Official Statistics

Adult tier 2 weight management services: short statistical commentary April 2023

Published 27 April 2023

Applies to England

Introduction

In March 2021, the government announced an additional £100 million of funding over the 2021 to 2022 financial year to support people living with excess weight and obesity to lose weight and maintain healthier lifestyles.

The adult weight management services grant (number 31/5440) distributed £30.5 million of this new funding between all local authorities in England who accepted the grant, to support the expansion of adult tier 2 behavioural weight management services commissioned by local authorities. This is part of a place-based whole systems approach to tackling obesity and promoting a healthier weight.

In order to understand the impact of this investment, any local authority in receipt of this grant funding must ensure all commissioned service providers collect data on all participants and their progress and return a minimum data set to the Office for Health Improvement and Disparities (OHID).

This publication provides figures covering the period April 2021 to December 2022 and updated figures for the period April 2021 to March 2022 which supersede the previous Adult tier 2 weight management services publication.

Interpreting the data

This report includes data for the period April 2021 to December 2022 which was submitted by 3 March 2023. Some services were still being set up to submit data and we expect further data to be retrospectively submitted for these time periods. Therefore, all counts of people being referred, enrolled and completing services in this report are provisional. In some instances, no data is available for a local authority as some service providers have not yet submitted data. 145 of the 152 local authorities accepted the grant funding. This report includes data for 132 of these local authorities.

In addition, some data has been submitted for services funded by the existing public health grant or where the funding stream is unknown. Therefore, data is not restricted to services funded by the new grant (number 31/5440). Unless otherwise stated, the commentary in this report refers to all data submitted regardless of funding stream. Table 1 in the published data shows the counts of participants by funding stream. The subsequent tables contain data split by funding stream.

The majority of tier 2 weight management services provide 12 week programmes, but there is some variation in length of interventions. The OHID minimum dataset collects data at 4 time points:

• referral
• enrolment onto the weight management service (week 0)
• at the end of the active intervention which is usually at week 12
• follow up data is collected at week 26, which is usually 14 weeks after the end of the active intervention

All tables now include figures from April to December 2022. Quarters 1 to 4 of the 2021 to 2022 financial year have also been updated for any data submitted before March 3, 2023. Data has been added to show the number of participants followed up in each quarter at 26 weeks following the start of their interventions (table 15). There is currently insufficient data to publish any further break downs of this analysis. Further data is expected to be submitted before the data collection closes in May 2023.

Main findings

For data submitted up to 3 March 2023 covering the period April 2021 to December 2022:

• 131,665 participants were referred to adult tier 2 weight management services

• 85,605 of these participants enrolled on adult tier 2 weight management services which is an enrolment rate of 65%. 44% of those enrolled were from high-risk groups (see below for definition)

• 29,235 participants had attended at least 75% of the service and were considered to have completed their programme with a calculated completion rate of 35% ^{[footnote 1] [footnote 2]}

• 9,065 participants had follow up data submitted 26 weeks following the start of their weight management interventions (table 15a)

• of those 131,665 participants referred to services, 40% of those referred were self-referrals, and a further 29% were GP referrals. The remainder were either referrals from other health care professionals (10%), non-health professionals (4%) or the referral source was unknown (17%) (table 2a)

• of those 85,605 participants enrolled on services, 65% were funded by the adult weight management services grant 2021 to 2022 (No 31/5440). 27% of participants were funded by existing public health grant funding and 7% were of unknown funding (table 1)

• 66% of participants were enrolled on services with a face-to-face element of its delivery. 60% of participants were enrolled on services delivered at least in part remotely via email, social media, telephone text or video call. 15% of participants received digital services delivered by technology such as apps and websites (table 3a)^{[footnote 3]}

• 25% of all enrolments to adult tier 2 weight management services lived in the most deprived 20% of areas in England (table 6a)

• 26% of those enrolled were in the obesity 3 BMI category (≥40 kg/m2), 25% in obesity 2 (35 to <40 kg/m2) and 34% in obesity 1 (30 to <35 kg/m2). A further 13% of participants were overweight (25 to <30 kg/m2) and 1% were a healthy weight (18.5 to <25 kg/m2) (table 14a)

• 40% of participants had lost weight by the end of their service, with 15% having lost at least 5% of their initial body weight (table 16) ^{[footnote 4]}

• tables also show counts of participants in adult tier 2 weight management by variables such as demographic characteristics, socioeconomic status, health status, and commissioning local authority

Summary figures and outcome measures

131,665 participants were referred to adult tier 2 weight management services in the period April 2021 to December 2022, 85,605 of these participants enrolled on services (table 2a) which is an enrolment rate of 65% (outcome measure AWM1, table 16).

