Table_2_“We’re one small piece of the puzzle”: evaluating the impact of short-term funding for tier two weight management services.XLSX

IntroductionOverweight and obesity are a global health epidemic and many attempts have been made to address the rising prevalence. In March 2021 the UK government announced £100 million of additional funding for weight management provisions. Of this, £30.5 million was split across local authorities in England to support the expansion of tier two behavioural weight management services for adults. The present work aimed to explore how this funding was used within the Yorkshire and Humber region to consolidate learning, collate best practice, and provide recommendations for future funding use.
MethodOne-hour semi-structured interviews were conducted with 11 weight management service commissioners representing 9 of the 15 local authorities in the region. Interviews were recorded, transcribed and analysed using an established health inequality framework. From this, recommendations were co-developed with the commissioner group to establish best practice for future funding use.
ResultsCommissioners recognised that targeted weight management services were only one small piece of the puzzle for effectively managing obesity. Therefore, recommendations include targeting underserved communities, focussing on early prevention, addressing weight management in a whole systems context, and embracing innovative and holistic approaches to weight management.
DiscussionCurrent short-term funding and restrictive commissioning processes of tier two services prevents sustainable and innovative weight management practice which is detrimental to patients, falls short of addressing health inequalities and negatively impacts staff health and wellbeing.

引言
超重与肥胖已成为全球性公共卫生流行病，针对其患病率持续攀升的现状，各方已开展诸多应对举措。2021年3月，英国政府宣布额外拨款1亿英镑用于体重管理相关支持项目。其中3050万英镑被分配至英格兰各地地方当局，用于扩大成人二级行为体重管理服务（tier two behavioural weight management services）的覆盖范围。本研究旨在探究约克郡与亨伯地区如何使用该笔拨款，以整合实践经验、梳理最佳实践范式，并为未来拨款的合理使用提供针对性建议。

方法
本研究对该地区15个地方当局中的9个的11名体重管理服务采购专员开展了时长1小时的半结构化访谈。访谈内容均被录制、转录，并采用成熟的健康不平等分析框架进行编码分析。基于此，研究团队与专员群体共同制定相关建议，以确立未来拨款使用的最佳实践标准。

结果
专员们认识到，针对性的体重管理服务仅是有效应对肥胖问题的众多环节之一。因此，本次研究提出的建议包括：关注服务供给不足的社区、聚焦疾病早期预防、从全系统层面推进体重管理工作，以及采用创新性与整体性的体重管理方案。

讨论
当前二级行为体重管理服务的短期拨款模式与限制性的委托流程，阻碍了可持续且具有创新性的体重管理实践，这不仅对患者群体不利，未能有效解决健康不平等问题，还会对工作人员的健康与福祉产生负面影响。