Tackling severe obesity

PROGROUP is a new group-based behaviour change programme for people living with severe obesity, which aims to establish best practice for group-based treatments in specialised weight management services in the UK. Dr Shokraneh Moghadam has written this article on behalf of the PROGROUP research team.

Living with obesity

Obesity is a major health concern and affects at least 26 per cent of adults in the UK. Having obesity increases the risk of many health conditions, including cardiovascular and kidney diseases, diabetes, cancers, and musculoskeletal disorders. 

Severe obesity (defined as a Body Mass Index > 40 kg/m2, or BMI > 35 kg/m2 with a comorbidity) is also progressively more common. Approximately 7-9 per cent of adults have a BMI > 35, and 3-5 per cent of middle-aged adults have a BMI > 40 kg/m2. There are also significant gender and ethnic variations. 

People with severe obesity report an impaired quality of life, including physical, social, and economic impacts, and have a reduced life expectancy of between 8-10 years. They are also likely to experience psychological concerns, such as depression and anxiety, which can be worsened by negative societal experiences, such as weight stigma.

In the UK, treatment options for obesity are categorised into four 'tiers' (Capehorn et al., 2016). Tier 1 includes a universal approach to promoting healthy behavioural choices aimed at the general public; Tier 2 includes local community-based services, which are NHS and commercially run; Tier 3 includes specialist multidisciplinary services, including the behavioural management of obesity, for those unresponsive to earlier treatments and with a BMI of either > 40 or > 35 kg/m2 with comorbidities; and Tier 4 includes bariatric surgery (Swancutt et al., 2019).

While there is a new wave of drugs (e.g. Semaglutide, Tirzepatide) to support short-term weight loss, the longer-term impacts (e.g. side effects) are yet to be observed. However, for sustained weight management, pharmacological interventions on their own are unlikely to provide individuals with the necessary behaviour change skills for maintaining weight and any associated health benefits. Nevertheless, accessing behavioural and multidisciplinary support (Tier 3) can take several months, even years, due to the rising number of referrals and limited resources.

The role of groups in Tier 3 services

Group programmes could support services in responding to the growing number of patients waiting to receive treatment for obesity, while having the potential to maximise staff time and resources. Beyond practical benefits, groups could also offer wider therapeutic benefits to patients, which come from being socially connected to members of a treatment group. 

In groups, the development of a shared social identity - i.e. when members identify with the group - could empower patients to use the group as a resource that motivates and sustains behavioural changes for improved health. Indeed, there is much research to show that shared social identity is associated with various health outcomes, including quality of life and wellbeing (see Steffens et al., 2021). Some of our recent work has articulated key points of practice that healthcare professionals can employ to build and manage shared social identity among patient groups (Tarrant et al. 2020).

What the PROGROUP programme involves

The PROGROUP programme, a new group-based behaviour change programme targeted at Tier 3 services, is informed by the social identity approach to health, particularly the social identity model of behaviour change, which prioritises shared social identity (e.g. feeling connected, supported) between group members. By developing social identity among group members, PROGROUP aims to motivate and empower members to use the group as a resource for sustained behavioural change and positive health outcomes.

PROGROUP includes 12 group sessions and three 1-1 consultations across a five-month period. The content of PROGROUP includes evidence-based behaviour change techniques focused on dietary behaviours, social and individual psychology, and physical/recreational activity, delivered by healthcare professionals working in weight management.

Our research programme is testing whether PROGROUP is effective and cost-effective as an NHS Tier 3 treatment. We recently tested the feasibility of PROGROUP in three weight management services in the UK, including in the Midlands, Wales, and the South West. 

Initial findings from the PROGROUP study

Encouragingly, we found that PROGROUP overall seemed acceptable by participants and healthcare staff. There was also evidence that the intervention supported patients to build shared social identity – a key hypothesised mechanism of action. A definitive trial of the intervention is now underway to determine whether it is effective in helping patients achieve weight loss and positive health outcomes.

We publish our study findings in scientific journals, and present at national and international conferences and public events. If you would like to keep up with our work, you can visit our website and social media page @PROGROUPStudy. If you have any questions or would like to find out more about PROGROUP, please do not hesitate to reach out to us via email at: [email protected].

References

Capehorn, M. S., Haslam, D. W., & Welbourn, R. (2016). Obesity treatment in the UK health system. In Current obesity reports (Vol. 5, Issue 3, pp. 320–326). https://doi.org/10.1007/s13679-016-0221-z

Steffens, N. K., LaRue, C. J., Haslam, C., Walter, Z. C., Cruwys, T., Munt, K. A., Haslam, S. A., Jetten, J., & Tarrant, M. (2021). Social identification-building interventions to improve health: A systematic review and meta-analysis. Health Psychology Review, 15(1), 85–112. https://doi.org/10.1080/17437199.2019.1669481 

Swancutt, D., Tarrant, M., & Pinkney, J. (2019). How group-based interventions can improve services for people with severe obesity. In Current Obesity Reports (Vol. 8, Issue 3, pp. 333–339). Current Medicine Group LLC 1. https://doi.org/10.1007/s13679-019-00348-y 

Tarrant, M., Haslam, C., Carter, M., Calitri, R., & Haslam S. Alexander. (2020). Social identity interventions. In Hagger S Martin, Cameron D Linda, Hamilton Kyra, Hankonen Nelli, & Lintunen Taru (Eds.), The Handbook of Behavior Change. Cambridge University Press.