35% of participants enrolled on adult weight management services completed the active intervention in the period April 2021 to December 2022 (outcome measure AWM2, table 16), this is defined as attending at least 75% of their intervention. This includes participants who have had referral, enrolment and end of service data submitted. It also includes participants for whom only referral and enrolment data has been submitted and should have finished their service by the end of quarter 4 but their end of service data has not been submitted. These participants are considered to have not completed their service. ^{[footnote 1]}

40% of all participants enrolled on adult weight management services in the period April 2021 to December 2022 lost weight at the end of their service when compared to their weight at the beginning of the service (outcome measure AWM4). Furthermore, 15% of participants enrolled on services lost a minimum of 5% of their body weight at the end of the active intervention in the period April 2021 to December 2022 (outcome measure AWM5). This analysis is restricted to those participants where both a weight measurement at enrolment and at least one other subsequent weight measurement during their service are available. Those participants where only one weight measurement at enrolment is available are excluded from this analysis as it is unknown whether these participants subsequently lost weight or not.

A new table has been added showing data for outcome measures by gender, age group, ethnic group, IMD decile, referral source, and BMI classification (table 17).

Enrolments from high risk groups

High risk groups are defined as:

• person lives in the most deprived 20% of areas in England
• person’s ethnicity is black, Asian or minority ethnic group
• person has a mental illness
• person has a disability (including learning disability)

44% of participants enrolled on services of all enrolments in the period April 2021 to December 2022 are from high risk groups (outcome measure AWM3).

14% of all enrolments in the period April 2021 to December 2022 were from ethnic minority groups, with 69% white British and 16% of unknown ethnicity (table 5a). 25% (21,805) of all enrolments in the same period were people living in the most deprived 20% of areas in England (table 6a).

12% of participants who enrolled on services in the period April 2021 to December 2022 stated at least one disability, with 53% stating they had no disability and a further 35% of enrolled participants for whom their disability status is unknown (table 10a). 2% of all enrolments were on the severe mental illness register in this period (table 10a).

Type of service

Of those referred to services, 40% of those referred were self-referrals, and a further 29% were GP referrals. The remainder were either referrals from other health care professionals (10%), non-health professionals (4%) or the referral source was unknown (17%).

66% of participants were enrolled on services with a face-to-face element of its delivery, 13% were individual 1:1 sessions and 53% utilised group sessions. 60% of participants were enrolled on services delivered at least in part remotely via technology, such as email, social media, telephone, text or video call. The majority of these remote services were conducted individually (40% of participants) rather than in groups (20%). 15% of participants received services delivered by using digital technology such as apps, websites, and devices monitoring participants’ physical activity (table 3a). These numbers don’t sum to 100% as 2 modes could be reported for each participant.

Of those enrolled on services, 65% were funded by the adult weight management services grant 2021 to 2022 (No 31/5440). 27% of participants were funded by existing public health grant funding and 7% were of unknown funding (table 1).

Weight change following active intervention

26% of those who enrolled on services in the period April 2021 to December 2022 were in the obesity 3 BMI category (≥40 kg/m2), 25% in obesity 2 (35 to <40 kg/m2) and 34% in obesity 1 (30 to <35 kg/m2). A further 13% of participants were overweight (25 to <30 kg/m2) and 1% were a healthy weight (18.5 to <25 kg/m2) (table 14a).

Of the 85,605 that enrolled on services in the period April 2021 to December 2022, 82,585 have had adequate time to complete their programme and have their data submitted (table 19).

