Title: Understanding barriers to referral for specialist weight management services and bariatric surgery and identifying ways to improve access
Funder: Health Education England

Abstract: BackgroundObesity is a major global health crisis which is associated with an increased risk of type 2 diabetes, cardiovascular disease, certain cancers, depression, reduced quality of life and premature death. Although public health interventions are critically important to prevent future obesity, effective clinical treatments are needed to achieve weight loss and health improvements in people who already live with severe and complex obesity (BMI 40 kg/m2, or 35-40 kg/m2 with co-morbidities). Obesity (bariatric) surgery combined with dietary and behavioural change, is the most clinical and cost-effective treatment in this group, leading to the greatest weight loss and improvement in type 2 diabetes. However, NHS-funded bariatric surgery treats less than 1% of those who could benefit from it, and the reasons for this are not well understood. AimsThis research aims to understand the barriers to accessing specialist weight management services and bariatric surgery in people with severe and complex obesity, and how access to these services could be improved. Key objectives include: Documenting NHS policies for specialist weight management services and bariatric surgery. Investigating real-life pathways of patients from primary to secondary care weight management services. Investigating multiple stakeholder views on accessing specialist weight management services and bariatric surgery. Developing recommendations on how access to specialist weight management services and bariatric surgery could be improved.Project plan The research process will encompass the following methodologies: Policy review. NHS commissioning policies for specialist weight management services and bariatric surgery will be collated and a 'policy map' drawn comparing access across England. Epidemiological study. Referral pathways of patients with severe and complex obesity will be documented from primary to secondary care to map out 'real-life' pathway journeys for accessing NHS weight management services. Qualitative study. Semi-structured interviews will be conducted with policy makers, professionals and patients to investigate individual views and experiences of accessing specialist weight management and bariatric surgery and identify barriers and facilitators to access. Stakeholder meetings will be conducted with policy makers, health professionals and patients to develop recommendations on how access to specialist weight management services and bariatric surgery can be improved.The project will be delivered over four years and will be supported by a specifically convened Patient and Public Involvement panel, an experienced mentorship team, and an Expert Scientific Steering Group comprising experts from each of the key stakeholder groups involved in the research. Anticipated impact and dissemination This research will develop recommendations applicable to all levels of NHS service delivery to ensure patients with severe and complex obesity can access specialist weight management support and bariatric surgery where appropriate. Improved access to these services will help to reduce the health burden and healthcare costs associated with severe and complex obesity. Patients, key health professionals and policy makers will be actively engaged throughout the research and dissemination process. Findings will be prepared into a variety of formats accessible to different audiences, and disseminated via key clinical journals and meetings, patient charities, relevant stakeholder networks, and social media.

Lay abstract: Background to the research Obesity is a major global health concern and is associated with multiple health problems, including type 2 diabetes, heart disease, certain cancers, and depression, which cost the healthcare system billions of pounds. Public health programmes are very important to prevent people from becoming obese but for those who are already obese, effective clinical treatments are needed to achieve weight loss and improve health, particularly for those with severe and complex obesity* who are at the highest risk of health problems. Weight loss surgery (bariatric surgery), combined with improvements to diet and exercise, is the most effective treatment for people with severe and complex obesity. It leads to better weight loss and improvement in some health problems (such as type 2 diabetes) than diet and exercise or medications alone. However, NHS-funded bariatric surgery treats less than 1% of those who could benefit from it, and the UK has lower rates of bariatric surgery than other countries with similar obesity rates. The reasons for the low rates of bariatric surgery in the UK are not well understood. Important factors to understand are the pathway of weight management services that patients must go through to access specialist care and bariatric surgery, and the policies which influence access to these services. Aims of the research This research aims to understand the obstacles to being referred for specialist weight management support and bariatric surgery in people with severe and complex obesity, and how access to these services could be improved. This research is essential to ensure that patients with severe and complex obesity can access treatment and support which can greatly improve their health and/or reduce their health risks. Improved access to bariatric surgery and associated specialist support will help to reduce the health burden and healthcare costs associated with severe and complex obesity. Design and methods used There are four stages to the research process which include: Reviewing and summarising current NHS policies for referral to specialist weight management services and bariatric surgery across all regions of England. Identifying how patients with severe and complex obesity move from weight management services attached to their GP surgery through to specialist weight management services in secondary care. Interviewing patients, policy makers, and health professionals to understand their views and experiences of accessing specialist weight management services and bariatric surgery. Conducting meetings with patients, policy makers and health professionals to develop recommendations about how access to specialist weight management services and bariatric surgery can be improved for people with severe and complex obesity.Patient and public involvement Patients with severe and complex obesity who have undergone bariatric surgery have contributed to the design of this research study, and will be involved in advising on the overall conduct of the research. A panel of 4-6 patient representatives will advise on the design of all patient-related material and key ethical issues. Dissemination The main outcome of this research will be the development of recommendations for health professionals and policy makers about how services and patient pathways could be improved to ensure appropriate patients are able to access specialist weight management services and bariatric surgery. Policy makers, health professionals and patients will be actively engaged throughout the research and dissemination process, and there will be a strong social media presence to encourage exchange of ideas between the public and the research team. *Severe and complex obesity is defined as a body mass index of 40 kg/m2 or 35-40 kg/m2 with another significant health problem that could be improved by weight loss.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;METABOLIC AND ENDOCRINE;ORAL AND GASTROINTESTINAL;STROKE