HSCB Primary Care Commercial Weight Loss Referral Pilot Dr Joanne McClean Consultant in Public Health Medicine Public Health Agency

Overview  Background  About the scheme  How we set it up  How it worked  Results and judging success  Next steps

Not a new idea

Lighten up trial  Weight Watchers, Slimming World, Rosemary Conley, group based dietetics led, GP 1:1 and Pharmacy led 1:1  12 weeks  Weight loss at programme end  Weight loss at one year  Commercial better weight loss and cheaper than NHS

Pilot Design and Evaluation

Provider Selection

Referral Criteria  Over 18 years of age  BMI ≥30 and weight related complication  Not attended a slimming organisation in the last 3 months  Ready and committed to make lifestyle changes  Not pregnant

Second Set of Vouchers  Lost at least 2.5% of their initial weight  Still committed and ready to change  Attended 12 sessions within the 4 month period

Process  Referral made to pilot office  Checked  Patient consent  Vouchers issued  Classes attended  Vouchers returned for payment

Referrals  6,227 referrals  Age range from 18 – 80 years  80% female  BMI range 30 – over 80 (60% 30 – 39)  Good geographical coverage  Referral rates highest in most deprived areas

Participation rates  Overall 70% of those referred consented and attended at least one class  75% women  55% men referred participated  43% among men in most deprived areas

Results and Judging Success

Only commission services where:  30% participants to lose 5% weight or more  Average weight loss is at least 3%

Results – last weight recorded  38% participants lost at least 5% (46% of men and 36% women)  26% participants lost 2.5 – less than 5%  18% weight unchanged  5% gained weight  Average weight loss was 4.1%

Attendance patterns  59% participants attended 10 or more sessions  Attendance patterns were similar across BMI groups  Women more likely to complete  Lower completion in more deprived areas

Deprivation NIMDM SOA Quintile 5% Weight loss* (%) 1 (most deprived) (least deprived)45

Second Set of Vouchers  26% participants received second set of vouchers  Over all impact was to increase proportion losing 5% or more from 36% to 38%  Of those who used second set of vouchers, 48% weight stayed the same or they gained weight over course of second set

Costs  Negotiated a pay per attendance system  £6 per session  £216 per patient who lost 5% weight in pilot  Estimate £191 outside pilot setting

Costs  Second set of vouchers reduced overall cost effectiveness of programme  £649 for every additional person losing 5% as result of second set

Conclusions  Performance against NICE standards  Acceptability to patients and referring clinicians  Potential impact on health inequalities  Access  Cost  Ease of implementation

 We would like to run again using learning from pilot  Further evaluation – Follow up patients – Work with referrers