Service evaluation of the effectiveness of hospital based weight management services in the one to one outpatient and group settings

Abstract

Background: Obesity levels continue to rise in the UK and the cost to the NHS is predicted to be more than £6 billion by 2015 if no action is taken to address this trend. Weight management services, given either in one-to-one clinic appointments or within a group setting, need to be evaluated to determine which system is more effective in terms of weight loss per patient and the cost to the National Health Service. This service evaluation is a preliminary investigation of the effectiveness of weight loss clinics compared with a group weight-loss programme. Methods: Data were collected on patients referred for weight management over a 15-month period from August 2009 to November 2010, attending either a general adult dietetic outpatient clinic (one-to-one) or the hospital's ‘Healthy Choice Group Programme’ (HCGP). The one-to-one clinic setting offered an initial dietetic appointment of 30 min and follow-ups of 15 min duration. The HCGP offered 10 weekly sessions of 90 min in duration. The gender, weight (kg), type of appointment and outcome of appointments were collected. The number of patients per pathway who had weight changes (defined as weight loss ≥−0.1 kg; weight gain ≥+0.1 kg) were compared with the National Institute of Health & Clinical Excellence (NICE) Guidelines for Obesity (2006), which recommend a maximum 0.5–1 kg per week weight reduction for long-term weight loss for adult patients. An unpaired t-test was used to compare weight change between the two services and chi-squared was used to observe change related to weight change defined between the two services. Results: Sixty-six percent (n = 67/102) of patients in one-to-one clinics were female and 52% of all patients showed weight change. The average weekly weight change was −0.4 kg, −0.2 kg, −0.1 kg and 0 kg for the 1st, 2nd, 3rd and 4th follow-up appointments, respectively. For the HCGP, 79% (n = 188/239) were female and 60% of all patients showed a weight change. The average weekly weight change was −0.4kg, −0.2kg, −0.3kg and −0.1kg for the 1st, 2nd, 3rd and 4th follow-up appointments, respectively. The average weekly weight loss for the remaining five follow-up HCGP sessions ranged from 0 kg to −0.2 kg. There was no significant difference (P > 0.05) in mean weight loss between the interventions but the chi-squared test showed significant difference between the services with more patients in the groups losing weight than in the clinic (P = 0.001). Table 1. Total weight change comparing one-to-one with Healthy Choice Group Programme Weight management session Patients with weight loss Patients with weight gain Patients with weight stable n (%) Total (kg) Mean (SD) (kg) n (%) Total (kg) Mean (SD) (kg) n (%) Outpatient clinic (one-to-one) (n = 63) 44 (70) −261.7 −5.9 (7.7) 19 (30) 66.5 3.5 (3.7) 0 (0%) HCGP (n = 143) 105 (73) –318.4 –3.0 (3.8) 32 (23) 97.6 3.1 (8.8) 6 (4%) Data presented on all patients who attended at least twice and excludes non-attendees. Discussion: The preliminary data from both services showed that the weekly weight changes were below the level recommended by the NICE guidelines. Although, on average, the mean (SD) weight loss was greater among patients attending the clinic compared to the groups [−5.9 (7.7) kg; −3.0 (3.8) kg, respectively], this difference was not statistically significant. Additionally a higher percentage of patient lost weight in the HCGP (60%) compared with those attending the one-to-one clinic service (52%) which was also confirmed by the chi-squared test. Conclusions: The average weekly weight changes for both the outpatient clinic and HCGP services were below the level recommended by the NICE guidelines for long-term weight management. A downward trend was also evident in the amount of weight lost across the follow-up sessions for both services. A similar percentage of patients achieved weight loss in the outpatient and HCGP sessions; however, the mean weight loss was greater in the one-to-one clinic sessions compared to the HCGP. Further work is needed to investigate factors affecting weight loss in patients such as readiness and motivation to change and the level of understanding of the importance of weight reduction to overall health. Additional research should also investigate whether a mixed intervention can achieve weight loss in more patients. Reference: NICE (2006) Obesity: Guidance on the Prevention, Identification, Assessment and Management of Overweight and Obesity in Adults and Children. Clinical Guideline 43. London: NICE (accessed 30 March 2011).