Must know: behavioural weight management services – a guide to tackling obesity

Helping people to achieve and maintain a healthier weight is everyone’s business. As an elected member your decisions can have a significant and positive impact on health improvement in your local area. We have known for decades that living with obesity reduces life expectancy and increases the risk of developing chronic diseases. Living with obesity can also affect people’s mental health and their social and emotional wellbeing. It has become more apparent than ever that excess weight is a serious matter, given the over representation of people living with obesity, having contracted COVID-19, in intensive care units (ICU) worldwide. All of this can affect people’s life opportunities and has a direct impact on the community.

The necessary measures to suppress COVID-19 may have increased the risk of weight gain, whilst also making it harder to access weight management services. We have seen changes in the patterns of food purchases and physical activity that may be associated with increased calorie intake, increased sedentary time and excess weight gain. There have also been changes in economic and psychosocial factors – such as rates of unemployment and mental illness - that have also been linked to excess weight gain.

Since the majority of adults in England are living with overweight or obesity, and a substantial number of children are on the same trajectory, tackling obesity remains one of the greatest health challenges this country faces. In a reflection of our shared commitment with government, local authorities have been offered additional funding for the expansion of weight management services, as part of a whole systems approach to tackling obesity. Given the socio-economic disparity in healthy life expectancy in England, tackling obesity is fundamental to, and at the heart of, the levelling-up agenda.

Key messages: 

• Almost two-thirds (63 per cent) of adults, and one in three children in England are living with overweight or obesity.
• Behavioural weight management services for adults living with overweight or obesity are multi-component programmes that aim to reduce a person’s energy intake, improve their dietary health and help them to be more physically active by changing their behaviour.
• There is good evidence that behavioural weight management services can help adults to lose weight in the short term.
• Providing access to weight management services is a key part of a whole systems approach to obesity and promoting healthier weight, alongside other actions at a national and local level.
• Societal changes associated with the necessary measures required to suppress COVID-19 may have increased the risk of weight gain, whilst also making it harder to access weight management services.
• In a reflection of our shared commitment to tackling obesity, the government has invested over £30 million into local authority commissioned adult behavioural weight management services. For children and families, £4.3 million has been invested to expand behavioural weight management services and deliver extended brief interventions.
• Learning from this one-year programme of funding will help to make the case for more sustained funding for weight management services in future years.
• Local authorities are encouraged to provide equitable access to population groups most in need, including men, people living with obesity from deprived areas and people from Black, Asian and Minority Ethnic groups, and also to enable inclusive services for people with protected characteristics.
• As elected members, your understanding of local communities will enable you to work effectively with officers to ensure that the new funding is applied to meet the needs of local people.

Obesity is a complex relapsing condition with multiple causes and significant implications for health and beyond. It has health implications at every stage across the life course, from pregnancy through to childhood and adulthood. Living with obesity increases the risk of developing chronic diseases, including type 2 diabetes, heart disease, many cancers, liver and respiratory disease. There is also now consistent evidence that people with COVID-19 who are living with obesity are at an increased risk of severe complications of COVID-19 and death.

Almost two-thirds (63 per cent) of adults in England are living with overweight or obesity, and one in three children leave primary school living with overweight or obesity, with children from more deprived areas twice as likely to be living with excess weight compared to children from less deprived areas.

Behavioural, or lifestyle, weight management services, for adults living with overweight or obesity, are multi-component programmes that aim to reduce a person’s energy intake, improve their dietary health and help them to be more physically active by changing their behaviour. These services are usually commissioned by local authorities and/or the NHS and typically last for at least 12 weeks. 

There are different levels of weight management services. Behavioural services, referred to locally as tier 2, form one part of a comprehensive approach to preventing and treating obesity.

Public Health England’s (PHE) guidance on commissioning and delivering tier 2 adult weight management services can help local areas in setting up effective services.

For people living with obesity, even modest weight loss has been shown to bring long-term health benefits. Weight loss of 5 per cent reduces a person’s risk of developing diabetes, lowering blood pressure and cholesterol. It is also possible that the benefits of weight loss could mitigate COVID-19 severity.

There is good evidence that behavioural weight management services can help adults to lose weight in the short term.

Given the wide-ranging implications of living with obesity on health and beyond, it is clear that investing in weight management services is beneficial to individuals and the wider community.

Improving and increasing access to weight management services, for the large numbers of people who could benefit from them, is a key part of a whole systems approach to tackling obesity.

The integration of these services alongside other actions at a national and local level strengthens and increases the effectiveness of the system, in supporting people living with overweight or obesity to achieve and maintain a healthier weight.  

