A qualitative study comparing commercial and health service weight loss groups, classes and clubs

Abstract

Background: Group-based interventions for weight loss are popular, however, little is known about how health service groups compare with the commercial sector, from either the participant or the group leader perspective. Currently health professionals have little guidance on how to deliver effective group interventions. The aim of this study was to compare and contrast leaders' and attendees' experiences of health service and commercial weight loss groups, through in-depth interviews and group observations. Methods: Purposive sampling, guided by a sampling frame, was employed to identify diverse groups operating in Scotland with differing content, structures and style. Data collection and analysis took place concurrently in accordance with a grounded theory approach. Thirteen semi-structured group observations and in-depth audio-recorded interviews with 11 leaders and 22 attendees were conducted. Identification of themes and the construction of matrices to identify data patterns were guided by the Framework Method for qualitative analysis. Results: Compared with commercial groups, health service "groups" or "classes" tended to offer smaller periodic fixed term groups, involving gatekeeper referral systems. Commercial organisations provide a fixed branded package, for "club" or "class" members and most commercial leaders share personal experiences of losing weight. Health service leaders had less opportunity for supervision, peer support or specific training in how to run their groups compared with commercial leaders Conclusions: Commercial and health service groups differ in access; attendee and leader autonomy; engagement in group processes; and approaches to leadership and training, which could influence weight loss outcomes. Health service groups can provide different group content and experiences particularly for those with chronic diseases and for populations less likely to attend commercial groups, like men

Group interventions to improve health outcomes: a framework for their design and delivery

“…Studies included a randomised controlled trial of a policy to provide breastfeeding groups across Scotland [17] with a mixed method evaluation of implementation processes [18]; a controlled intervention study of individual and group peer support for breastfeeding [19,20] and an ethnographic study of participant and provider experiences of weight management groups [21]. All of these studies conducted in-depth qualitative interviews with participants and providers and group observations.…”

“…Convenience, minimising barriers and ensuring that the participant benefits outweigh the risks are crucial to a successful group and will be highly context dependent [20]. In a study comparing commercial and health service groups for weight loss, some participants valued the flexibility and autonomy offered by groups where you could drop in just to be weighed and leave with minimal group interaction whereas others preferred leader facilitated discussion [21]. Relationships between professional gatekeepers and "the group" can both facilitate or hinder attendance, for example infrequent midwife participation led to limited attendance by pregnant women in a trial of breastfeeding support groups [18].…”

“…For example, a group leader may be an advocate of a method, philosophy, activity, seller/deliverer of a "product" or a facilitator of person centred approaches, for example empowerment, counselling or support [49]. How leaders with personal experience of a condition, for example in commercial weight management groups [21] and the expert patient programme [7], influence group outcomes is largely unknown. Some groups are multifaceted with communication interspersed with activities like relaxation, physical activity, weighing or physiological monitoring.…”

Systematic reviews of and integrated report on the quantitative, qualitative and economic evidence base for the management of obesity in men

“…240 In the UK, men appear to be more likely to raise weight problems with primary care nurses than with their GPs. 241 Research by Dutton and colleagues 242,243 in the USA found that physicians had target BMIs that were significantly lower for obese women than for obese men.…”

A qualitative evaluation of an NHS Weight Management Programme for obese patients in Liverpool

“…Furthermore, work by Allan et al (2010) suggests that whereas the use of marketing theory and class styles often dominate in 'branded package' commercial services, more informal, less explicit formats are frequently adopted in health service programmes. It should be noted however that reports such as these are sparse;…”