Memorandum by Slimming World (OB 105)
SLIMMING WORLD
Slimming World is a UK-based slimming organisation.
The company was founded in 1969 by Margaret Miles-Bramwell, and
was the first to recognise the burden carried by overweight people
is two-fold. There is excess weight, but there is a far heavier
burden to be lifted—that of guilt, self-criticism and poor
self-esteem. There are now over 5,000 Slimming World groups held
each week across the UK. These are run by a network of 2,500 Slimming
World trained Consultants supported by an additional 200 head
office and field staff. Consultants undergo a three-day foundation
training course, completion of four diploma examinations and are
then supported with an on-going training and development programme
including co-ordinated fact sheets to cover a number of issues
that might be encountered in the group situation (from nutritional
topics to motivational interviewing). All Slimming World Consultants
have been members and lost weight themselves and so are very aware
of the difficulties of losing weight and the effect it can have
on self-esteem and mental well-being. Slimming World's approach
is based on the philosophy and deep understanding that dieting
alone is not the solution to long-term weight management. It is
an integrated approach combining psychological and dietetic expertise
to provide an effective, nutritiously balanced and practical solution
to members. Within a motivating group setting, Consultants use
a number of behaviour modification tools to empower members to
make healthy lifestyle changes towards diet and physical activity.
Slimming World promote healthy eating as Food
Optimising, an eating plan which is fully in line with current
recommendations on weight management and healthy eating. Essentially
Food Optimising takes account of a food's energy density, its
health-giving properties, ability to satisfy the appetite quickly,
ability to maintain a feeling of fullness and peoples' behavioural
patterns. Overall, it offers a realistic, flexible and practical
eating plan that, importantly, allows members to lose weight without
restriction or deprivation. This year Slimming World also introduced
Body Magic to their groups, a system designed to help build members'
confidence, expertise and commitment in building up levels of
regular physical activity. Combined within a highly developed
support system (injected with a bit of fun and humour) Slimming
World's unique approach ensures members have the practical skills,
motivation, confidence and vital ongoing support to successfully
make these healthy lifestyle changes and so achieve their personal
goals.
With the help of group Consultants, members
choose their own personal target weight (as long as this does
not fall below a BMI = 20kg/m2). Interim targets are also encouraged
and a 10% weight loss is very much recommended (Slimming World
acknowledge this achievement with Club 10 membership). Waist circumferences
are also considered and are particularly emphasised in the men's
strategy where BMI may not always be an appropriate tool. As part
of the company's strategy to encourage and support weight maintenance,
members are invited to continue to attend their group free of
charge once they reach their chosen target weight.
Behind the scenes the company invests in a variety
of research programmes to advance the understanding of the causes
and treatment of obesity and an advisory panel meet on a regular
basis to ensure that the "product" remains uptodate
and evidence based. There are policies for members who are pregnant
or breast-feeding who may benefit from continuing to attend group
meetings, devised in conjunction with the Royal College of Midwives.
Slimming World supports the building of partnerships with the
National Health Service to develop practical and accessible strategies
to manage overweight and obesity in the community and has recently
been working with primary care on a number of projects, in particular
to explore the feasibility of "slimming on referral".
Slimming World has held the Investor in People award for its training
and support programmes since 1997.
Slimming World regularly supports 250,000 members,
including 12,000 target members attending free of charge to maintain
their personal target weight. The majority of members are female,
although there are an increasing number of men attending which
currently equates to around 5% of total members. Our data compares
very favourably with current weight loss therapy targets of an
initial 5-10% weight loss achieved within three-six months. Recent
company research shows the average BMI of members on joining is
32kg/m2. Members achieve 10% weight loss in an average 13 weeks,
independent of initial BMI, and six months later over 90% of those
still attending will have kept this weight off or gone on to lose
more.
RESPONSE TO
THE RELEVANT
PARTS OF
THE COMMITTEE'S
TERMS OF
REFERENCE
What can be done about it and recommendations
for national and local strategies
Slimming World believe that responsible commercial
slimming organisations can offer valuable service in helping tackle
overweight and obesity, particularly by working in partnership
with primary and secondary care. There is a need to be innovative
in the management of obesity, with dietitians and nursing staff
increasingly in short supply. The commercial sector has an established
infrastructure and product that is well taken up. Collaboration
between health and commercial sectors could provide a realistic,
cost effective and sustainable approach to support people in losing
and maintaining weight loss.
Slimming on Referral
Slimming World are actively working with primary
care to investigate potential opportunities for effective partnership
working. A collaborative project between Greater Derby Primary
Care Trust and Slimming World was set up in 2001 to investigate
the feasibility and practicalities of running slimming on referral
schemes. The specific aims were to monitor and record referrals
from primary care and attendance at a commercial slimming group,
identify factors associated with successful participation, and
to gather baseline data to help plan future interventions comparing
similar referral schemes with other interventions. Two inner city
Derby practices recruited patients (BMI > 30kg/m2) who were
given vouchers covering free membership and 12 week's attendance
at a Slimming World group of their choice. Patients were encouraged
to continue attending after 12 weeks but became responsible for
weekly fees, and monitoring continued for a further 12 weeks.
