SLIMMING WORLD—AN INTRODUCTION

  Founded in 1969, Slimming World is the most advanced and effective weight management organisation in the UK. Each year Slimming World influences over 3 million people to eat more healthily and adopt a healthier, more active lifestyle each year. Slimming World holds 5,500 weekly groups across the UK run by a network of 2,500 Slimming World trained consultants. Over 5 million people have attended Slimming World group meetings, with individual weight losses achieved from 1 stone to over 25 stones.

  Slimming World Consultants are all recruited from successful group members, working in their local community. Because groups are held in the heart of communities, eg church halls, sports clubs and other local venues, we are uniquely placed to reach a range of people from very diverse social and ethnic backgrounds.

  Every week Slimming World helps around 250,000 people who fund their own attendance, to manage their weight. Each month 50,000 new members join and 9,500 men attend our groups. A further 50,000 people chose alternative channels to access Slimming World support through the internet, Slimming World's magazine and at home service.

  In 2000, Slimming World pioneered a subsidised Slimming World on Referral programme, which allows health practitioners to offer patients free membership to one of our weekly groups in their area. The programme is proving very popular with over 30 primary or secondary care teams now offering the service to their patients. We have also set up Slimming World on Referral schemes with Sure Start groups.

  We are also working with a number of the spearhead PCTs who are developing obesity strategies and services. Slimming World operates a total of 1540 groups, run by 740 Slimming World trained Consultants in the 62 spearhead PCT areas. Over 72,000 members attend Slimming World groups each week within the spearhead PCT areas and 16,000 join each month. We have the capacity to double the membership in these areas with the current Slimming World infrastructure and our long term aim is to develop the number of groups to 3,300 with over 165,000 members attending each week (that is to support 2% of the overweight and obese population in these areas).

  Slimming World welcomes the opportunity to comment on this inquiry and we hope you will find our comments of assistance.

EXECUTIVE SUMMARY

1.  Slimming World believes that the way forward in tackling obesity is a whole society approach and that partnership with private sector organisations such as Slimming World can play a constructive and effective role to support health services tackle health inequalities.

2.  The role of private sector could be further enhanced by effective take up of Practice Based Commissioning (PBC). As a result, we believe the Department of Health should develop clearer signposting to services that meet set service standards or criteria. This would encourage the Commissioners and PCTs to implement PBC more effectively and explore more innovative options to tackle health inequalities.

3.  We also suggest that in addition to allocating points for measuring patients' BMI, GPs should be allocated points for referring obese patients to services that can help and support them to take active steps to address their weight issues. For example GPs could be allocated points for referring patients to weight management services or exercise schemes in their local area.

HEALTH INEQUALITIES

  We would in particular like to comment on the following aspects of the inquiry:

The distribution and quality of GP services and their influence on health inequalities, including how the Quality and Outcomes Framework and Practice Based Commissioning might be used to improve the quality and distribution of GP services to reduce health inequalities;

  1.  Slimming World believes both the Quality and Outcomes Framework (QOF) and Practice Based Commissioning (PBC) have considerable potential to improve the quality and distribution of GP services to reduce health inequalities.

  2.  As acknowledged by the Foresight report, there is a greater prevalence of obesity among poorer social groups[188].

  3.  Therefore, it is important that in order to tackle health inequalities, there must be systems in place that encourage health professionals to deal more effectively with health issues, such as obesity, that are more prominent in these target groups.

  4.  Under the QOF indicator on obesity, GPs can accumulate 6 QOF points by producing a register of patients aged 16 and over with a BMI greater than or equal to 30 in the previous 15 months.

  5.  Slimming World believes that in addition to allocating points for measuring patients' BMI, GPs should be allocated additional points for referring obese patients to services that can help and support them to take active steps to address their weight issues. For example GPs could be allocated points for referring patients to weight management services or exercise schemes in their local area.

  6.  Our Slimming World on Referral programme provides an excellent example of how PBC can be effectively used to reduce health inequalities.

  7.  In 2000, Slimming World pioneered a subsidised Slimming World on Referral programme in collaboration with Greater and Central Derby PCTs, which allows health practitioners to offer patients free membership to one of Slimming World's weekly weight management support groups.

  8.  Our initial research study investigated the feasibility, practicalities and cost-effectiveness of referring patients from primary care into Slimming World groups[189]. The study demonstrated that beneficial weight loss could be achieved in a significant percentage of patients referred to Slimming World within a population that includes a high percentage of socially disadvantaged groups and low socioeconomic status. We also discovered that people who had never considered joining a weight management group, perhaps because of the financial commitment, did so when encouraged and subsidised by their GP. As well as helping patients lose weight, significant improvements in mental well-being were also reported after 12 weeks. Furthermore, over 70% of those completing the free 12-week programme went on to self-fund further attendance at the group, many reporting that now they had seen improvements in their weight and health they were willing to invest their own time and money to continue to improve their lifestyle.

  9.  Since the nationwide launch of the programme in 2002, we are now working in partnership with over 30 primary or secondary care teams to offer the Slimming World on Referral scheme to patients.

  10.  Data from the first 2,100 patients to finish 12-week programme are very encouraging:

—  34% were considered morbidly obese (BMI>40)

—  Average attendance was 9.4 weeks (of 12)

—  64% completed the programme (10 of 12 weeks)

—  Average weight loss of completers was 5.5% (4.2% across total population)

—  55% of completers lost > 5% bodyweight (39% of total population)

—  Non-completers attended an average of 5.6 weeks and lost 2.1% of bodyweight

  11.  Based on the evidence of success in these schemes increasing numbers of PCTs are rolling the Slimming World on Referral programme out to GP practices within their Trust.