At a local level, PHE, in partnership with the Local Government Association (LGA), Association for Directors of Public Health (ADPH) and local authorities, has co-developed and published guidance to support local areas in implementing a whole systems approach to obesity and promoting a healthier weight.

At a national level, there is a wide programme of work underway to address obesity and help adults and children to live healthier lives. This includes commitments to further restrict the advertising and promotion of less healthy food, as well as improving front of pack labelling on pre-packed foods, introducing calorie labelling within out-of-home businesses, including restaurants, cafes and takeaways, and calorie labelling of alcoholic drinks.

These are all policy actions designed to empower and support everyone to have access to healthier options and access support to achieve and maintain a healthier weight, through bringing about change across the system.

Insight gained from local authorities has shown that the pandemic has reduced access to weight management support for children, young people and adults, and these changes are felt by officers to have increased inequalities.

Some groups of people are likely to benefit from different ways of engaging them in services, and from services which are tailored to their needs and how they live their lives. Such groups include men, people living with obesity from deprived areas, people from Black, Asian and Minority Ethnic groups, and people who are also living with physical and/or learning disabilities.

Providing equitable access to weight management services to population groups most in need is an essential part of supporting communities disproportionately affected by the drivers of obesity and addressing inequalities. Evidence based services must be adapted to make them culturally competent and relevant to the needs of population groups.

Local authorities have been allocated over £30 million new funding to help people achieve a healthier weight, through increasing the provision of weight management services. All local authorities have been offered a portion of this universal funding, with allocations weighted – according to population size, obesity prevalence and deprivation levels - to enable the money to go where the need is greatest. This funding is currently available for 2021 to 2022.

There has also been investment in childhood obesity, with £4.3 million of new funding allocated to local authorities to support the expansion of weight management services and support for children and families in 2021 to 2022. Following a competitive application process, eight applicants representing 11 local authorities have been awarded funding to expand child and family weight management services for children identified as overweight or living with obesity. This will include offering new or expanded behavioural weight management services and trialling extended brief interventions that use behaviour change approaches to support families and facilitate onward referral to services, where appropriate.

Data generated by local authorities on the additional behavioural services commissioned through this funding will be used to help make the case for more sustainable long-term funding in the future, to learn lessons on service performance and to understand what works best to support good outcomes for all.

PHE have responsibility for managing the programme and will be working, in collaboration with the LGA and ADPH, to support local authorities with the roll out and implementation of these grants.

Local authorities will be supported to commission adult behavioural weight management services through the provision of a dynamic purchasing system. This will be developed by PHE in consultation with local authorities and weight management providers, designed to help the efficient procurement of adult weight management services which have demonstrated that they can meet a set of minimum service standards.

The LGA will work with PHE and local authorities to co-develop approaches to facilitate and sustain knowledge sharing.

Guidance will be developed in collaboration between local authorities and PHE. In addition to this, work will be undertaken at a national level to build the evidence base and identify tools needed to promote healthy lifestyles in the early years to help prevent overweight or obesity concerns in families with young children.

To help align the NHS and local authority funded services PHE, NHS England and NHS Improvement (NHSE&I) are working in partnership.

As elected members you are pivotally placed to champion this investment into healthier weight in your local area, engaging the local community and collaborating with officers.

Your understanding of local communities will enable you to work effectively with officers to ensure that the new funding is applied to meet the needs of local people. This will be vital in achieving the ambition for services to prioritise helping those who need the most support to achieve a healthier lifestyle, including men, people living with obesity from deprived areas, Black, Asian and Minority Ethnic groups, and who are also living with physical and/or learning disabilities.

The provision of active involvement and ongoing and visible support will send a clear signal that tackling obesity, as a part of a whole systems approach, is a priority for the local area. The commitment and support of members will also help to ensure that sufficient time and resource will be available to maintain momentum.

The following questions apply to lead members, but all members may wish to consider them:

• Is the council providing weight management services to support people already living with obesity, alongside preventative actions?
• What measures are in place to support underserved/at risk communities in accessing weight management services?
• How does a whole systems approach to tackling obesity and promoting a healthier weight, including weight management services, feature in the council’s overview and scrutiny process?
• Has the council used data on its services previously and how does data that is routinely collated and provided feature in scrutiny committee?
• How is the council monitoring and evaluating progress on actions that are in place to tackle obesity and related drivers, including weight management services?
• Is the council working with the NHS to align weight management services? 
• Does the council have a shared vision, narrative and communications strategy in place to communicate publicly why tackling obesity is important and the approach the council is taking to address it?
• Are all council departments contributing to tackling obesity through their relevant functions? Do other departments clearly understand how tackling obesity benefits their own agendas?