Psychological support within tier 2 adult weight management services, are we doing enough for people with mental health needs? A mixed‐methods survey

Marwood, Jordan; Brown, Tamara; Kaiseler, Mariana; Clare, Kenneth; Feeley, Alison; Blackshaw, Jamie; Ells, Louisa

doi:10.1111/cob.12580

Cited by 4 publications

(5 citation statements)

References 32 publications

(38 reference statements)

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“…22 Other insights from the evaluation 23 suggest that providers view service users with mental health issues and disordered eating to be 'inappropriate' referrals, therefore training for coaches should cover supporting participants with emotional and disordered eating behaviours. 24 Procedural items were most consistently observed when they related to programme reporting. The other elements of the specification that were observed under this component were often not delivered in adherence to the specification, such as the provision of non-starchy vegetables, the use of TDR products, and the appropriateness of physical activity in TDR stage.…”

Section: Discussionmentioning

confidence: 96%

“…Additionally, a significant proportion of people referred to the LCD programme report binge or emotional eating 22 . Other insights from the evaluation 23 suggest that providers view service users with mental health issues and disordered eating to be ‘inappropriate’ referrals, therefore training for coaches should cover supporting participants with emotional and disordered eating behaviours 24 …”

Section: Discussionmentioning

confidence: 99%

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Is the NHS low‐calorie diet programme delivered as planned? An observational study examining adherence of intervention delivery to service specification

Marwood,

Kinsella,

Homer

et al. 2024

Clinical Obesity

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SummaryObesity and Type 2 Diabetes Mellitus (T2DM) are chronic conditions with significant personal, societal, and economic impacts. Expanding on existing trial evidence, the NHS piloted a 52‐week low‐calorie diet programme for T2DM, delivered by private providers using total diet replacement products and behaviour change support. This study aimed to determine the extent to which providers and coaches adhered to the service specification outlined by NHS England. An observational qualitative study was conducted to examine the delivery of both one‐to‐one and group‐based delivery of programme sessions. Observations of 122 sessions across eight programme delivery samples and two service providers were completed. Adherence to the service specification was stronger for those outcomes that were easily measurable, such as weight and blood glucose, while less tangible elements of the specification, such as empowering service users, and person‐centred delivery were less consistently observed. One‐to‐one sessions were more successful in their person‐centred delivery, and the skills of the coaches delivering the sessions had a strong impact on adherence to the specification. Overall, the results show that there was variability by provider and delivery mode in the extent to which sessions of the NHS Low‐Calorie Diet Programme reflected the intended service specification. In subsequent programmes it is recommended that one‐to‐one sessions are used, with accompanying peer support, and that providers improve standardised training and quality assurance to ensure specification adherence.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Is the NHS low‐calorie diet programme delivered as planned? An observational study examining adherence of intervention delivery to service specification

Marwood,

Kinsella,

Homer

et al. 2024

Clinical Obesity

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“…23 Provision and conceptualisation of psychological support within tier 2 services is poor despite it being identified as a need by service commissioners, providers and users. 23,24 Several services also provided support for other health and wellbeing related issues, for example, smoking, debt assistance, whilst some reported signposting to other support services. Whilst support for mental health and wider determinants of health are not traditionally considered to be within the remit of WMS, this approach represents a more holistic and person-centred model of health that acknowledges psychosocial factors as a cause and consequence of obesity.…”

Section: Discussionmentioning

confidence: 99%

“…Whilst there is evidence that behavioural weight loss interventions can improve some psychological outcomes 21,22 research on the effectiveness of psychological support embedded WMS is sparse 23 . Provision and conceptualisation of psychological support within tier 2 services is poor despite it being identified as a need by service commissioners, providers and users 23,24 . Several services also provided support for other health and wellbeing related issues, for example, smoking, debt assistance, whilst some reported signposting to other support services.…”

Section: Discussionmentioning

confidence: 99%

A cross‐sectional survey study exploring provision and delivery of expanded community tier 2 behavioural weight management services in England

