What interventions are effective and cost-effective for supporting the health and well-being of people with obesity on healthcare waiting lists? A rapid review

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Introduction

The prevalence of obesity has risen rapidly in recent decades and is considered one of the most significant public health challenges worldwide. In Wales, around one in four adults aged 16 and over are obese. 

In the UK NHS, there is a ‘four-tier’ pathway of services to support adults with overweight and obesity to lose weight. In Wales specifically, there is an All-Wales Weight Management Pathway. Patients are waiting up to five years for the tier 3 services, which provide emotional and physical support, and referral to surgery if needed. Patients referred to Tier 3 services have severe obesity or have obesity as well as other medical conditions. There is a risk that these patients may worsen whilst waiting to be seen.

We conducted a rapid review of published research studies. We aimed to find evidence of interventions which might prevent patients’ health and well-being from worsening whilst waiting for Tier 3 services. We focused on interventions that could be used within the current limits on healthcare resources. 

Main points

How up to date is this evidence?

We searched for existing research on this topic, looking at studies published between 2017 and 2024. As there was no research specific to Tier 3 services, they looked for interventions supporting adults with obesity on any waiting list.

What we found

We reviewed seven relevant studies from a range of countries. The types of interventions identified included:

• Exercise: four studies showed some evidence of improving quality of life and mental well-being.
• Text message-based, educational, and physical counselling: each one was assessed by a single study. 

Overall, the confidence in the findings is very low. Most interventions required costly equipment and input from healthcare staff and none of the studies considered the cost-effectiveness of interventions.  

This rapid review did not find any studies on interventions for people on waiting lists that could realistically be put in place within the budget and resources available to typical tier 3 weight management services in Wales.

What this means

Findings from this review need to be carefully applied. More robust UK-based studies that examine the effectiveness and cost-effectiveness of interventions supporting patients waiting for weight management services are needed.

Technical information

Our rapid reviews use a variation of the systematic review approach, abbreviating or omitting some components to generate the evidence to inform stakeholders promptly whilst maintaining attention to bias. This rapid review aimed to identify and synthesise the evidence for the effectiveness of scalable strategies for supporting the health and well-being of individuals on waiting lists, with a focus on practical and resource-efficient interventions that can be implemented within current healthcare constraints.

Stakeholders

The review was conducted as part of the Evidence Service’s collaboration with Health and Care Research Wales. The question was proposed by the Cwm Taf Morgannwg University Health Board Weight Management Service.

Lay summary written by Praveena Pemmasani, Public Partnership Group Member.