Project #19:
How has the COVID-19 pandemic impacted the need for targeted weight management interventions amongst adults in the UK? An evaluation of pandemic-associated changes in BMI and metabolic parameters.

Lockdowns, stay at home orders and social distancing guidelines have had an impact on the lifestyles of people living in the UK. Studies have shown a reduction in physical activity during the pandemic, using a variety of data sources such as smartphone apps, recording from implantable cardiac devices and surveys. Some international surveys have reported that lifestyle changes during the pandemic have resulted in weight gain and increased Body Mass Index (BMI) (a measure of if you are a healthy weight for your height). In the UK people joining the NHS Diabetes Prevention Program, a targeted intervention for people at high risk of diabetes, in the year following the pandemic were on average heavier than those who joined the programme in the years before the pandemic. But there is a lack of data on how the weight (and consequently BMI) of the general population of adults living in the UK has changed since the onset of the pandemic.

Even prior to the pandemic, obesity was common in the UK. The 2019 Health Survey for England demonstrated that 64% of adults were overweight or obese. Obesity has long been known to be a risk factor for the development of a range of conditions such as diabetes, heart disease and stroke. This can be through the effect of obesity on established markers of metabolic risk such as: Blood Pressure (BP), Blood Cholesterol and Lipids Profiles (Lipid Profile), and blood sugar levels measured by Haemoglobin A1c (HbA1c). Furthermore, obesity, and conditions linked to obesity such as diabetes, have been shown to increase the risk of hospitalisation and/or death from COVID-19.

In response to these challenges the NHS has invested in a range of interventions to support weight loss. Such as the NHS England Digital Weight Management Programme (DWMP), which is currently available to help overweight and obese people living with diabetes and/or hypertension manage their weight. This analysis will look at how the number of people meeting the eligibility criteria for the DWMP has changed since the onset of the pandemic through assessing BMI changes in these groups. We will also describe, amongst all adults living in the UK, how BMI and metabolic markers have changed since the onset of the pandemic, in order to assess the need for weight loss interventions in the overall population.

We will further investigate whether some groups of people have, since the onset of the pandemic, experienced more weight gain (and resultant increase in BMI) and/or worsening of their metabolic markers than others. These groups will be identified based on personal characteristics (such as age, sex, ethnicity, deprivation and/or region of residence) and whether they have another co-existent medical condition, such as asthma or chronic kidney disease. This will demonstrate specific population groups that may most benefit from targeted weight loss interventions. We will specifically look at co-existing medical conditions that have been deemed common and important by the NHS Qualify Outcome Framework (QOF) - a tool that is used to assess the quality of care provided by GPs.

The findings of this study will help inform NHS England health care policy around the extent of need for specific weight loss interventions and which specific groups are at greatest need of these interventions. Furthermore, we hope the findings of the analysis will inform future focussed research.