An Exploration of Health Inequalities in a Tier 3 Specialist Weight Management Service

Background: Almost two thirds of the adult UK population is either overweight or obese, a condition associated with physical and psychological comorbidities. Evidence shows that engaging with specialist weight management services can lead to significant reductions in weight. However, little is known about how legally protected characteristics impact on access to services and on outcomes. The purpose of this evaluation was to explore any barriers and health inequalities related to patients’ age, gender, disability, ethnicity, and socio-economic background in access or outcomes within a Tier 3 specialist Weight Management service in the UK. Methods: The evaluation was conducted in a pragmatic paradigm. Mixed methods were used in an iterative design where findings informed action. The evaluation included a narrative literature review, a quantitative demographic analysis on equity of access to the service (n=1896), a quantitative analysis on patient pathways and outcomes (n=2148), a patient focus group and interview (n=3), staff interviews (n=7) and a survey amongst referring General Practitioners (n=9). Results: Both weight stigma and male gender are perceived as barriers to accessing and engaging with weight management. Fewer men than women are referred to and access the service. However, after 52 weeks, both genders have similar outcomes in terms of BMI reduction. Older adults are under-represented in the service due to a lower referral rate, but they achieve higher than average BMI reduction. People from areas with the highest levels of deprivation are over-represented at referral and as starters in the service, and whilst they have lower-than-average BMI reduction after six months, longer engagement (12 months) achieves above average outcomes. Mistrust and disempowerment can be barriers to access but support from staff can help build trust and empowerment, facilitating positive outcomes. Staff’s existing skills facilitate working with people with protected characteristics, yet skills gaps still exist that act as barriers. Conclusions: Individual, societal and structural factors intertwine to generate inequalities. Relationship-building and empathy skills from health professionals, combined with improved communication, practical information, and support may alleviate these inequalities. However, some sample sizes were small and generalisations may only be made with caution.