Fong,

McSweeney,

Adamson

et al. 2023

Clinical Obesity

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SummaryGuidelines recommend provision of local behavioural weight management (tier 2) programmes for adults living with overweight and obesity. Following the publication of the UK Government's publication ‘Tackling Obesity: empowering adults and children to live healthier lives’ in July 2021, Government invested around £30 million of additional funding to support the expansion of local authority commissioned tier 2 provision for adults living with excess weight. We conducted a cross‐sectional survey study to scope the types of services available, to whom they were made available, and barriers and facilitators to service delivery. An e‐survey was disseminated to local authority commissioned tier 2 service providers in England from September to October 2022. Through a combination of closed and open (qualitative) questions, the survey collected data on referral routes, participant eligibility criteria, service content and format, and challenges and enablers to service delivery. Quantitative data were analysed descriptively whilst thematic content analysis was applied to qualitative data. We received 52 responses (estimated response rate = 59%) representing all nine England regions and 89 unique local authorities. Most services were multi‐component (84.3%), were 12 weeks duration (78.0%), were group‐based (90.0%), were primarily delivered in‐person (86.0%), and were free to participants (90.2%). Five responses indicated provision of support for other health and wellbeing issues, for example, mental health, assistance with debt. To improve future WMS service commissioning and delivery, WMS providers need to be allowed adequate time and resource to properly prepare for service delivery. Referral systems and criteria should be made clear and straightforward to both referrers and service users, and strategies to manage surplus referrals should be explored.

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“…Disordered eating is increasingly recognised as an important factor in person-centred weight management support (39). However, participation of people with disordered eating in weight management programmes is controversial, as restricted eating and eating beliefs can in uence the development and maintenance of disordered eating (40).…”

Section: To Existing Researchmentioning

confidence: 99%

The weight management practices and support needs of young adults living with excess weight in the UK and Australia: A mixed methods cross-sectional study using data from the YOUTH cohort

Evans,

Marwood,

Kolokotroni

et al. 2024

Preprint

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Background Young adulthood is a critical period where there is an increased weight gain trajectory. Understanding the weight management support needs of young adults with excess weight is essential to enable the delivery of appropriate and tailored services and prevent the development of comorbidities. This study sought to determine the current health service usage, weight management practices and support needs, in young adults with excess weight. Methods A mixed-methods convergent parallel design was employed. A cohort of community-dwelling young adults (18–35 years), with excess weight (BMI ≥ 25), residing in the UK and Australia participated in an online, longitudinal survey. Cross-sectional data was analysed descriptively, including quantitative measures of health service usage and weight management practices. Responses to an open-ended question asking what support participants would find most helpful were analysed using Thematic Template Analysis. Convergence and divergence across sociodemographic characteristics were explored. Results The sample (n = 410) included 204 women, 201 men and five non-binary people with a mean age of 28.3 and BMI of 35.8. Most participants reported a white ethnicity (80%) and resided in the UK (83%). Half reported a below median gross household income (49%). Most (73%) reported currently trying to manage their weight and 63% were using commercial weight management products or self-directed diets. Only 12% of participants reported accessing healthcare services for weight management support or treatment, yet qualitative responses indicated a desire for support from a dietitian or psychologist. Five themes indicated a need for structured but tailored resources, simplicity, addressing internal and external barriers, access to holistic professional support, and access to networks vs a preference for self-reliance. Conclusions Young adults with excess weight are using commercial products and self-led diets but many desire specialist healthcare professionals to support their weight management. Young adults appear to prefer online resources and support that are simplistic, structured and individually tailored to their diverse cultural preferences, routines, environments, and comorbidities. Furthermore, findings indicate unmet psychological support needs amongst young adults with excess weight in the UK and Australia. Protocol Whatnall, M., Fozard, T., Kolokotroni, K.Z., Marwood, J., Evans, T., Ells, L.J. and Burrows, T., 2022. Understanding eating behaviours, mental health and weight change in young adults: protocol paper for an international longitudinal study. BMJ open, 12(9), p.e064963.

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Psychological support within tier 2 adult weight management services, are we doing enough for people with mental health needs? A mixed‐methods survey

Abstract: and Ells, Louisa (2023) Psychological support within tier 2 adult weight management services, are we doing enough for people with mental health needs? A mixed-methods survey. Clinical Obesity. e12580-e12580.

Cited by 4 publications

References 32 publications

Is the NHS low‐calorie diet programme delivered as planned? An observational study examining adherence of intervention delivery to service specification

Is the NHS low‐calorie diet programme delivered as planned? An observational study examining adherence of intervention delivery to service specification

A cross‐sectional survey study exploring provision and delivery of expanded community tier 2 behavioural weight management services in England

The weight management practices and support needs of young adults living with excess weight in the UK and Australia: A mixed methods cross-sectional study using data from the YOUTH cohort

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