  12.  However, considering that on current trends, by 2050, 60 per cent of men, 50 per cent of women and 25 per cent of children and young people will be obese[190]; take-up of PBC for weight management services by GPs could be dramatically improved.

  13.  In our experience PCTs and GPs are not always aware what types of services they can commission. This creates entry barriers to new service providers and can prevent the introduction of innovative interventions, especially interventions designed to support healthy lifestyles etc, which often can reduce the use of more expensive interventions in the long run.

  14.  Therefore, we feel that to overcome this problem, the Department of Health should develop clearer signposting to services that meet set service standards or criteria. This would encourage the Commissioners and PCTs to explore more innovative options and improve the effective implementation of commissioning across the country in order to address health inequalities and tackle long-term conditions such as obesity.

The effectiveness of public health services at reducing inequalities by targeting key causes such as smoking and obesity, including whether some public health interventions may lead to increases in health inequalities, and which interventions are most cost-effective;

  1.  The effectiveness of public health services at reducing inequalities by targeting obesity is variable across the UK. However, Slimming World has a consistent and effective range of services available nationally. We are uniquely placed to provide support in tackling obesity across a range of platforms. We can help the individual, the family, a GP or practice nurse wanting to refer their patient, and businesses wanting to set up occupational health schemes. With almost two thirds of the adult population now overweight or obese, the challenge it poses to the NHS is enormous, not least in financial terms. The government cannot tackle this alone and private sector organisations can play an important role in supporting the health services to meet their health improvement targets and to reach more people than they alone can, and thus tackle health inequalities.

  2.  Our subsidised Slimming World on Referral programme, as described above, is being used by PCTs to address health inequalities and was piloted in a population that included a high percentage of socially disadvantaged groups and low socioeconomic status. Offering free membership and attendance ensures equality of access to Slimming World.

  3.  Importantly, the service was shown to be more cost-effective than other current weight management options such as setting up in-house services or prescribing of anti-obesity medication. For example, the cost of the 12-week Slimming World on Referral programme is £44.50 per patient which is on average a third of the cost of drug treatment such as sibutramine and orlistat (which also does not include the cost of providing a concomitant weight management programme as recommended by NICE). Furthermore, in addition to the short-term cost-effectiveness whilst patients are participating in the scheme it is also important to consider the long-term benefits of such a scheme, which provides support in behaviour change to help patients adopt healthier lifestyle habits.

  4.  The Foresight report estimated that by 2050 there will be additional costs to the NHS of between £5.5 billion and £6.5 billion because of obesity[191]. Any decrease in obesity will also have huge cost benefits to the NHS as well as helping individuals live longer, healthier lives.

  5.  One of the long-term benefits of behaviour change programmes is that their reach extends much further than the member attending a group. Many members use the advice they receive at their Slimming World group to help other family members at home. Our research shows that three quarters of members are influencing their family to eat more fresh fruit and vegetables, less sugary and fatty food and fewer convenience foods, with over a third inspiring family members to be more active in everyday life[192].

  6.  In January 2006 we also launched a new initiative called Family Affair, designed to give even more targeted support to families, and help tackle the rising prevalence of adolescent obesity. The Family Affair scheme directly helps 11 to 15 year olds to manage their weight if their parent(s) and family GP believe it is right for them to do so, and with guidance on weight change directed by the adolescent's health care team. The scheme engages the whole family in making changes to adopt new healthier eating habits and a more active lifestyle. By focusing on behaviour change rather than weight loss we empower adolescents to take responsibility for developing their own personal route to healthy eating and activity. No fees are charged for adolescents between 11 and 16 wishing to attend our groups along with their family and with their health carer's agreement. To date nearly 17,000 11 to 15 year olds have benefited from our support through this scheme.

  7.  Another example of how private sector organisations can effectively support health services in tackling health inequalities would be Slimming World's workplace referral scheme. In the past couple of years, Slimming World has been successfully working with a number of employers who wish to offer their employees opportunities to improve their lifestyle. Recent and current examples include Land Rover and Jaguar, which both offer financial support to employees wishing to participate in Slimming World groups in their local area. We also run groups that are based in the work place itself and funded by the employer.

  8.  We believe the Government could encourage employers to take a more active role in encouraging their employees to achieve healthier lifestyle. Apart from the obvious benefits for the employer in terms of having healthier and more productive work force, there is also huge potential to reach many more people who would not necessarily come to the National Health Service to seek advice and support, and therefore play an important role in tackling health inequalities.

CONCLUSION

  In summary our recommendations are:

1.  In addition to allocating points for measuring patients' BMI, GPs should be allocated additional points for referring obese patients to services that can help and support them to take active steps to address their weight issues. For example GPs could be allocated points for referring patients to weight management services or exercise schemes in their local area.

2.  In order to improve the effective implementation and take up of commissioning across the country, the Department of Health should develop clearer signposting to services that meet set service standards or criteria. This would encourage the Commissioners and PCTs to explore more innovative options to address health inequalities and to find long-term solutions to conditions such as obesity.

3.  Private sector organisations, such as Slimming World, can play an important role in supporting the health services to meet their health improvement targets and to reach more people than they alone can, and thus tackle health inequalities.

January 2008

189   Feasibility and benefits of implementing a Slimming on Referral service in primary care using a commercial weight management partner. Public Health (2006) 120, 872-881. Back

190   Official Report, House of Commons, 17 October 2007, Volume 464, Column 825. Back

191   Foresight Tackling Obesities: Future Choices Project, 17 October 2007, p.40. Back

192   Influence of Slimming World's lifestyle programme on diet, activity behaviour and health of participants and their families. Submitted to Journal of human Nutrition & Dietetics (2007). Back