Increase referrals to total diet replacement programmes

This policy would ensure that everyone with a BMI of 30 or above is offered a referral to a weight management programme with a total diet replacement component. These programmes offer eligible participants low calorie, total diet replacement products including soups and shakes consisting of 800-900 kcals a day for a period of twelve weeks. For the first twelve weeks, all normal food is replaced with these products. Following this, participants receive support to reintroduce food to help maintain weight loss achieved in the first 12 weeks. 

In the UK, different tiers of weight management services cover different activities. Definitions vary locally, with tier 1 typically covering universal services (primary care delivered education), tier 2 covering community-based support, tier 3 covering specialist weight management services, and tier 4 covering surgical interventions including bariatric surgery. Behavioural weight management programmes fall under tier 2 services.

National Institute for Health and Clinical Excellence (NICE) guidance on the prevention and management of overweight and obesity in adults sets out the guidelines for referral to weight management services in the UK. Existing guidance recommends that individuals be referred to a total diet replacement programme if they are aged 18-65, have a BMI of 27 or above (25 or above for some ethnic groups), and who have had a diagnosis of diabetes. The current policy would extend the eligibility so that adults living with a BMI of 30 or greater (regardless of diabetes status) would be eligible to receive a free referral to a total diet replacement programme.

Weight management services are devolved in Wales and included in the Healthy Weight, Healthy Wales whole-system approach to healthy weight. The programme funds a national team within Public Health Wales and systems officers within Health Board Public Health Teams. Funding comes from the Welsh Government and individual Health Boards. 

In Scotland, responsibility for the operation and availability of weight management services is assigned to regional Health Boards. Scotland’s Diet and Healthy Weight Delivery Plan considers access to efficient weight management services to be a core outcome to tackling obesity and overweight in Scotland.

There is high local variation of weight management services across the UK due to the funding and commissioning landscape. The ability of a local authority to extend access will depend on funding available (for public or private services), service capacity (including workforce), and digital infrastructure (which may boost local capacity).

Increased take up of weight management services across the population could have a positive effect on inequalities. 

Evidence suggests some groups are more likely to take up weight management services than others. There are few widely implemented weight management programmes designed for specific population groups, meaning cultural and content applicability of existing programmes is likely to vary by population group. People living in deprived areas and with complex additional needs such as disabilities, along with men, are less likely to engage and more likely to drop out. This has the potential to widen health inequalities. Co-designing services with underserved groups to better meet their needs may be an effective way to counter this.

We asked experts working in the fields of obesity, food, and health research to rate the strength of the evidence base for each policy, taking into account both reliability (size and consistency) and validity (quality and content) of the evidence. Policies were rated on a Likert scale of 1–5 (none, limited, medium, strong, and very strong evidence base). The Blueprint Expert Advisory Group rated the evidence base for TDR programmes to be Very Strong.