What interventions are effective and cost-effective for supporting the health and well-being of people with obesity on healthcare waiting lists? A Rapid Review

Abstract

Currently, there is a significant demand for tier 3 weight management services, with individuals waiting between three and five years to access these services in parts of Wales. This rapid review aimed to identify and synthesise the evidence for the effectiveness of strategies for supporting the health and well-being of individuals with obesity on such waiting lists, with a focus on practical and resource-efficient interventions that can be implemented within current healthcare constraints. Seven studies were included, and these were published between 2017 and 2024. Studies were conducted in a range of countries, and no relevant UK based study was identified. Studies investigated exercise, physical activity counselling, education and text message-based prehabilitation interventions in people awaiting surgery. This review did not identify any studies assessing the effectiveness of interventions that could be feasibly implemented or scaled up within the resource limitations of typical tier 3 weight management services in Wales. Most studies required significant resource and input from healthcare professionals, and were delivered in-person at healthcare settings or remotely via teleconferencing. All studies assessed patients with obesity on a waiting list for surgery, but none included a patient population that matched those on waiting lists for tier 3 weight management services in Wales. None of the studies evaluated the cost-effectiveness of interventions. Overall, we are not confident in the evidence. Most studies were of low quality, with significant methodological and reporting limitations affecting the reliability of their findings. Although we have little confidence in the evidence, there is some evidence from four studies, that suggest exercise interventions may support the quality of life and anthropometric measures of people with obesity waiting for surgery. This evidence could be cautiously considered to inform interventions in practice, but those designing interventions should be mindful of the population and setting in which they are applied. Other interventions, including text message-based prehabilitation interventions, preoperative educational interventions and physical activity counselling interventions were reliant on findings from single low-quality studies. Some of these interventions showed improvements for participants quality of life, mental well-being and anthropometric measures. In relation to obesity weight management services, allocation of resources should allow for conducting and evaluating robust studies and economic evaluations investigating interventions for those awaiting obesity weight management services. Given the current healthcare resource constraints, it may be beneficial to consider the feasibility and scalability of interventions during their design.