Timetable and Budget
| Description | Deadline/Limit |
|---|---|
| Deadline for Stage 1 Applications | 14 February 2023, 1 PM |
| Notification of outcome of Stage 1 Application | April 2023 |
| Deadline for Stage 2 application | 06 June 2023, 1 PM |
| Notification of Stage 2 Application | October-November 2023 |
| Project Start | November 2023 |
| Project Duration | 24 months |
| Budget | £350,000 to £400,000 |
Introduction
The National Institute for Health and Care Research (NIHR) Policy Research Programme (PRP) invites applications for a single research project to support policy makers in the Department of Health and Social Care (DHSC) to shape policy on healthy weight in relation to weight management services. This research call aims to commission a project to 1) understand the expectations, experiences, and needs of people who regain weight after completing tier 2 weight management services and 2) understand how current services address weight regain.
This is a significant opportunity to contribute to building an evidence base on a high profile and important policy area of significant interest to the Government.
Background
Obesity is one of the leading public health challenges facing the UK. An excess BMI increases the risk of developing comorbidities including cancer, type 2 diabetes, kidney and liver disease, musculoskeletal problems, cardiovascular disease and poorer mental health. Based on the most recent data on adult obesity rates, around 64% of all adults are either overweight or living with obesity with around a quarter of adults living specifically with obesity. It is estimated that obesity and poor diet costs the NHS £6.5bn each year.
The Government is committed to helping everyone achieve and maintain a healthier weight. As part of this approach, we had invested previously c.£70m in weight management services (WMS) to support people to lose weight and live healthier lives and are assessing the best approach to support and enable access to these services.
WMS are provided by local authorities and the NHS (as well as the private sector) within a tiered approach that cares for and supports people at different stages of the life course, from infants to adults. Services range from information and advice (tier 1), through behaviour change programmes (tier 2) to interventions with multi-disciplinary teams (tier 3) and surgical interventions (tier 4).
There is evidence that tier 2 WMS are effective and likely to be cost effective, however this is dependent on how long weight loss is maintained.
When participating in tier 2 WMS, people can experience varying degrees of success. Upon completion of the programme, some people struggle to sustain their weight loss and maintain a healthier weight and then find themselves cycling between self-led weight maintenance and potentially repeating the same, or other, tier 2 WMS.
National Institute for Health and Care Excellence (NICE) guidelines identify a lack of evidence on weight cycling in relation to weight management programmes [6]. A recent systematic review identified some characteristics of behavioural weight loss programmes that may affect the rate of weight regain. At present, not enough is known about the experiences and needs of individuals who struggle to retain weight loss after attending WMS and how to adapt WMS to meet the needs of a population who relapse.
The current research project will inform policy and practice on the design and provision of WMS, in the health system and in the community for this population. The outputs of the research will help practitioners in tier 2 WMS better understand how WMS could improve outcomes for adults living with overweight or obesity over the longer term. It could also help identify cost-effective service provision approaches to addressing relapse and weight gain that would be acceptable to people at risk of relapse and weight cycling.
Given that adult WMS funding is split between the NHS and local authority commissioned services, there is both a local and national interest in this research.
Research priorities
Research is required to understand the expectations, experiences and needs of people who have accessed tier 2 WMS and have regained weight, and what considerations need to be made when delivering WMS in this population. We would like the research to provide insight into:
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how tier 2 WMS could improve outcomes for adults living with overweight/obesity over the longer term, helping them to avoid relapse and weight cycling
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what forms of and approaches to service provision could offer a cost-effective approach to addressing relapse and weight gain that would be acceptable to people at risk of relapse and weight cycling.
In particular we want this research to focus on the following two strands:
Strand A: Understanding the experiences and needs of people who have regained weight
We would like research to examine both user and providers’ views of the current system (i.e. WMS and the referral process) and what works. For service users, questions could include:
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How do users think the system could work better for them?
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What do users want from services when re-engaging with the system? Do they want to try the same service again?
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What are the enablers and barriers to users re-engaging with WMS?
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We would also like to explore any differences between people who have been re-referred, or elected to sign up for another programme, and those who have chosen not to engage again with tier 2 WMS or who have focussed on self-help models (including the NHS 12 week weight loss app).
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Research should also examine the views of professionals working in WMS, including commissioners, those making referrals (e.g. GPs), and providers. For healthcare professionals and providers, questions could include:
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What evidence do professionals have of the longer-term needs of service users? What do professionals think service users want from the system?
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How do professionals think the current referral process and WMS could be improved for service users?
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Given the evidence gap in this area we would envisage a qualitative approach to this research. This research should also consider health disparities and possible ways in which to narrow the gap in health disparities.
Strand B: Mapping existing services
The research should also include a workstream which maps existing services, including those provided by the private sector, which have a focus on weight regain. This mapping should identify whether this type of service exists, what types of schemes exist, current levels of provision of this type of service, and whether schemes have been evaluated for effectiveness.
