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  • NHS

Case study: Tier 2 lifestyle weight management

Reviewing the evidence for the effectiveness of tier 2 lifestyle weight management programmes



The Public Health Programme Lead for Physical Activity, Nutrition and Obesity was working collaboratively with the ICB. They requested from their in-house Evidence Assistant, a review of evidence for the effectiveness of tier 2 lifestyle weight management programmes for adults in the UK to inform future decision-making.

The search question was defined as:

“In overweight and obese adults in the UK, how effective are tier 2 lifestyle weight management programmes in encouraging weight reduction and the maintenance of weight loss?”

The Evidence Assistant used PICO to separate the question into searchable concepts:

Population: Overweight and obese adults in the UK.

Intervention: Lifestyle weight management interventions.

Comparator: No lifestyle weight management interventions.

Outcomes: Reduction of weight and maintenance of weight loss.

Within the time frame it would have been impossible to conduct an in-house systematic review, however it was agreed that a wide range of sources would be searched.



The following databases were searched for systematic reviews, structured abstracts, economic evaluations, health technology assessments and Randomised Controlled Trials:

  • Cochrane Database of Systematic Reviews
  • NHS Economic Evaluation Database
  • Health Technology Assessment
  • WHO International Clinical Trials Registry Platform
  • metaRegister of Controlled Trials


Additionally, the following websites were searched for relevant studies:

  • NICE
  • SIGN
  • NHS England
  • Public Health England
  • Department of Health
  • British Dietetic Association (Association of UK Dieticians)
  • National Obesity Forum
  • National Obesity Observatory
  • Obesity Learning Centre
  • Rotherham Institute for Obesity (RIO)
  • Association for the Study of Obesity
  • EMBASE, BNI and PsycINFO databases (via NHS Evidence)
  • Slimming World
  • Weight Watchers
  • Google and Google Scholar search engines


Unpublished studies and grey literature were searched for using OpenGrey.

The search strategy included the following combination of index terms and free-text: overweight; obese; BMI; body mass index; co-morbidities; tier 2; lifestyle weight management; weight management; effectiveness; evaluation.



The Evidence Assistant reported on the current NICE guidance and recommendations; evaluating and discussing its strengths such as relevance, weaknesses such as lack of generalisability and gaps in evidence. She appraised and summarised the most recent high quality systematic reviews, a methodologically robust economic evaluation, a retrospective observational study, a prospective non-randomised pilot service evaluation and a case study. This evidence was synthesised in the conclusion to her report.



The findings in the Evidence Assistant’s report to the commissioners indicated that tier 2 weight management programmes should:

  • Consist of multi-component interventions delivered over three-months at weekly or fortnightly intervals
  • Address dietary intake, physical activity and behaviour change
  • Be developed by relevant multidisciplinary teams
  • Include focus on long-term maintenance


Evidence was found that demonstrated effectiveness for weight loss over 12 to 18 months, but inconclusive and/or weak evidence for long-term maintenance from such programmes.

A need to conduct high-quality randomised controlled trials in a UK setting to compare existing services (and their individual components), with a particular emphasis on their long-term effectiveness was identified.


Share & Manage

The report was saved within a repository so that it could be used by others as necessary. Access to the repository is available through the current Evidence Assistant post holder.

Commissioner’s feedback stated that the evidence provided was used to revise and develop an obesity pathway, including building the case for a proposed tier 3 weight management service across Bristol CCG. They added that the service may be one that is jointly commissioned across Bristol, North Somerset and South Gloucestershire.

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