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Summary: Benefits of bariatric surgery for obesity related comorbidities are well established. However, in the longer term, patients can become vulnerable to procedure specific problems, experience weight regain and continue to need monitoring and management of comorbidities. Effective longer term follow‐up is vital due to these complex needs post‐surgery. Current guidance recommends annual long‐term follow‐up after bariatric surgery. However, attendance can be low, and failure to attend is associated with poorer outcomes. Understanding patients' experiences and needs is central to the delivery of effective care. This rapid review has synthesized the current qualitative literature on patient experiences of healthcare professional (HCP) led follow‐up from 12 months after bariatric surgery. A recurring theme was the need for more and extended follow‐up care, particularly psychological support. Enablers to attending follow‐up care were patient self‐efficacy as well as HCP factors such as a non‐judgemental attitude, knowledge and continuity of care. Barriers included unrealistic patient expectations and perceived lack of HCP expertise. Some preferences were expressed including patient initiated access to HCPs and more information preoperatively to prepare for potential post‐surgery issues. Insights gained from this work will help identify areas for improvement to care in order to optimize longer term outcomes. [ABSTRACT FROM AUTHOR]

Objective: Helping people to change their health behaviours is becoming a greater feature within the role of health professionals, including through whole system initiatives such as Making Every Contact Count. Health services provide an ideal setting to routinely promote health behaviours, including physical activity. Snacktivity is a novel approach that promotes small bouts of physical activity (activity snacks) throughout the day. This study explored health professionals' initial experiences of delivering a Snacktivity intervention to promote physical activity within routine health consultations. A further aim was to investigate health professionals' ability/fidelity in delivering the Snacktivity intervention to their patients., Design: Semistructured interviews (n=11) and audio recording of consultations (n=46)., Setting and Participants: Healthcare professionals from a variety of specialisms who delivered the Snacktivity intervention within patient consultations., Results: Analyses revealed two higher-level themes of interest: (1) health professionals' conceptualisation of Snacktivity (subthemes: observations/reflections about patients' understanding, engagement and enthusiasm for delivering the Snacktivity intervention) and (2) health professionals' understanding of Snacktivity and experience in delivering the intervention (subthemes: delivering Snacktivity; limitations, challenges and possible improvements). Consultation audio recordings demonstrated health professionals delivered the Snacktivity intervention with high levels of fidelity. Health professionals were proficient and supportive of delivering the Snacktivity intervention within consultations although practical barriers to implementation such as time constraints were raised, and confidence in doing so was mixed., Conclusions: Health professionals were proficient and supportive of delivering the Snacktivity intervention within consultations. The primary barrier to implementation was the time to deliver it, however, gaining greater experience in the intervention and improving behaviour change counselling skills may reduce this barrier., Trial Registration Number: ISRCTN64851242., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

The number of displaced people, including asylum seekers and refugees, in the UK continues to rise. This article highlights findings from two participatory community listening exercises on the topic of health of displaced people., Competing Interests: Conflict of InterestThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: This is a summary of engagement events run as part of a National Institute for Health Research (NIHR) In-Practice Fellowship Programme. The views expressed are those of the author(s), and not necessarily those of the NHS, NIHR or Department of Health and Social Care.

Uptake of child weight management (CWM) support is typically low, and services are not available in all areas. Extended brief interventions (EBIs) have been proposed as an affordable way to provide enhanced support, at a level between one-off brief advice and intensive CWM programs. This rapid systematic review sought to synthesize evidence on the efficacy of EBIs for weight management and obesity prevention in children (2-18 years). Embase and Web of Science were searched from January 2012 to January 2022. Nineteen studies, reporting on 17 separate EBIs, were included. The quality of studies was variable, and the EBIs were heterogeneous. The majority of EBIs (n = 14) were based on motivational interviewing. Five of the included studies reported significant improvements in parent or child determinants of health behavior change. However, robust measures of behavioral determinants were rarely used. No studies reported significant positive effects on child weight. No clear patterns in outcomes were identified. There is currently insufficient evidence for EBIs to be adopted as part of CWM services. To improve the evidence base, EBIs that are currently being implemented by local health services, should be evaluated to establish the most effective content, how it should be delivered, and by whom., (© 2023 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity Federation.)

