“It’s the biggest not one-size-fits-all service I’ve ever worked in”: the realities of delivering a ‘complications of excess weight’ service for children and young people in England from a multidisciplinary team perspective

Background

Thirty-eight specialist weight management services for children and young people (CYP) living with severe obesity are being piloted across England. These ‘Complications of Excess Weight’ (CEW) services aim to provide holistic, person-centred care to CYP, delivered by a multi-disciplinary team (MDT). The ENHANCE study (NIHR, 158453), a national evaluation of the CEW programme, sought to develop the evidence base and understanding of optimal models of care. This qualitative study aimed to explore the realities of delivering a CEW service from the perspective of MDT members.

Methods

Online semi-structured one-to-one interviews (N = 28 MDT members) were conducted across seven purposefully sampled CEW services between April-June 2025. Interviews explored barriers and facilitators to delivery, perceptions of patient cohort, service demand, and how CEW fits within wider weight management systems. Data were transcribed and analysed using Framework Analysis.

Results

Three overarching themes were identified: (1) Achieving person-centred care in CEW services; (2) Navigating complexity in the CEW patient journey; and (3) The challenges of designing and delivering a pilot. Participants described a complex patient group who required holistic, innovative approaches to care. Challenges included high service demand, a lack of appropriate step-down from CEW services, a lack of transitional care pathways into adult weight management for 16-18-year-olds, and uncertainty about sustainable long-term funding and staffing in the context of a pilot programme.

Conclusions

A long-term commissioning plan would be needed to ensure stability and appropriate care for CEW services and the families they support. MDTs must be equipped with the skills to respond effectively to high levels of patient complexity, and gaps in the availability of less intensive services (step-down) and transitional care into adult weight management require urgent attention to ensure any positive medical and psychosocial improvements yielded from CEW are not lost.