The primary audience for this research will include policymakers from the Office for Health Improvement and Disparities, NHS England, local authorities and weight management providers. Policymakers and analysts expect a close relationship with the research team to provide feedback on interim findings and ensure impact for policy implementation.
New Guidance on Health Inequalities data collection within NIHR PRP Research:
Health Inequalities is a high priority area within the Department of Health and Social Care and the NIHR and is often present in a majority of funded projects. We are now assessing all NIHR research proposals in relation to health inequalities. We are asking applicants to identify in their application whether or not there is a health inequalities component or theme and how this research hopes to impact health inequalities. We are also asking researchers to collect relevant data, if appropriate for the research. Our goal is to collect information on health inequalities in research and data relating to the main outcome(s) of the proposed research. Please clearly identify in the research plan section whether or not your application has a health inequalities component or relevance to health inequalities and detail the core set of health inequalities breakdowns that will be reported; if none please explain why. We understand that research projects have different methodologies and focus on different populations, so please explain what data will be collected and reported for the methodology you plan to use. If a health inequalities component is not included, please explain why this does not fit within your proposed research. This should only be a few sentences.
For quantitative research we would ideally like researchers to provide one-way breakdowns of their main outcome(s) by the following equity-relevant variables: age, sex, gender, disability, region, 5 ONS Ethnic groups, and the 5 IMD quintile groups. If more detailed cross tabulations are appropriate, please include these. This table should be submitted to NIHR PRP at the end of the project. Due to data limitations, judgement calls may be necessary about which breakdowns to report and whether to merge categories to increase counts in particular cells; we ask you to make these judgement calls yourself, bearing in mind our data curation aim of enabling future evidence synthesis work in pooling results from different studies. More details and an example table can be found in Appendix
For qualitative research projects, this can be purely descriptive statistics giving the number of observations against the various variables.
Further details about this new request can be found in Appendix A
A recording of the Health Inequalities in NIHR PRP Research Q&A Event which was held on 19 September 2022 is available to view on Youtube.
Areas out of scope for this programme of work
Projects proposing to include populations of people who maintain weight loss and other tiers of WMS are out of scope for this programme of work.
Expertise required
This work will require qualitative research expertise, understanding of Tier 2 WMS and recurring weight, and person-centred approaches to weight management.
Outputs
Outputs should include:
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interim reports and updates as agreed at project scoping;
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draft publishable reports and a final publishable report, with executive and lay summary in a form suitable for policy colleagues in a 1:3:25 format; and
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a presentation of findings to DHSC colleagues and key stakeholders.
- The successful applicant will produce a final report, fully accessible to policymakers, local authorities, weight management providers, academics and members of the public and circulate to DHSC. When the study is complete, the successful applicants will place a final report summary on the NIHR Policy Research Programme website, where outputs resulting from public expenditure are available for public scrutiny. It is important the final report summaries are easily accessible to lay readers.
- Applicants should consider the full range of potential audiences and describe how to disseminate research findings most effectively so lessons from this research affect policy and practice.
- Applicants are asked to consider the timing and nature of deliverables in their proposals. Policymakers will need research evidence to meet key policy decisions and timescales, so resource needs to be flexible to meet these needs. A meeting to discuss policy needs with DHSC officials will be convened as a matter of priority following contracting.
Budget and duration
A total of up to £400,000 is available for this project. Costings can include up to 100% full economic costing (FEC) but should exclude output VAT. Applicants are advised that value for money is one of the key criteria that peer reviewers and commissioning committee members will assess applications against.
We expect the research to be completed within 24 months of contracting.
Management arrangements
A research advisory group including, but not limited to, representatives of DHSC and other NHSE, and the successful applicants for the research should be established. The advisory group will provide guidance, meeting regularly over the lifetime of the research. The successful applicants should be prepared to review research objectives with the advisory group, and to share emerging findings on an ongoing basis. They will be expected to:
- Provide regular feedback on progress
- Produce timely reports to the advisory group
- Produce a final report for sign off
Research contractors will be expected to work with nominated officials in DHSC, its partners and the NIHR Central Commissioning Facility. Key documents including, for example, research protocols, research instruments, reports and publications must be provided to DHSC in draft form allowing sufficient time for review.
