HC 1048-III Health CommitteeWritten evidence from LighterLife (PH 26)

Executive Summary

LighterLife programmes provide a multi-component, effective and cost efficient weight-management solution for people who are heavily obese and have large amounts of weight to lose. Problems with public health in England have meant that such programmes have often been overlooked when it comes to treating overweight and obese individuals.

The reforms proposed by the Coalition Government present a number of potential improvements to the system. However, questions remain about a number of areas. LighterLife would make the following recommendations:

LighterLife welcome this Government’s evident interest in tackling the pressing public health issues that affect this country and commitment to public health, the funding of which has been ring-fenced. We consequently hope that sufficient resources will be allocated to effectively improve public health. With the Foresight report estimating that two thirds of men could be obese by 2050, LighterLife would like to see appropriate and sufficient investment in the provision of effective, and cost-effective, weight-management options.

It is encouraging to see central government planning to work more and more with local government on improving public health, as both have a considerable financial stake in ensuring that England’s population becomes healthier. As it stands, however, there are considerable fears that the systems and processes that should be in place to ensure that the two work effectively with each other are not there. This threatens to undermine the Government’s stated aims and set back improving public health.

The experience of many obesity professionals with the QOF incentive scheme for GPs has shown that simply incentivising people to register the numbers of overweight and obese people is ineffective. LighterLife would like to see the Public Health Outcomes Framework recognise this by measuring the number of people that are treated for overweight or obesity instead.


1. LighterLife is a UK company offering weight loss and weight-management programmes for people who are clinically obese or overweight. Our programmes are based on the recognition that lasting weight-management success can only come by addressing the underlying reasons behind weight gain. Without this understanding, weight re-gain is highly likely.

2. The LighterLife programme was researched and developed over many years before finally being launched in 1996. In 2007 LighterLife for Men was established – the only national weight-management and coaching programme developed specifically for men. In November 2008 LighterLife Lite was launched – a weight-loss programme for overweight people, with one to three stone to lose (BMI 25-29.9).

3. LighterLife is supported by expert teams, including nursing and nutrition advisors, a medical director, psychotherapist support and a medical advisory board, comprising international experts in obesity, metabolism, endocrinology, clinical nutrition and psychology. The board’s role is to review all clinical aspects of LighterLife, and provide advice and direction to ensure compliance with best practice applicable to the use of very-low-calorie diets (VLCDs) and low-calorie diets (LCDs), current evidence-based research and health guidelines, including NICE guideline 43 on obesity. This ensures the best possible programmes are delivered, thus facilitating safe and effective weight loss.

LighterLife Programmes in Detail

4. LighterLife offers multi-component programmes, with increased physical activity, behavioural change and healthy eating being key features. The emphasis is on identifying personal psychological drivers of obesity and overweight. This enables individuals to achieve a healthier and manageable BMI by making sustainable changes to the way they eat, think and live.

5. Weight loss is initiated via either:

LighterLife Total – a VLCD for the obese (BMI ≥30kg/m2) or for women/men with BMI ≥28–29.9kg/m2 and a waist circumference >88cm/102cm, using four nutritionally complete Foodpacks per day


LighterLife Lite – an LCD for the overweight (BMI 25–29.9kg/m2), combining three nutritionally balanced Foodpacks (including soups, shakes, bars and porridge) per day with a meal from a selection of specified foods to provide key nutrients and energy during weight loss.

6. In conjunction, LighterLife Weight-Management Counsellors work with participants in single-sex, weekly groups (maximum 12) to facilitate techniques from transactional analysis and cognitive behavioural therapy. Developed for behavioural modification in weight management, these techniques aim to help participants understand their relationship with food and develop new skills to support healthier eating and lifestyle behaviours, including being more active.

7. Following weight loss, LighterLife’s Management Programme focuses on establishing a healthier lifestyle through the continued development of a healthier psychology. It empowers people with coping mechanisms developed in the weekly group meetings to support ongoing change, both physical and emotional. This enables sustainable weight management and a reduction in the risk of weight-associated co-morbidities. The Management Programme progresses individuals to a healthy, balanced and varied diet, consistent with current advice on healthy eating, and support meetings and weight checks are free for life.