Background: Adults living with overweight/obesity are eligible for publicly funded weight management (WM) programmes according to national guidance. People with the most severe and complex obesity are eligible for bariatric surgery. Primary care plays a key role in identifying overweight/obesity and referring to WM interventions. This study aimed to (1) describe the primary care population in England who (a) are referred for WM interventions and (b) undergo bariatric surgery and (2) determine the patient and GP practice characteristics associated with both., Methods and Findings: An observational cohort study was undertaken using routinely collected primary care data in England from the Clinical Practice Research Datalink linked with Hospital Episode Statistics. During the study period (January 2007 to June 2020), 1,811,587 adults met the inclusion criteria of a recording of overweight/obesity in primary care, of which 54.62% were female and 20.10% aged 45 to 54. Only 56,783 (3.13%) were referred to WM, and 3,701 (1.09% of those with severe and complex obesity) underwent bariatric surgery. Multivariable Poisson regression examined the associations of demographic, clinical, and regional characteristics on the likelihood of WM referral and bariatric surgery. Higher body mass index (BMI) and practice region had the strongest associations with both outcomes. People with BMI ≥40 kg/m2 were more than 6 times as likely to be referred for WM (10.05% of individuals) than BMI 25.0 to 29.9 kg/m2 (1.34%) (rate ratio (RR) 6.19, 95% confidence interval (CI) [5.99,6.40], p < 0.001). They were more than 5 times as likely to undergo bariatric surgery (3.98%) than BMI 35.0 to 40.0 kg/m2 with a comorbidity (0.53%) (RR 5.52, 95% CI [5.07,6.02], p < 0.001). Patients from practices in the West Midlands were the most likely to have a WM referral (5.40%) (RR 2.17, 95% CI [2.10,2.24], p < 0.001, compared with the North West, 2.89%), and practices from the East of England least likely (1.04%) (RR 0.43, 95% CI [0.41,0.46], p < 0.001, compared with North West). Patients from practices in London were the most likely to undergo bariatric surgery (2.15%), and practices in the North West the least likely (0.68%) (RR 3.29, 95% CI [2.88,3.76], p < 0.001, London compared with North West). Longer duration since diagnosis with severe and complex obesity (e.g., 1.67% of individuals diagnosed in 2007 versus 0.34% in 2015, RR 0.20, 95% CI [0.12,0.32], p < 0.001), and increasing comorbidities (e.g., 2.26% of individuals with 6+ comorbidities versus 1.39% with none (RR 8.79, 95% CI [7.16,10.79], p < 0.001) were also strongly associated with bariatric surgery. The main limitation is the reliance on overweight/obesity being recorded within primary care records to identify the study population., Conclusions: Between 2007 and 2020, a very small percentage of the primary care population eligible for WM referral or bariatric surgery according to national guidance received either. Higher BMI and GP practice region had the strongest associations with both. Regional inequalities may reflect differences in commissioning and provision of WM services across the country. Multi-stakeholder qualitative research is ongoing to understand the barriers to accessing WM services and potential solutions. Together with population-wide prevention strategies, improved access to WM interventions is needed to reduce obesity levels., Competing Interests: HP has received speaker honoraria from Johnson & Johnson and Novo Nordisk for educational events. Honoraria received for participating in the development and presentation of an algorithm for the management of obesity in primary care supported by arm’s length sponsorship from Novo Nordisk. She is a co-author on a publication of UK data from a study funded by Novo Nordisk (no honorarium)., (Copyright: © 2023 Coulman et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Competing Interests: Competing interests: We declared the following interests based on NICE’s policy on conflicts of interests (https://www.nice.org.uk/Media/Default/About/Who-we-are/Policies-and-procedures/declaration-of-interests-policy.pdf): no conflicts of interest were declared. The guideline authors’ full statements can be viewed at https://www.nice.org.uk/guidance/gid-ng10182/documents/register-of-interests-2

