Tackling obesity in primary care: assessing the practicalities of working in partnership with the commercial slimming sector

Introduction: The prevention and management of overweight and obesity are fundamental to a number of national service frameworks. The strategic aims for managing obesity in southern Derbyshire include the proposal that obese individuals would be provided with one free opportunity to join a weight management programme run by a commercial slimming organization (Avery, 2000). The aims of the present study were to investigate whether people referred from primary care to a commercial slimming club went on to attend the club and to reduce their body weight. The study also aimed to examine experiences of participants and to consider the cost implications. Method: Between September 2001 and February 2002, two inner-city practices recruited patients who fulfilled the following criteria: body mass index (BMI) >30 kg m−2, aged 18–70 years, not pregnant and no attendance of a slimming group in the previous 3 months. Each patient was given vouchers covering free membership and 3-month attendance at a local Slimming World class of their choice so that they could participate without being made to feel different from other class members. Patients were encouraged to stay in the programme after 3 months but they then became responsible for their own weekly fees. The primary care team reviewed each patient on referral, and 3 and 6 months later examining weight change and using a series of questionnaires designed to collect socio-economic data and information relating to general health, lifestyle, motivation to lose weight and experience of the club. Data were analysed using SPSS. Results: A total 107 patients were recruited, 88% of whom were women. The mean age was 49.5 years and 11% were known to have diabetes. At the start of the study, the mean BMI was 36 kg m−2 (range, 30–47) with 50% having a BMI >35 kg m−2. Following recruitment, 85% (n = 91) participants enrolled with a Slimming World class. Of the enrolled population, 68% (n = 62), completed the 3-month free attendance at the class of their choice. Of the participants who completed, 76% (n = 47) indicated that they intended to carry on attending the class, but paying normal class fees. At 3 months, the mean weight loss of participants completing the free attendance was 5.4 kg (SD 3.5), while at 6 months, the mean weight loss was 11.0 kg (n = 34). The qualitative data support the partnership between the health sector and a commercial slimming organization, expressed by individual patients: ‘had I not had the push from the surgery I would not have gone despite being overweight’, ‘I was helped at a time when I had a low self-esteem and financial problems’. Discussion: There is a need to be innovative in the management of obesity, with dietitians and nursing staff becoming increasingly in short supply. The commercial sector has an already established infrastructure and a ‘product’ that is well taken up by the general public. Collaboration betweem primary care trusts and commercial organizations has the potential to benefit both in an approach that could be cost-effective and sustainable. The standard cost per patient for Slimming World membership and 3-month attendance is £55 with bulk packages being available to primary care trusts at approximately £42.50 per patient. This compares favourably with other treatment options for obese patients including, for example, pharmacotherapy where the typical cost of 3-month treatment with Orlistat is approximately £126. The work was supported by Southern Derbyshire Health Authority and Slimming World.