The association between excess weight and poor outcomes with COVID-19 has led to even greater pressure on public health organisations to deliver successful weight loss programmes; ShapeUp4Life presents an effective solution to this long-standing problem.
The well-established relationship between the prevalence of chronic disease and excess weight and obesity has long been a cause for concern in public health. Obesity is associated with reduced life expectancy, and lower quality of life. But the realisation that being obese also leads to an increased risk of experiencing adverse outcomes from COVID-19 has catapulted the issue of successful weight management strategies to the top of the agenda—particularly as the UK approaches winter, and a second wave of the pandemic.
A majority (62%) of adults in England are overweight (defined as a body mass index [BMI] of ≥25kg/m2 to 29.9kg/m2) or obese (BMI ≥30kg/m2), with similar figures for Scotland, Wales, and Northern Ireland. A meta-analysis of 75 studies has suggested that, compared to individuals with a normal BMI, people who are obese who become infected with COVID-19 are twice as likely to require hospitalisation, and 74% more likely to be admitted to an intensive care unit, as well as having a greater risk of mortality. And the presence of many of the underlying conditions associated with being obese—such as, type 2 diabetes, hypertension, dyslipidaemia, and chronic kidney or liver disease—also greatly increase the risk of worse outcomes with COVID-19. Diabetes is associated with a significantly increased severity and mortality with COVID-19, even in the absence of other comorbidities. Prime Minister Boris Johnson has famously attributed the severity of his own bout of COVID-19 to his weight, and has instigated a drive to tackle levels of obesity in the UK population.
Looking for a long-term fix
A tried-and-tested weight management strategy on offer to health service commissioners is that of Shapeup4Life from Solutions4Health. Solutions4Health have been providing community group-based child and adult weight management programmes for the past 10 years. The aim of ShapeUp4Life is to make changes to lifestyle and behaviours that not only lead to weight loss, but that can also be maintained over a long-term period. The programme aims to help people to increase immunity, improve gut health, reduce the risk of diabetes, increase physical activity and lose weight. ShapeUp4Life also offers a virtual service, with live Zoom weight management classes consisting of advice on reducing the risk of diabetes, healthy eating, recipes, exercise, and movement.
The programme has achieved a 70% completion rate, with 92% of those losing weight; 77% of participants reported an increase in their overall wellness, and 60% achieved the recommended physical activity guidelines, 10% above target. Of those who had high blood pressure, 70% had reduced it by the end of the programme. The completion rate for those from the lowest quintile on the index of deprivation is 62%, and 92% of participants have rated the service as good/excellent.
Dudley is doing it
Dudley Borough Council has been using ShapeUp4Life as part of its integrated adult wellness service since April 2017. Prior to that, adult weight management was commissioned through other commercial weight management programmes. Levels of excess weight in adults within Dudley are about 72%. In the period 2019–20, 960 people accessed weight management services in the area.
“From 2019–20 onwards,” explains Diane Boros, Public Health Manager, Healthy Adults, at Dudley Borough Council, “the offer was targeted solely at the ShapeUp4Life service; in previous years we had other external services available, but the integrated model required a more cost-effective and targeted offer that reaches our most deprived populations and target groups.”
Dudley has a population of 320,629, with an average life expectancy of 78.9 years for men, and 82.8 years for women. The locality’s most recent annual report details that the face to face ShapeUp4Life rolling programme has reached 618 people in Dudley, 38.5% of whom have achieved a 5% weight loss in 12 weeks. The online programme has reached 342 people. The annual report identifies the further development in 2020–21 of a ShapeUp4Life advanced programme, to focus on those with a BMI of ≥40.
Ms Boros says: “The purpose of an integrated lifestyle service managed by one provider is to provide ‘one front door’ for all services, and this integrated service has had a successful impact. Change management time must be allowed throughout the programme and, with the ShapeUp4Life programme, the offer has evolved over the last 12 months—from face-to-face sessions within community settings, to the addition of online support for those that perhaps work and are not able to attend sessions. And now, due to COVID restrictions, it also offers a digital solution.”
Online and on-demand
The digital platform—Digital Shapeup4Life—is available on both iOS and Android, and provides continuous on-demand support for those aged ≥18 years, with a bespoke assessment at the start and end of the programme. The system evaluates data on behavioural changes and success, and working online removes the traditional barriers of face-to-face services while maintaining quality. The programme is adaptable to suit individual areas, and can be tailored for differing regions and requirements.
