What promotes uptake and retention in group-based weight management services?

Obesity is fuelling an increase in Type 2 diabetes

We dwell in an more and more obesogenic setting, making it more durable for people to keep away from unhealthy way of life selections. This results in higher proportions of the inhabitants being chubby or overweight, that are the primary modifiable threat elements for Type 2 diabetes. For overweight folks, there’s a seven occasions higher threat of diabetes in comparison with these of a wholesome weight, and for chubby folks the chance is thrice higher.

Joining a group-based weight management programme is a generally chosen route for individuals who wish to lose weight. In addition to the various business programmes which are accessible, the NHS presents group-based programmes particularly to people susceptible to Type 2 diabetes, via the Healthier You: NHS Diabetes Prevention Programme (NDPP).

The NDPP – a nationwide programme for England – goals to establish folks at excessive threat of Type 2 diabetes and refer them onto a behaviour change programme for weight management. Due to the elevated threat of Type 2 diabetes for overweight and chubby folks, these programmes are a central part of many NDPP companies.

There is a spread of sensible, socio-demographic, psycho-social, contextual and behavioural elements that influence upon preliminary and common attendance at group-based weight management interventions. Studies have proven that individuals who entry and stay engaged with a programme for longer are inclined to lose extra weight, so, it’s very important that we now have a transparent understanding of what encourages folks to start and stay engaged.

To handle this, PHE’s Behavioural Insights workforce labored with researchers from Staffordshire University to conduct a literature review and behavioural evaluation.

The methodology: A literature evaluate and behavioural evaluation

First, the workforce at Staffordshire University carried out a literature evaluate, which appeared on the printed qualitative and quantitative literature on these programmes, and collated data on the primary business programmes. They additionally carried out a behavioural analysis, which investigates the drivers of behaviour utilizing a behavioural framework.

Two behavioural instruments have been utilized to the qualitative and quantitative outcomes in the literature. One device was used to categorise drivers of participant uptake and retention, and the opposite to establish particular behaviour change strategies – in phrases of programme recruitment strategies and intervention design – related to excessive uptake and retention.

These have been then mapped on to the behaviour change wheel’s ‘Capability’, ‘Opportunity’, ‘Motivation’ and ‘Behaviour’ (COM-B) model, which was used as a framework to tell suggestions relating to which intervention parts promote uptake and retention.

The findings: The foremost drivers behind programme uptake and retention


The behavioural evaluation discovered that people with the motivation to attend, and the data and psychological abilities to vary their behaviour have been extra prone to take up group weight-management programmes.

However, it was discovered that for motivation to be efficient, social alternative is especially vital. Those who perceived a scarcity of social help from household and buddies, or feared stigma from attending the programmes, have been much less prone to enrol.


In phrases of continued engagement, the primary drivers have been the optimistic social influences of group-based supply, together with:

  • social help
  • peer strain or accountability
  • having a supportive chief

Other vital elements have been recognized as being:

  • the flexibleness of group classes
  • the perceived relevance of classes
  • the inclusion of instructional parts

The evaluation additionally discovered that the primary limitations to continued engagement have been a scarcity of social help exterior of the programme from household and buddies, in addition to practicalities of attendance, reminiscent of a scarcity of time and competing commitments. When these elements have been mapped to the COM-B mannequin, it was clear that social alternative was the dominant part in relation to retention.

How can we maximise uptake and retention?

There is an growing quantity of proof from behavioural insights that the strategy in which individuals are invited to participate in preventive health programmes influences participation. As such, there’s want for higher consideration and specificity in the reporting of recruitment strategies of group-based weight management programmes. Reporting has usually lacked element thus far, making it tough to discern patterns in relation to uptake.

The behavioural evaluation recognized various key suggestions and intervention parts that promote participant retention, together with:

• prioritise efforts to foster social help via:
– guaranteeing the group chief is supportive
– together with actions that encourage help between group members
– together with actions that contain individuals’ household and buddies

• embody an academic part to empower individuals via growing data

• embody self-monitoring and provision of suggestions on behaviour the place attainable, together with biofeedback reminiscent of coronary heart price monitoring throughout train

• use graded duties inside programmes to construct up sustainable modifications in the specified behaviour, reminiscent of health-enhancing ranges of bodily exercise, or 5 or extra fruit and vegetable parts per day

• set targets for goal behaviours, reminiscent of bodily exercise and food plan, in addition to for outcomes, reminiscent of weight loss and change in physique fats share

• present classes that:
– embody train courses
– are in a handy location
– permit flexibility
– permit selection in supply mode
– are perceived as pleasing by individuals
– present optimistic reinforcement

You can learn extra in regards to the NDPP in our previous edition of Health Matters.

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