References and key documents
- Department of Health and Social Care (2020) Tackling obesity: empowering adults and children to live healthier lives. [Accessed November 2022]
- NHS Digital (2022) National Child Measurement Programme, England, 2021 to 2022 school year. [Accessed November 2022]
- NHS Digital (2020) Health Survey for England 2019 Overweight and obesity in adults and children. [Accessed November 2022]
- Hartmann-Boyce J, Johns D, Aveyard P, Onakpoya I, Jebb S, Phillips D, Ogden J, Summerbell C. Managing overweight and obese adults: update review. National Institute for Health and Care Excellence (NICE). (2013) [Accessed November 2022]
- Loveman E, Frampton G K, Shepherd J, Picot J, Cooper K, Bryant J, Welch K, Clegg A. The clinical effectiveness and cost-effectiveness of long-term weight management schemes for adults: a systematic review. Health Technology Assessment. 2011; 15(2):1-182. [Accessed November 2022]
- National Institute for Health and Care Excellence (NICE) (2014) Weight management: lifestyle services for overweight or obese adults. [Accessed November 2022]
- Hartmann-Boyce J, Theodoulou A, Oke J L, Butler A R, Scarborough P, Bastounis A, Dunnigan A, Byadya R, Hobbs F D R, Sniehotta F F, Jebb S A, Aveyard P. Association between characteristics of behavioural weight loss programmes and weight change after programme end: systematic review and meta-analysis. The BMJ. 2021; 374:n1840. [Accessed November 2022]
Appendix A: Further Detail on the New Guidance on Health Inequalities data collection within NIHR PRP Research
Health Inequalities is a high priority area within the Department of Health and Social Care and the NIHR and is often present in a majority of funded projects. We are now assessing all NIHR research proposals in relation to health inequalities. We are asking applicants to identify in their application whether or not there is a health inequalities component or theme and how this research hopes to impact health inequalities. We are also asking researchers to collect relevant data related to health inequalities, if appropriate for the research. Collecting specific information about health inequalities in research submitted to the programme will allow for categorisation of health inequalities research, curation of data to aid future health inequalities research and enable policymakers to better understand the implications of health inequalities within their policy areas. This is a new request from the NIHR PRP and we will be continuing to monitor queries and adapt the process as needed. If you have any feedback on this new request, please contact us at prp@nihr.ac.uk.
Our goal is to facilitate more widespread and consistent reporting of health inequality breakdown data relating to the primary outcomes of NIHR funded research. We would ideally like researchers to focus on the following equity-relevant variables: age, sex, gender, disability, region*, 5 ONS Ethnic groups**, and the 5 IMD quintile groups. These variables are considered an ideal, but we understand that these are subject to change depending on the sample population and specific research question.
For qualitative research projects, this can be purely baseline characteristics of the participants, for example, the number of participants in each ethnic group.
For quantitative research projects, if there are multiple outcomes/effects with your stakeholders, select a small number of main outcomes as appropriate to report equity breakdowns. We will not be prescriptive about the number of the outcomes, as it will depend on the number of study design types and the nature of the project aims. We are asking for one way cross tabulations of each primary outcome by these equity-relevant variables, if appropriate for your research, together with the number of observations in each cell. If more detailed cross tabulations are appropriate for your proposed research, please include these as well. This request applies to both primary data collection studies and secondary analysis of routine data, and to causal inference studies as well as descriptive studies; however, if this is not possible due to data limitations then please explain. Due to sample size and other data limitations there may be difficult scientific and/or data security*** judgement calls to make about which breakdowns to report and whether to merge categories to increase counts in particular cells; we ask you to make these judgments yourself, bearing in mind our data curation aim of enabling future evidence synthesis work in pooling results from different studies. We also ask that researchers report breakdowns for the unadjusted as well as adjusted outcomes/effects, as appropriate.
We understand that research projects may employ different methodologies, and focus on different populations. Please explain how the variables and data collection methods chosen are appropriate to the methodologies used.
We ask that you please clearly identify in the research plan section of the application whether your application has a health inequalities component or not and detail the core set of health inequality breakdown data that will be collected, if applicable. Submission of the data collection will be a condition of the final report for all research with relevant methodologies regardless of whether the research has a health inequalities component that will need to be submitted to NIHR PRP when the grant has finished. This should only take a few sentences within the research plan section.
* Table below uses the nine regions in England, further regions can be used if using the UK as the study population. Please report region breakdown for large samples in nationally representative descriptive studies. There is no need to report this for small sample studies, for sub-national studies, or for quasi-experimental studies where it would require time-consuming re-estimation.
** White, Mixed/ Multiple ethnic groups, Asian/ Asian British, Black/ African/ Caribbean/ Black British, Other ethnic group. If the sample size is small then it is fine to report only some of the requested equity breakdowns and to merge some of the sub-groups as appropriate.
*** For guidance on how to handle data security concerns in reporting of sensitive data please see ONS guidance.
Example data table for submission at the end of the funded research project
(N.B. If there is more than one main outcome then you will require more tables and if you adjust your outcome then you will need two tables for the adjusted outcome and unadjusted outcome. For other methodologies, variable vs number of observations may be more appropriate to record participant data). This table is for an example only. It does not contain sub variables and does not illustrate any preference for certain variables, as these will be dependent on the proposed research.
| Variable | Outcome (an appropriate average for this subgroup, usually the mean) | Number of observations | Additional information about variation if appropriate, e.g. range, standard deviation |
|---|---|---|---|
| Age | |||
| Sex | |||
| Gender | |||
| Disability | |||
| Ethnic Group | |||
| IMD Group | |||
| Region |