Unlike various countries and organisations, including the World Health Organisation and the European Parliament, the United Kingdom does not formally recognise obesity as a disease. This report presents the discussion on the potential impact of defining obesity as a disease on the patient, the healthcare system, the economy, and the wider society. A group of speakers from a wide range of disciplines came together to debate the topic bringing their knowledge and expertise from backgrounds in medicine, psychology, economics, and politics as well as the experience of people living with obesity. The aim of their debate was not to decide whether obesity should be classified as a disease but rather to explore what the implications of doing so would be, what the gaps in the available data are, as well as to provide up-to-date information on the topic from experts in the field. There were four topics where speakers presented their viewpoints, each one including a question-and-answer section for debate. The first one focused on the impact that the recognition of obesity could have on people living with obesity regarding the change in their behaviour, either positive and empowering or more stigmatising. During the second one, the impact of defining obesity as a disease on the National Health Service and the wider economy was discussed. The primary outcome was the need for more robust data as the one available does not represent the actual cost of obesity. The third topic was related to the policy implications regarding treatment provision, focusing on the public's power to influence policy. Finally, the last issue discussed, included the implications of public health actions, highlighting the importance of the government's actions and private stakeholders. The speakers agreed that no matter where they stand on this debate, the goal is common: to provide a healthcare system that supports and protects the patients, strategies that protect the economy and broader society, and policies that reduce stigma and promote health equity. Many questions are left to be answered regarding how these goals can be achieved. However, this discussion has set a good foundation providing evidence that can be used by the public, clinicians, and policymakers to make that happen., Competing Interests: All authors declare no competing interests relevant to this conference report. ADM has received grants or contracts from Fractyl, Novo Nordisk and Randox, and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Novo Nordisk AstraZeneca, Currax and BI. HP has received grant funding paid to institutions, from Public Health England, the Office for Health Improvement and Disparities, and the National Institute for Health Research; honoraria for educational events from Johnson & Johnson; as well as honoraria for educational materials and accompanying presentations – arms length sponsorship and travel expenses for delivering an educational presentation from Novo Nordisk. She has also had unpaid leadership or fiduciary roles as a British Obesity and Metabolic Surgery Society council member, Obesity Empowerment Network professional steering group co-opted member and NICE weight management guidelines committee member. EFr has received research grants from NIHR (NIHR 152858; NIHR204247; NIHR300773; NIHR133099; NIHR203012; NIHR 13/164/51; RP-PG-0618-20008), and UKRI (BB/V004832/1); Royalties from authorship on an OUP Book from Oxford University Press; travel and accommodation support for attending the UK ASO22 conference from the Association for Study of Obesity, and travel support for attending an NIHR Academy training meeting in London as invited speaker from NIHR. She has also had leadership or fiduciary roles as an Elected Board member for the International Health Economics Association and a Member of NIHR Public Health Research funding panel. SB has received a grant paid to his employer, the Institute for Employment Studies IES, from Novo Nordisk to conduct research on obesity stigma in employment. IES retains full editorial control of all research outputs. AB has received researcher led research support and supported attendance of the Obesity Week/BOMSS 2022 from Novo Nordisk, and researcher led research grants from NIHR/BRC, Rosetrees Trust, MRC, BDA, BBSRC and Innovate UKRI. He has also received personal honoraria for presentations/chairing from Novo Nordisk, personal honoraria from Obesity UK and Johnson & Johnson, institutional fees from PHE and stocks from Reset Health Ltd. He has had unpaid leadership or fiduciary roles as Vice Chair Obesity Specialist Group for British Dietetic Association, Committee member OPEN, Scientific Council for British Nutrition Foundation, and Strategic Council for All Party Parliamentary Group on Obesity. JL has received grants or contracts, paid to institutions, from the National Institute of Health Research and personal consulting fees, support for attending meetings and/or travel, as well as participation on a Data Safety Monitoring Board or Advisory Board from Novo Nordisk. She is also a Current employee of AstraZeneca but was not at the time of this work and AstraZeneca had no role in this work. NI has received a grant from NIHR, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Obesity Empowerment Network, National Obesity Audit, Novo Nordisk and Johnson & Johnson, as well as support for attending meetings and/or travel from SQOT and BOMSS. She has also had leadership or fiduciary roles for Obesity Empowerment Network and BOMSS. ML has received consulting fees from Novo Nordisk and Nestle and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Nestle, Oviva, Roche and Novo Nordisk. SW has had travel costs paid by Novo Norisk for attendance at obesity conferences. KC has received payment for Lecture Apollo Endosurgery and speaking fees from Novo Nordisk. GKD has received research grants from Novo Nordisk and DDM, as well as payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Novo Nordisk and J&J/Ethicon & Medtronic. SLB has received direct payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Novo Nordisk and Guys & St Thomas Trust, as well as direct payment for expert testimony from Novo Nordisk. JM has an unpaid leadership or fiduciary role in the Association for the Study of Obesity as a Trustee. RLB has received personal payments for consulting fees from Novo Nordisk, Pfizer, Eli Lilly, ViiV, Gila and Therapeutics Ltd; personal payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from International Medical Press, Novo Nordisk, ViiV, Eli Lilly and Medscape; support for attending meetings and/or travel from Novo Nordisk and Eli Lilly, and personal payment for participation on a Data Safety Monitoring Board or Advisory Board from Novo Nordisk, Pfizer, Eli Lilly, ViiV, Gila and Therapeutics Ltd. She also has unpaid leadership or fiduciary roles as Chair of the Royal College of Physicians (RCPs) Advisory Group on Nutrition, Weight and Health, Member of the RCPs Advisory Group on Health Inequalities, Founding member, Trustee and Steering Group Chair for the Obesity Empowerment Network UK, Committee Member for BOMMS, Committee Member for NBSR, Co-opted Trustee ASO, and Co-Chair of NHS England Tier 3 and Tier 4 Clinical Advisory Group., (© 2023 The Authors.)