It is difficult to calculate the average weight loss amongst participants while data continues to be collected. For example, some of the 82,585 participants have only had one weight measurement at referral submitted and no subsequent weight measurements even though they should have completed their service by the end of December 2022.

Therefore, this section provides 3 estimates of average weight loss (table 19):

• firstly, those participants who only had one initial weight measurement submitted were included and it is assumed they had no weight change at all during their service. This gave a mean weight loss of 1.95kg (95% confidence intervals 2.00 to 1.90kg)
• secondly, those participants with only one measurement were excluded from the analysis. This gave a mean weight loss of 3.16kg (95% confidence intervals 3.23 to 3.09kg)
• the final method only includes those participants who attended at least 75% of the programme and are therefore classed as completed. This gave a mean weight loss of 4.20kg (95% confidence intervals 4.30 to 4.10kg)

For all these estimates, any participants who were pregnant during the programme are excluded.

A new table has been added showing data on the movement between BMI classifications of enrolled participants between the start and end of the active intervention (table 20). 75% of the participants who started the intervention with a BMI between 30 to <35kg/m2 in the ‘obesity 1’ classification remained in that classification, 22% moved to the ‘lower overweight’ BMI classification with a BMI between 25 to <30 kg/m2 and 2% moved to a higher BMI classification (note totals do not sum to 100% due to rounding). 27% of enrolled participants in the ‘obesity 2’ (BMI 35 to <40 kg/m2) classification moved to the lower ‘obesity 1’ (BMI 30 to <35 kg/m2) classification and 19% of enrolled participants in the ‘obesity 3’ (BMI ≥40 kg/m2) classification moved to the lower ‘obesity 2’ (BMI 35 to <40 kg/m2) classification.

Other tables

Data tables have been produced to show counts of participants in adult tier 2 weight management services in England split by age, gender, ethnic group, sexual orientation, religion, local authority and region, employment status, and Index of Multiple Deprivation decile of residence. Tables are also included that show counts of participants by stated disabilities and co-morbidities as well as the type of weight management intervention. These variables have been included in the data collection to further help assess access to services from high risk groups.

Figures for outcome measures are calculated where a sufficient amount of data is available. More analysis will be added to subsequent publications as more data is collected. Information will be included in later publications on maintenance of weight loss when the service has finished, informing the ‘Percentage of participants who maintain their lower weight’ outcome measure (outcome measure AWM6, table 16). This will be available for different population groups and weight management intervention types.

At this stage the data is provisional and published as experimental statistics. OHID are seeking feedback on the data tables from users and stakeholders to improve the quality and useability of the data. We welcome any feedback via [email protected].

Background

Further information about this publication and the data used:

• guidance on the data collection is available in the minimum data set technical guidance document

• detailed metadata for this statistical release is available in the Adult tier 2 weight management services: data tables April 2023

• see OHID guidance for further information on the adult tier 2 weight management services grant for local authorities

• for more information on experimental statistics see the Office for National Statistics Guide to Experimental Statistics

Responsible statisticians, product lead: Caroline Hancock, Catherine Bray

For queries or comments relating to this document and accompanying data tables, please contact: [email protected]

1. Completion rate cannot be calculated by dividing the number of completers by the number of enrolments, as those starting their service in the latest quarter will not have had time to complete their service (a service is usually 12 weeks) by the data submission date of 3 March 2023. ↩ ↩²

2. To calculate the completion rate, the analysis includes participants who have had referral, enrolment and end of service data submitted. It also includes those participants for whom only referral and enrolment data have been submitted and should have finished their service by the end of quarter 4 but their end of service data has not been submitted. These participants without end of service data are considered to have not completed their service. ↩

3. Data on type of intervention may not fully capture the complete mode of service delivery where a service uses more than 2 delivery modes (including blended services) or where remote and/or digital services use a range of communication methods and/or media. Local authorities were asked to report on the main 2 modes of delivery. The delivery modes are set out in the minimum data set technical guidance. ↩

4. This analysis is restricted to those participants where both a weight measurement at enrolment and at least one other subsequent weight measurement during their service are available. Those participants where only one weight measurement at enrolment is available are excluded from this analysis as it is unknown whether these participants subsequently lost weight or not. ↩