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Interventions that can support the health and well-being of people with obesity on healthcare waiting lists

Published: 13 December 2024

A rapid review conducted by Public Health Wales in collaboration with Health and Care Research Wales Evidence Centre has identified interventions that may help support the challenges faced by individuals with obesity on long waiting lists for healthcare services in Wales.

The report, ‘Interventions for supporting people with obesity on healthcare waiting lists’ sought to identify scalable strategies for supporting the health and well-being of people with obesity on healthcare waiting lists, with a focus on resource-efficient interventions that could be feasibly implemented within current healthcare constraints 

Obesity has risen rapidly in recent decades and is considered one of the most significant public health challenges worldwide. In Wales, it is estimated around one in four adults aged 16 and over are living with obesity. 
 
Projections suggest that if rates of overweight and obesity continue to rise in line with recent trends within Wales, by 2050, costs to the NHS in Wales could rise from £73 million to an estimated £465 million per year, with wider societal costs reaching £2.4 billion. 

Across the  UK, services to support people with obesity follow a four-tier pathway which increases in intensity to match obesity severity and complexity. The All-Wales Weight Management Pathway sets out the strategy in Wales. However, the demand for tier 3 services, which cater to individuals with severe obesity and related health conditions, has led to waiting times of up to five years in some areas. These lengthy waits risk further deterioration in patients’ physical and mental well-being. 
 
This rapid review found no studies evaluating the effectiveness of scalable interventions that could be implemented within the resource constraints of typical tier 3 weight management services in Wales. 

Despite this, researchers did identify and combine seven studies published between 2017 and 2024, which focused on interventions to support individuals with obesity while on waiting lists, primarily for bariatric surgery. 

  • Exercise Programmes:  limited evidence suggests that these interventions may improve quality of life in some cases, although evidence was inconsistent. 
  • Text Message-Based Support, educational interventions and physical activity counselling: Very limited low-quality evidence found minor improvements in quality of life, mental well-being and measures that assess the body such as weight. Educational Interventions:  

However, the rapid review also highlighted critical gaps in the evidence: 

  • No UK-Based Studies: The lack of studies conducted in the UK limited the applicability of existing findings to local healthcare settings. 
  • Focus on Tier 4 Patients: Most studies addressed patients awaiting bariatric surgery (Tier 4) rather than Tier 3 services, making their relevance to current Welsh Tier 3 pathways uncertain. 
  • Limited Evidence: None of the studies assessed cost-effectiveness, participant engagement, or low-resource interventions suitable for scalable implementation 
  • Low Quality Evidence: the evidence that was identified was mostly of low quality. 

Hannah Shaw, Principal Evidence and Knowledge Analyst for the Evidence Service at Public Health Wales, said:   

“The long waiting times for Tier 3 services can significantly impact both physical and mental well-being. This rapid review found limited evidence that may help those waiting a long time for support. We need more robust studies to examine practical and equitable solutions for this group of people who are waiting for support and mitigate the long-term health risks associated with delayed care."