Overweight People to Low Energy total diet replacement Treatment (DROPLET): pragmatic randomised controlled trial. BMJ. 2018 Sep 26;362:k3760.
  10. Astbury NM, Edwards RM, Ghebretinsea F, Shanyinde M, Mollison J, Aveyard P, et al. Extended follow-up of a short total diet replacement programme: results of the Doctor Referral of Overweight People to Low Energy total diet replacement Treatment (DROPLET) randomised controlled trial at 3 years. Int J Obes. 2021 Nov;45(11):2432–8.
  11. Kent S, Aveyard P, Astbury N, Mihaylova B, Jebb SA. Is Doctor Referral to a Low-Energy Total Diet Replacement Program Cost-Effective for the Routine Treatment of Obesity? Obesity. 2019;27(3):391–8.
  12. Farhat G, Majeed S, Rutter MK, Issa B, Harvie M. Comparing the acceptability of total diet replacement and food-based low-calorie diets for type 2 diabetes remission amongst Southeast Asians: a public and patient involvement activity. NIHR Open Res. 2021 Nov 30;1:24.
  13. Robertson C, Archibald D, Avenell A, Douglas F, Hoddinott P, van Teijlingen E, et al. Systematic reviews and integrated report on the quantitative, qualitative and economic evidence base for the management of obesity in men. Health Technol Assess. 2014 May 27;18(35):1–424.
  14. Abbott S, Smith E, Tighe B, Lycett D. Group versus one-to-one multi-component lifestyle interventions for weight management: a systematic review and meta-analysis of randomised controlled trials. J Hum Nutr Diet. 2021;34(3):485–93.
  15. Hartmann-Boyce J, Theodoulou A, Oke JL, Butler AR, Scarborough P, Bastounis A, et al. Association between characteristics of behavioural weight loss programmes and weight change after programme end: systematic review and meta-analysis. BMJ. 2021 Aug 17;n1840.
  16. Khunti K, Griffin S, Brennan A, Dallosso H, Davies MJ, Eborall HC, et al. Promoting physical activity in a multi-ethnic population at high risk of diabetes: the 48-month PROPELS randomised controlled trial. BMC Med. 2021 Jun 3;19(1):130.
  17. Fildes A, Charlton J, Rudisill C, Littlejohns P, Prevost AT, Gulliford MC. Probability of an Obese Person Attaining Normal Body Weight: Cohort Study Using Electronic Health Records. Am J Public Health. 2015 Sep;105(9):e54–9.
  18. Daley A, Jolly K, Madigan C, Griffin R, Roalfe A, Lewis A, et al. A brief behavioural intervention to promote regular self-weighing to prevent weight regain after weight loss: a RCT. Public Health Res. 2019 May 1;7(7):1–66.
  19. Sidhu MS, Daley A, Jolly K. Evaluation of a text supported weight maintenance programme ‘Lighten Up Plus’ following a weight reduction programme: randomised controlled trial. Int J Behav Nutr Phys Act. 2016 Feb 12;13(1):19.
  20. Sniehotta FF, Evans EH, Sainsbury K, Adamson A, Batterham A, Becker F, et al. Behavioural intervention for weight loss maintenance versus standard weight advice in adults with obesity: A randomised controlled trial in the UK (NULevel Trial). PLOS Med. 2019 May 7;16(5):e1002793.
  21. Robertson W, Fleming J, Kamal A, Hamborg T, Khan KA, Griffiths F, et al. Randomised controlled trial evaluating the effectiveness and cost-effectiveness of ‘Families for Health’, a family-based childhood obesity treatment intervention delivered in a community setting for ages 6 to 11 years. Health Technol Assess. 2017 Jan 6;21(1):1–180.
  22. Law C, Cole T, Cummins S, Fagg J, Morris S, Roberts H. A pragmatic evaluation of a family-based intervention for childhood overweight and obesity. Public Health Res. 2014 Oct 8;2(5):1–184.
  23. Viner RM, Kinra S, Christie D, Cole TJ, Costa S, Croker H, et al. Improving the assessment and management of obesity in UK children and adolescents: the PROMISE research programme including a RCT. Programme Grants Appl Res. 2020 Apr 1;8(3):1–264.
  24. Sacher PM, Kolotourou M, Chadwick PM, Cole TJ, Lawson MS, Lucas A, et al. Randomized Controlled Trial of the MEND Program: A Family-based Community Intervention for Childhood Obesity. Obesity. 2010;18(S1):S62–8.
  25. Little M, Serber-Souza S, Kebbe M, Aveyard PN, Jebb SA. A Natural Experiment Comparing the Effectiveness of the ‘Healthy Eagles’ Child Weight Management Intervention in School Versus Community Settings. Nutrients. 2021 Oct 31;13(11):3912.
  26. Logue J. BEhavioural Weight Management: COMponents of Effectiveness (BE:COME) NIHR129523. NIHR Funding and Awards Search Website. [cited 2022 Feb 4].
  27. Ahern A, Griffin S. Scalable behavioural weight management programmes for the prevention and treatment of type 2 diabetes. RP-PG-0216-20010. NIHR Funding and Awards Search Website. [cited 2022 Feb 4].
  28. Jebb S, et al. Online Weight Loss Study. [cited 2022 Feb 4].