In the UK, 27% of men and 30% of women are living with obesity (NHS Digital, 2019). Treatment of obesity and associated ill health was estimated to cost £6.1 billion in 2014, and is projected to reach £9.7 billion by 2050, with wider costs to society estimated to be £49.9 billion per year (Public Health England, 2017).
A tiered approach to weight management exists in the NHS. Tiers 1 and 2 are delivered in primary care and consist of healthy lifestyle promotion and advice. Tiers 3 and 4 are often delivered in secondary care and represent the specialist weight management services, providing intensive management and comprising support from dietitians, specialist doctors, psychologists and surgeons (NHS England, 2016).
People with a BMI over 40 kg/m2 or over 35 kg/m2 with comorbid medical problems (e.g. diabetes) are eligible for referral to Tier 3/4 weight management services (NICE, 2022). However, current Tier 3/4 service provision is insufficient to meet population needs in the UK.
The use of digital health tools for management of chronic conditions is rapidly expanding. These tools, including mobile health applications, wearable devices, online programmes, SMS messaging and combinations of these, act as triggers to support behaviour change in their users (Muench and Baumel, 2017). Digital tools are increasingly being used on a population level as a weight loss strategy for people living with overweight and obesity (Price et al, 2022). Digital interventions have the potential to provide an attractive method of prompting users to not only change but also maintain their behaviours and allow continuous targeting of healthy behaviour related to weight management. Current evidence supports the acceptability of digital tools for management of obesity in the community, and there is evidence that such tools are also accepted in specialised NHS Tier 3/4 weight management services (Hanson et al, 2021; Huntriss et al, 2021).
Many digital tools are available for supporting people living with obesity. However, people referred to weight management services have different needs compared to those living with obesity in the community and, as such, they need more bespoke resources. The fundamental aspect of any interventions designed to help people living with obesity is involvement of the people themselves in the creation and delivery of such tools.
Gro Health W8Buddy
Gro Health W8Buddy is a bespoke version of the NHS-certified app Gro Health (available at: www.grohealth.com). It is a digital platform co-created by patients, clinicians and digital experts, and is one of the first digital interventions for weight management services co-created with clinicians working in the NHS. It is currently offered to our weight management service users. We are in the process of evaluating its clinical effectiveness and impact on our service.
This precision digital health platform helps to reduce body weight and improve glycaemic control and wellbeing among people living with obesity, overweight and/or type 2 diabetes (Saslow et al, 2018; Summers et al, 2021). It has over 60 modules covering four main areas of education: diet, activity, mental health and sleep. The contents of these were designed together with clinicians and patients, in order to address the specific needs of people accessing weight management services. Each user’s experience is tailored to their individual goals, accessibility and literacy needs, language, disease profile, ethnicity, age, gender and location.
The platform enables clinicians to view engagement of users with the contents. Additionally, users can engage in self-monitoring and tracking of their health-related data.
It is important to highlight that incorporation of this digital platform should not replace face-to-face care; rather, it should augment the care patients receive in the service. Referred users will get access to this platform even before they are seen by clinicians in the service, thus maximising delivery of education and support. Gro Health W8Buddy then accompanies users on their journey in the weight management service and provides bespoke and personalised education. If an individual chooses to progress to bariatric surgery, they will be able to engage in surgery-specific content.
As a healthcare system, we still have a long way to go to create the personalised care incorporating digital platforms and tools seamlessly into the patient journey. However, this is a promising start, offering our patients more choice and greater involvement, as well as enabling patient-driven healthcare.