Evaluation of Aintree LOSS, a community‐based, multidisciplinary weight management service: outcomes and predictors of engagement

Abstract

Aintree LOSS is a community-based, multidisciplinary weight management programme for patients with severe and complex obesity, focusing on a flexible and individualized service with follow-up for up to 2 years. We evaluated all 2472 patients referred to the service between October 2009 and 2013. Demographic data were recorded at baseline, with the Index of Multiple Deprivation (IMD) used to measure socioeconomic deprivation. Weight was recorded at each visit. Mean body mass index at baseline was 45.6 (standard deviation 6.8), and 58.9% of patients lived in areas in the most deprived decile nationally. Of 2315 appropriate referrals, 1249 (55.1%) attended >2 visits; mean final weight loss was 3.50 ± 8.55 kg, and 24.1% achieved ≥5% weight loss. Of the patients, 754 (33.3%) attended for over 6 months; mean final weight loss was 4.94 ± 10 kg, and 34% achieved 5% weight loss. Multivariate logistic regression analysis showed increasing age, residence in a less deprived area and sleep apnoea to be independently associated with attendance for >6 months, and there was a linear relationship between 6-month attendance and deprivation quintile. Year-on-year analyses showed improvement in engagement over time, coinciding with efforts to improve access to the service. This work shows a multidisciplinary, community-based weight loss programme prioritizing a fully flexible and individualized approach functioning effectively in real-world practice. Maintaining engagement remains a challenge in weight loss programmes, and our results suggest younger patients living in areas with greater deprivation should be a target for efforts to improve engagement.

Beyond lifestyle interventions: exploring the potential of anti‐obesity medications in the UK

“…In Liverpool, the Aintree Liverpool Obesity Support Service (LOSS) programme provides community-based, multidisciplinary support for people with severe and complex obesity (average BMI 45.6 kg m −2 ) in a community setting (34). During the 4-year period from 2009 to 2013, 2472 people were referred to the service; a retrospective follow-up of 2315 appropriate referrals showed that, of those who engaged with the programme, over one-third attending for longer than 6 months achieved a weight loss of more than 5% (34). This study also highlighted the difficulty in maintaining engagement, especially in younger individuals from areas of high socioeconomic deprivation (34).…”

“…During the 4-year period from 2009 to 2013, 2472 people were referred to the service; a retrospective follow-up of 2315 appropriate referrals showed that, of those who engaged with the programme, over one-third attending for longer than 6 months achieved a weight loss of more than 5% (34). This study also highlighted the difficulty in maintaining engagement, especially in younger individuals from areas of high socioeconomic deprivation (34). Despite the successes, there is evidence to suggest that Tier 3 services are often poorly implemented or lacking in some areas of the UK, with substantial regional variation (8,35).…”

“…Whilst we have examples of where this is possible (e.g. RIO, FWMS, Aintree LOSS ), there is substantial regional variation in the provision of dietary advice, education (on obesity risk factors, lifestyle factors, obesity‐related health risks and weight loss options) and psychological support. The transfer of public health services from Primary Care Trusts to Local Authorities in 2013 resulted in further disruption to services .…”

Tackling reporting issues and variation in behavioural weight management interventions: Design and piloting of the standardized reporting of adult behavioural weight management interventions to aid evaluation (STAR‐LITE) template

“…The current paper describes the development and piloting of a template for the standardized descriptive reporting of adult BWMIs, to complement this core outcome set. Readily available descriptive data for BWMIs is predominantly from lab‐based trials or research settings, which may not entirely reflect that of clinical interventions 20,21 . Moreover, this information is found within individual papers and must be deconstructed by readers without a consistently encouraged reporting style or structure.…”

Adult weight management across the community: population‐level impact of the LOSE IT to WIN IT challenge

“…Evaluations of their performance, however, are quite limited. Most published community programs are community‐based, meaning they are conducted in non‐clinical settings or are otherwise designed for specialized groups within the community . Programs targeting entire defined communities are rarer.…”