Support for eating difficulties in NHS Complications of Excess Weight Clinics: A service evaluation

Abstract

Background: In 2021, NHS England commissioned a specialist weight management pilot; the Complications of Excess Weight (CEW) programme, which aimed to deliver multidisciplinary intervention for children and young people (CYP) living with severe obesity. The support provision included medical, dietetic, psychological, social and physical activity support. Around 80% of CYP seeking support for weight management are reported to experience some form of eating difficulty (1), which, if left unmanaged, may escalate into clinical eating disorders (2). Aims: To explore provision of support for eating difficulties in a single CEW service, examining the realities of delivering simultaneous weight management and eating support for CYP living with severe obesity. Methods: A qualitative service evaluation was conducted in one CEW service. A Patient and Public Involvement group of CYP and their caregivers with interests in eating difficulties informed the project design, methods, and analysis. Semi-structured interviews were conducted with four healthcare professionals delivering the CEW service and one CYP receiving support. Data were triangulated and analysed using reflexive thematic analysis. Results: Five overarching themes were identified: (a) Structure to facilitate a holistic service; (b) Tools are not designed for this population; (c) Challenges of establishing an eating support pathway; (d) Wider considerations in delivering support; and (e) Complexities of eating difficulties in higher weight. Staff described confidence in delivering integrated support for eating difficulties within the weight management setting, especially with interdisciplinary work with specialist eating disorder teams. Systemic challenges, including lack of pathways outside CEW, and lack of validated assessment tools for this population, were identified. Conclusion: The CEW service offers a holistic, person-centred model for integrating eating difficulty support with weight management. These findings highlight the value of strengthened collaboration between eating difficulty and weight management services, and improved assessment tools. Knowledge sharing and integration across disciplines is recommended to enhance patient experience and potential outcomes.