BackgroundOver sixty percent of adults in the UK are now overweight/obese. Weight management on a national scale requires behavioural and lifestyle solutions that are accessible to large numbers of people. Evidence suggests commercial weight management programmes help people manage their weight but there is little research examining those that pay to attend such programmes rather than being referred by primary care. The objective of this analysis was to evaluate the effectiveness of a UK commercial weight management programme in self-referred, fee-paying participants.MethodsElectronic weekly weight records were collated for self-referred, fee-paying participants of Slimming World groups joining between January 2010 and April 2012. This analysis reports weight outcomes in 1,356,105 adult, non-pregnant participants during their first 3 months’ attendance. Data were analysed by regression, ANOVA and for binomial outcomes, chi-squared tests using the R statistical program.ResultsMean (SD) age was 42.3 (13.6) years, height 1.65 m (0.08) and start weight was 88.4 kg (18.8). Mean start BMI was 32.6 kg/m2 (6.3 kg/m2) and 5 % of participants were men. Mean weight change of all participants was −3.9 kg (3.6), percent weight change −4.4 (3.8), and BMI change was −1.4 kg/m2 (1.3). Mean attendance was 7.8 (4.3) sessions in their first 3 months. For participants attending at least 75 % of possible weekly sessions (n = 478,772), mean BMI change was −2.5 kg/m2 (1.3), weight change −6.8 kg (3.7) and percent weight change −7.5 % (3.5).Weight loss was greater in men than women absolutely (−6.5 (5.3) kg vs −3.8 (3.4) kg) and as a percentage (5.7 % (4.4) vs 4.3 % (3.7)), respectively. All comparisons were significant (p < 0.001). Level of attendance and percent weight loss in the first week of attendance together accounted for 55 % of the variability in weight lost during the study period.ConclusionsA large-scale commercial lifestyle-based weight management programme had a significant impact on weight loss outcomes over 3 months. Higher levels of attendance led to levels of weight loss known to be associated with significant clinical benefits, which on this scale may have an impact on public health.

Summary Weight loss is a difficult journey often characterised by repeated faltering attempts. There are numerous approaches to weight management but they all involve changes in self‐management, eating or activity behaviour. Weight loss induces changes in physiological and emotional systems, which tend to pull people back to where they came from. At the present time, it is not clear how the rate, extent or type of weight loss impact on signalling systems that oppose weight loss. Dietary changes in behaviour appear to be more achievable for weight loss earlier in the weight loss journey, while physical activity becomes a critical adjunct to initial dietary changes for weight loss maintenance. A range of weight control behaviours characterises weight loss and weight loss maintenance. People successfully maintaining significant weight loss tend to control their appetite, do more physical activity and remain vigilant, to catch slips in behaviour that may lead to weight regain. There may be differing clusters of behaviours, which characterise weight loss compared with weight loss maintenance, and there appear to be different clusters of behaviours that characterise weight loss maintainers. To navigate from the journey of weight loss to one of habitual weight loss maintenance requires long‐term self‐management. Environments and programmes that support, nurture and facilitate long‐term behaviour change give people the capability, the opportunity and the motivation to navigate to a healthy weight.

A healthy rate of weight loss of 0.5-1.0 kg/week can be achieved by invoking an energy deficit of 450-900 kcal/day. This assumes an energy cost of weight loss of 6300 kcal/kg. This value will increase with percent body fat. Diet and physical activity strategies should be combined to lose weight. However, dietary approaches to weight management appear most efficacious for initial weight loss.Energy density should be the cornerstone of dietary weight reduction strategies because it helps people develop and optimise healthy eating habits that are sustainable in the longer-term. However, healthy diets for weight management should be seen as a package including reduced fat, energy density, sugars and salt, increased fibre, protein and water content of foods. Healthy diets also have to be palatable, to maintain interest in healthy eating.Monotherapies for weight loss are subject to the laws of diminishing returns.Practical approaches to weight management should be focused on a package of weight loss and maintenance strategies, including relapse prevention. It is important to provide consumers with a flexible approach to behaviour change and lifestyle solutions that they can match to their individual lifestyle needs. Evidence from studies of successful weight-loss maintainers shows that people can work this out for themselves if they can access the right tools, continuing care, guidance and social support to achieve sustainable lifestyle change.

BackgroundPeople with intellectual disabilities (ID) may not be able to access and respond to uniformly delivered health interventions. Public bodies have a legal duty to make ‘reasonable adjustments’ to policies and practices to provide fair access and treatment for people with ID. This study aimed to identify adjustments to the Slimming World weight management programme to improve accessibility and assess acceptability and feasibility for this population.MethodsThis user-centred qualitative study was carried out with a steering group of people with ID (n = 4). Barriers and facilitators to using Slimming World were identified through interviews and focus groups with people with ID (n = 54), carers (n = 12) current members with ID (n = 8) and Slimming World group leaders (n = 11). Adjustments were made and their feasibility and acceptability were explored in a before-and-after mixed methods study where people with ID attended Slimming World for eight weeks. Participants (n = 9), carers (n = 7) and Slimming World group leaders (n = 4) were interviewed to explore their experiences of the adjustments. Participants were weighed at baseline then each week.ResultsFour key adjustments were identified and addressed by Slimming World who developed prototype Easy Read materials and a letter for carers. Six of the nine participants attended Slimming World for eight weeks and lost weight (1.4 kg to 6.6 kg, reduction in BMI between 0.5 and 1.7 kg/m2), indicating that the adjustments were feasible and acceptable. Two participants dropped out because they felt uncomfortable in a mainstream group and another left because they lacked control over food choice in their residential setting.ConclusionsThis user-centred approach identified reasonable adjustments that were feasible to implement. In a small uncontrolled feasibility study, people with ID were positive about the adjustments and lost weight. However, issues in the wider context of people’s lives, such as obesogenic environments and concerns about joining mainstream groups, limited the acceptability of Slimming World even with these adjustments. These findings have important implications for policy and suggest that environmental and organisational level interventions are needed alongside those targeting individual behaviour to tackle the obesogenic environment in which many people with ID spend their time, in order to reduce inequalities associated with the consequences of obesity.

BackgroundIt is not clear if behaviour change programmes are more or less effective for weight management in people with high BMIs than for those who are moderately overweight. An earlier service evaluation reported on the rate and extent of weight loss in a primary care/commercial weight management organisation partnership scheme, in 34,271 patients were referred by their health care professionals to a UK commercial weight management organisation, Slimming World for 12 weekly sessions. This project updated that service evaluation by examining weight loss outcomes as a function of initial BMI in the same 34,271 patients.FindingsPatients referred to the scheme (n = 34,271) were categorised by BMI groups <30 kg/m2, 30-34.9 kg/m2, 35-39.9 kg/m2 and to ≥ 40 kg/m2. Mean weight losses after 12 weekly sessions were 2.9, 3.6, 4.1, and 4.8 kg for each BMI category respectively. Regression analysis showed that after adjusting for age and gender, relative to the <30 kg/m2 group, absolute weight losses were 0.8, 1.4 and 2.4 kg more for the 30-34.9 kg/m2, 35-39.9 kg/m2 and to ≥ 40 kg/m2 groups, respectively (all p<0.001). Percent weight loss was similar in each BMI category: 3.7%, 4.0%, 4.0% and 3.9%, respectively (p<0.001).ConclusionsThis service evaluation demonstrates that 12 week referral to a commercial organisation is as effective for people with high BMIs as for those who are moderately overweight.