8. We would like to thank the Health Select Committee for the opportunity to comment on the Coalition Government proposals for public health. While our comments will focus, for obvious reasons, on obesity, we hope that these examples illustrate wider issues with the Government’s planned changes in public health.

Answers to Specific Questions

The creation of Public Health England within the DH

9. Although LighterLife welcomes the establishment of Public Health England (PHE) as a co-ordinating body for public health, we have some concerns that its remit is too narrow.

10. Ideally, LighterLife would like to see PHE take a strong role in guiding the myriad commissioning bodies towards treatment options that are both effective and cost-effective and based on clinical evidence. Such guidance will ensure that there is a more uniform national approach towards obesity solutions, which will help to reduce not only inequality across the country but will also allow for more innovative solutions to be taken forward and applied.

11. PHE should also find a role as a provider of the latest clinical evidence, underpinning the services that local commissioners wish to use. This would complement and enhance NICE’s already existing role. The need for this is explained by the fact that NICE clinical guidance is only reviewed at most once every three years.

The public health role of the Secretary of State

12. LighterLife welcomes the Secretary of State’s role in improving public health in England. There is no doubt that for this improvement to happen strong political leadership is needed; considerable resources are required to slow the rising obesity rate in this country, let alone to actually reduce it. The 2007 Foresight Report on obesity predicted that by 2050 obesity alone could affect 60% of adult men, 50% of adult women and 25% of children. The resulting costs to the NHS could be in the region of £10 billion a year, with wider costs to society reaching nearly £50 billion annually.

13. Resources targeted at treating obesity now will benefit not just the individual who is able to lose weight, but also the future NHS and taxpayer, who will not have to pay to treat illnesses related to obesity, such as Type-2 diabetes. Priority must be given to ensuring that public health programmes are properly funded.

The future role of local government in public health (including arrangements for the appointment of Directors of Public Health; and the role of Health and Wellbeing Boards, Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies)

14. There is plenty to recommend the involvement of local government in public health. Although not responsible for direct healthcare costs, local authorities will be responsible for related costs, and it is right that they should have a say in how public health spending is prioritised in their area not least because they are in a better position to be more familiar with local needs.

15. Localities can also act as laboratories, enabling them to experiment and innovate with approaches that work best for them and sharing best practice with other local authorities.

16. This all assumes that central government and local government will be able to work effectively together; we are concerned that this is too big an assumption. Though it is vital for improving public health outcomes that the centre and the regions work well together, LighterLife is concerned that the systems that will ensure this are not in place.

17. A related concern is about funding. The Government has promised £4bn in ring-fenced public health spending, something to be welcomed considering that such spending has too often been the first to be disappear in previous times of austerity. Nevertheless, with local authorities suffering a considerable cut in funding they may be tempted to stretch the definition of public health and divert funding away from more pressing concerns, such as obesity treatment.

18. In addition, our experience with local designs for public health interventions finds that they are often a poorly designed intervention with unrealistic funding expectations. The programme that current local public health providers such as PCTs want to commission for their obese population often seeks a small total weight loss of 5kg to be achieved by end of the 12 week intervention period, with a long term maintenance weight loss of only 2.5 kg six months after the intervention. However, for a significant health benefit to occur, most obese people would need to lose much more than that, and at least 5–10% of their weight. Such weight loss could be achieved by an effective programme such as that provided by LighterLife.

19. Furthermore, in most cases of local public health interventions, the budget provided per person per week is low; for example, as little as £3 is provided, per person, per week, while private providers are more expensive (LighterLife’s programmes that replace the totality of a person’s diet cost £72 per week, which does include all of the person’s meals). As such the public health intervention as proposed by a PCT often leads to a loss of money/investment while contributing neither to the reduction of obesity nor the reduction of the prevalence of obesity related illnesses. Effective, yet privately provided, programmes are deemed to be too expensive and the rate of weight loss experienced on the programme too high to be successful at the tender. In the longer term, however, use of effective weight-loss and weight-management programmes will help many people lose weight and prevent a great many people from becoming obese, preventing them from developing obesity-related conditions, such as Type-2 diabetes, that are expensive to treat.

