From policy to person-centred care: insights into the development of complications of excess weight clinics in England

Background

The Complications of Excess Weight (CEW) Programme, funded centrally by NHS England, aims to provide innovative, person-centred, holistic care for children and young people living with severe obesity and associated complications (e.g. hypertension, type 2 diabetes, depression). Twenty-one CEW services were established across England in 2021, rising to 38 in 2024. This qualitative study aimed to gather the perspectives of senior professionals involved in the design, development, and commissioning of the CEW programme.

Methods

Eleven online semi-structured interviews were completed between April and November 2024. Participants included senior officials from NHS England, the Department for Health and Social Care, the Office for Health Improvement and Disparities, specialist weight management clinicians, and a national children’s charity. Interview questions examined stakeholder involvement, the policy backdrop, the intended purpose and expectations of the CEW programme, evaluation expectancies, and future directions. Data were analysed thematically.

Results

Participants described how the CEW programme was developed to meet the needs of a vulnerable population while developing a robust evidence base, aligning with aspirations of the NHS Long Term Plan. The CEW service specification was designed at a high-level to allow local flexibility in implementation and delivery approaches. Key concepts included a biopsychosocial multi-disciplinary approach to manage obesity and complications. Despite systemic challenges, the dedication of staff and involvement of patients supported CEW delivery.

Conclusions

This study offers insight into the development of CEW services from a range of key stakeholders. The importance of public involvement to deliver a complex service within the context of perceived challenges of a fragmented and underfunded system are highlighted. There is a need for sustained investment in CEW, which incorporates a holistic multidisciplinary design to ensure equitable and effective healthcare provision for this vulnerable patient group.