Impact of and Comparative Outcomes for Digital and In-Person Interventions for Complex Obesity in a Diverse Urban Population.

INTRODUCTION

Obesity management in the UK includes multicomponent weight and behavioural interventions delivered at Tier 3 of the NHS model of care. This study presents the impact of and comparative outcomes for the Tier 3 Southeast London Healthy Living programme (SELHLP) in a diverse population.

METHODS

The SELHLP is a multicomponent, multidisciplinary programme that includes face-to-face (F2F) and virtual (V) delivery. Two management strategies are offered: Balance, a weight behavioural intervention and Kickstart, a three-month total meal replacement intervention followed by a weight and behavioural intervention. Eligibility criteria were adults (≥ 18 years) with a BMI ≥ 35 kg/m2. Baseline data and exit data were collected at session 9-12. Primary outcomes included weight change from baseline to programme completion; secondary outcomes included both clinical and behavioural outcomes.

RESULTS

Programme completers of both Balance and Kickstart were predominantly female (82% and 79% respectively). Among completers for Balance, weight change from baseline was -2.8 (8.4) kg for Balance F2F (p < 0.001) and -5.1 (11.7) kg for Balance V (p < 0.001). A similar trend was observed for Kickstart F2F -11 (13) kg and Kickstart V -11 (11) kg (p < 0.001) but did not differ between service delivery models (p > 0.005). 34% of participants of the combined Balance and Kickstart programmes lost ≥ 5% of initial weight, -10.7% and -18% weight loss respectively. Black participants and women were less likely to achieve ≥ 5% weight loss in both programmes, but deprivation status had no effect.

CONCLUSION

The SELHLP resulted in significant weight loss, but weight loss varied by service delivery, ethnicity and sex. Future efforts should focus on cultural salience and digitisation of Tier 3 programmes to support better engagement and completion among participants of Black ethnicity. Tailoring of Tier 3 interventions and triaging of participants at the onset should be investigated to improve both patient and service outcomes.