Arrangements for public health involvement in the commissioning of NHS services; arrangements for commissioning public health services

20. As a provider of weight-management programmes, LighterLife has concerns that the commissioning of weight-management/obesity services in particular has become confused. There are three types of treatment for obesity, two of which are provided by the NHS – bariatric surgery at one, extreme end; drug treatment at the other, milder end. Weight-management services, which fill a crucial gap in between expensive surgery and often ineffective drugs, are to be commissioned by local authorities. The potential for confusion is clear and clarification is required.

21. Despite this, LighterLife strongly believes that there should be strong cooperation between the different institutions/authorities that share responsibility for tackling public health and weight-management issues in particular. Such cooperation will help to ensure the much needed balance between national guidance that can help to increase the provision of uniform solutions for obesity and the specific needs required at local level.

The structure and purpose of the Public Health Outcomes Framework

22 Although LighterLife appreciates the Government’s intentions with this Outcomes Framework, obesity is one of the most important pressing public health issues as it affects so many people. The Outcomes Framework needs to reflect this and one way it can do this is by featuring indicators that measure an area’s progress in lowering the obesity rate, rather than simply measuring the prevalence of healthy weight.

23. Simply doing the latter, as this Outcomes Framework proposes, will not have the impact required. The experience of many public health professionals with the GP incentive scheme, the QOF, has shown this.

24. If the Outcomes Framework is adjusted so that it highlights those authorities that are most successfully tackling obesity, other local authorities will also be incentivised to learn and share best practice.

25. Developing an indicator that measures progress in tackling obesity would encourage transparency in local authorities, as they would be required to demonstrate that they are actively tackling the problem identified and thereby helping to reduce health inequalities.

Arrangements for funding public health services (including the Health Premium)

26. It is significant and welcome that the Government has chosen to ring-fence the public health budget, particularly at a time of austerity. Too often in the past this budget has been targeted for cuts and the least well-off have suffered accordingly. In view of the number of people whose lives are blighted by this condition and past inadequate designs for interventions, LighterLife hope that Local Government will allocate sufficient and much needed funding from this budget to effective weight-management treatments.

27. A Health Premium will only produce results if it is spent on services that actually help an individual improve their health. As noted above, the Outcomes Framework should measure an area’s progress in lowering the obesity rate, rather than simply measuring the prevalence of healthy weight, to enable better targeting of the Premium.

How the Government is responding to the Marmot Review on health inequalities

28. 2010’s Marmot Review into health inequalities noted that “as in other high-income countries, in England, obesity is associated with economic and social deprivation...and is becoming increasingly common”. Prevalence of overweight and obesity is strongly linked to lower socioeconomic groups and the areas of England with the highest obesity rates are amongst the poorest.

29. Well directed and well targeted use of extra money distributed under the auspices of the Health Premium will incentivise Local Authorities to actively try and bring down the local obesity rate. In particular, use of private providers who can provide clinically effective and cost-effective weight-management services will demonstrate value for the extra money invested.

30. Private providers such as LighterLife are especially well equipped to deal with health inequalities as our local Weight-Management Counsellors are often able to access hard-to-reach groups (eg ethnic minorities). Government can help through increased use of Personal Health Budgets, which give the user greater choice and control over their own treatment.


31. Whilst LighterLife broadly welcomes this Government’s plans for an appropriately funding public health service, there are still a great many issues which require clarity. It is not clear, for example, how much funding will be available to treat obese and overweight patients and thus help prevent future public health problems.

32. Similarly, LighterLife has considerable concerns about the practicalities of the system that the Government has proposed. Who will ensure that central and local governments work effectively together? How will the Public Health Outcomes Framework encourage steps to actively tackle obesity in certain areas? We hope that this inquiry casts some more light on these proposals.

July 2011

Prepared 28th November 2011