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 0.005). 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.