In summary, the average age of participants was 49 years, 88%
were female and 11% were known to have diabetes. The average BMI
of participants was 36kg/m2, with 50% having BMI>35. Following
recruitment 91 (85%) participants enrolled with a Slimming World
group. Of these, 62 (68%) completed the 12-week free attendance
with a mean weight loss of 5.4kg (6.4%). 34 participants (37%)
went on to complete 24 weeks with a mean weight loss of 11.0kg
(11.2%). Improvements in feelings of well-being were also found.
Qualitative data supports the partnership between the health sector
and Slimming World ("had I not had the push from the surgery
I would not have gone despite being overweight", "I
was helped at a time when I had a low self-esteem and financial
problems"). Results also highlighted the importance of subsidy
to ensure equality of access to the scheme. The study demonstrated
that it is quite feasible to set up referral schemes from primary
care into commercial sector slimming groups with minimal extra
resources for administration and audit of participation and outcome.
The required target of 5-10% weight loss for health improvement
was achieved in a significant percentage of referred patients.
Importantly, these results were achieved in a population that
includes a high percentage of socially disadvantaged groups and
low socio-economic status. The standard cost per patient for Slimming
World membership and three months attendance is £57.40. Compared
with current obesity therapy options, for example drug treatment
(the average cost of three months' Orlistat treatment being around
£126 depending on the dosage given), such a partnership provides
a highly cost effective approach.
Similar results have been obtained from other
referral schemes now running. For example, a trial referral scheme
set up with Burntwood, Lichfield and Tamworth PCT offers patients
referral to a choice of commercial slimming groups. Results from
patients referred to Slimming World groups show the scheme has
been very successful with, to date, 50 out 67 patients receiving
vouchers packs completing the initial 12 weeks attendance, six
still attending this trial period and only 11 failing to attend
for more than nine weeks. Average weight loss of those completing
the initial 12 weeks was 5.1kg (5% weight loss). Data continues
to be analysed as further patients complete the trial. This scheme
has now been extended with funding secured to offer a further
100 patients referral to a local Slimming World group.
Following the results of the pilot study Slimming
World have developed Slimming on Referral into a nation-wide scheme
which provides Primary Care supported packages of reduced membership
and weekly fees, which also includes administration and evaluation.
In addition, Slimming World plans to extend the initial study
into a larger intervention trial run in partnership with primary
care with long-term follow up of patients' attendance and outcome.
Rotherham Primary Care Trust—Tackling obesity:
factors influencing success
A recent study conducted as part of a series
of projects exploring access to services related to heart disease
within the South Yorkshire Coalfields Health Action Zone, focused
on factors which supported people in pursing their effort to lose
weight and those which acted as barriers. The study reported benefits
of commercial slimming sector (specifically Slimming World) services
over NHS services. It was recommended that in light of the current
restraints on the NHS and the extent of the psychological and
motivational support some people require, it is necessary to consider
the potential contribution of commercial organisations in tackling
overweight and obesity. Slimming on Referral partnerships between
the NHS and commercial organisations were strongly encouraged
as a way of removing financial barriers to effective weight management
services for those on low income.
Involvement in local strategies
Slimming World local management teams are currently
represented on a number of Primary Care Trust obesity strategy
groups and others are actively working with local GP surgeries.
We are keen to support more local obesity strategies and believe
we can offer a positive contribution; offering a sustainable approach
to weight management with already established local groups in
convenient locations and meeting times to suit lifestyle needs.
Slimming World responds to the needs of slimmers.
We provide for all socio economic groups in our meetings, making
no distinction in service or support. Our long-term target is
to provide a class for every 5,000 head of population in all sectors,
irrespective of income or employment status. We have a significantly
higher proportion of members in lower income groups. Groups are
run by a local Consultant and in meetings members share information,
recipes and news relevant to the locality and of particular benefit
and interest to the members. Recipe books cater for all tastes
and all pockets including a Convertible Cuisine cook book, which
makes use of leftover ingredients from yesterday's cooking to
optimise expenditure on store cupboard stocks. Consultants and
members together develop class resources and directories providing
information on local physical activity groups and a number organise
exercise groups and activities outside of meetings. Members are
very resourceful and very generous in their support of each other.
Slimming World have also launched an initiative
to help overweight men follow a healthier lifestyle and manage
their weight. We know that compared with women, there is a reluctance
and resistance for men to seek out help in a weight loss campaign
and currently men are under-represented in weight loss programmes
nationally. Although more men are seeking help, the biggest fear
when deciding to join a slimming group is that they will be the
only man. Within our strategy we aim to raise awareness among
men about the dangers of being overweight, and make practical
slimming solutions more accessible to men through a national network
of male-only groups run by men, as well as through other forms
of provision.
December 2003
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