Slough Borough Council launched its ShapeUp4Life initiative in April 2020. Julia Wales, the prevention & wellbeing commissioning manager, says: “We are really pleased that Solutions4Health has developed a digital offer, as this supports one of Slough Borough Council’s five-year outcomes: Outcome 2. Our population will be healthier and able to manage their own care needs. Online access makes it easier for people to participate and undertake it at a time that suits them.”
Her colleague Tim Howells, senior programme officer in public health at Slough Borough Council, explains: “Prior to commissioning Shapeup4Life, we had a face-to-face weight management programme for children and adults. But we wanted a more accessible service that could reach a greater number of people in a more convenient way; something that can be accessed in the comfort of their own home.”
A whole systems approach
Levels of obesity in Slough are higher than that across the rest of the South East, with 67.5% of adults considered to be overweight or obese. ShapeUp4Life is part of a wider whole systems approach to weight management in the borough, which Howells describes as “crucial in this current climate”. A service review of the first six months of the initiative is due in October 2020.
He adds: “ShapeUp4Life will provide our targeted Tier 2 weight management offer to residents that are most at risk and of a higher weight. The hope is that this will help reduce pressures on primary and secondary care by reducing the need for a Tier 3 service, and on conditions such as cardiovascular disease, hypertension, and Type 2 diabetes. It is also part of our ‘reducing risk’ work on COVID-19, where we are supporting our communities to improve their immune system and reduce their risk of complications from the virus through weight management, physical activity, and smoking cessation. This is all part of our future preparedness work. It will help reduce the inequalities that exist around worse outcomes from the virus, and better protect our residents going forward.”
Health commissioners in Birmingham are looking closely at using ShapeUp4Life. Dr Marion Gibbon, interim Assistant Director of Public health at Birmingham City Council, agrees that the “need for an effective weight management strategy is much greater at the moment, with those who are overweight or who have diabetes much more likely to have an adverse outcome from COVID-19”. Currently, 61.7% of adults in Birmingham are overweight or obese.
“If 10% of all those who are eligible were to participate, the outcomes would be fantastic,” she says. “There are 1.4 million people in Birmingham. There would most definitely be an impact on secondary and primary care, and on quality of life measures. You would expect to see reductions in the numbers of people developing heart failure and other conditions associated with being overweight or obese, as well as in the incidence of musculoskeletal problems.”
ShapeUp4Life also provides women-only weekly classes and sessions for the Black and minority ethnic (BAME) population, featuring culturally-aware diets and simple ideas for food swaps. Experts provide nutrition and exercise support that is appropriate for patients with a variety of health conditions, and from a wide range of communities. This has achieved even greater significance at the moment, with BAME population groups having higher rates of the comorbidities that are associated with severe disease and mortality in COVID-19. It has also been shown that those from the BAME population experience an increased risk of acquiring the disease, greater disease severity, and poorer outcomes.
In an area as ethnically and economically diverse as Birmingham, says Dr Gibbon, the targeted support offered by ShapeUp4Life is very relevant. “We have a large Asian community, and we also have some areas that are quite wealthy and others that are really poor. There are cultural dimensions to weight management and exercise—some women are more restricted in their ability to go out and about, or may be unlikely to attend a gym for religious or cultural reasons. For them, being able to access the programme online is invaluable. A community-based programme is also very helpful, by bringing people together and providing a morale boost through peer support, as we have found with our Stop Smoking initiative through Solutions4Health.”
A positive impact
For neighbouring Dudley, Ms Boros says: “The offer of ShapeUp4Life within the service has been positive. The range of delivery styles has given weight management opportunities a new focus, and allows a range of individuals to access the service and stay in touch; therefore, it is more effective at supporting people to lose weight. As ShapeUp4Life is part of a wider offer, we are also supporting people in Dudley to improve other areas of their lifestyle at the same time.”
A local resident quoted in the Dudley annual report has lost more than two stone with the programme, and is no longer pre-diabetic: “What I liked about ShapeUp4Life is that it wasn’t another diet, but more a change of attitude and a healthier way of life. The combination of changes has left me feeling healthier, energetic and the healthiest weight I have been in 40 years.”6
As public health grapples with the challenges of COVID-19, an overarching solution such as ShapeUp4Life is what is needed to combat the ills of excess weight.