Background: People living with overweight or obesity (PLwO) can be stigmatised by healthcare professionals (HCPs). Reducing focus on weight is a proposed strategy to provide less threatening healthcare experiences. Given the lack of research on weight bias within obesity services, this study aimed to explore implicit bias among obesity specialist HCPs and explore views on non-weight focused approaches., Methods: Obesity specialist HCPs were invited to a webinar, "An exploration of non-weight focused approaches within bariatric services", held in October 2021. Implicit weight bias was examined using the BiasProof mobile device test, based on the Implicit Association Test. Poll data was analysed descriptively, and qualitative data was analysed using framework analysis., Findings: 82 of the 113 HCPs who attended the webinar consented to contribute data to the study. Over half (51%) had an implicit weight bias against PLwO. Most (90%) agreed/strongly agreed that obesity services are too weight focused and that patients should not be weighed at every appointment (86%). Perceived benefits of taking a non-weight focused approach included patient-led care, reducing stigma and supporting patient wellbeing, while perceived barriers included loss of objectivity, inducing risk and difficulty demonstrating effectiveness., Interpretation: Our findings indicate that half of obesity specialists HCPs in our sample of 82 providers, who are primarily dieticians and psychologists, have an implicit weight bias against PLwO. HCPs feel that a weight-focused approach within services was a barrier to patient care, but that there is a lack of alternative non-weight focused measures. Further research is needed into substitute outcome measures for clinical practice, also seeking the views of PLwO, and into interventions to address implicit weight bias., Funding: Johnson & Johnson funded the BiasProof licence and publication open access charge., Competing Interests: S.A. has received speaker honorarium from Johnson & Johnson for educational events and support for attendance at academic meetings from Novo Nordisk and British Dietetic Association GET Fund. S.A. reports research grants from British Dietetic Association Obesity Specialist Group. E.S. has received speaker honorarium from Johnson & Johnson for educational events. P.C. has received speaker honorarium from Johnson & Johnson for educational events. S.W.F. reports research grants from National Institute for Health Research, Public Health England, Doncaster Council, West Yorkshire Combined Authority, Johnson and Johnson, Novo Nordisk and the University of Leeds, personal fees from the Royal College of General Practitioners, Institutional fees from Public Health England, and support for attendance at academic meetings from Novo Nordisk and Johnson & Johnson. H.M.P. has received speaker honoraria from Johnson & Johnson and Novo Nordisk for educational events. Honoraria received for participating in the development of an algorithm for the management of obesity in primary care supported by arm's length sponsorship from Novo Nordisk. Co-author on a publication of UK data from a study funded by Novo Nordisk (no honorarium). H.M.P. reports research grants from National Institute for Health Research, Public Health England and the Office for Health Improvement and Disparities., (© 2022 The Author(s).)

Background: Guidelines suggest that GPs should intervene on patients' weight, but to do so GPs must first recognise that a patient may have a weight problem and weigh them., Aim: To examine whether GPs and trainee GPs can identify overweight and obese body weights by sight, and if this influences whether they would discuss weight with a potential patient., Design and Setting: Study of GPs and trainee GPs on the lists of the UK NHS Workforce West Midlands Deanery and NHS Sandwell and West Birmingham Clinical Commissioning Group., Method: Participants viewed 15 standardised photographs of healthy-weight, overweight, and obese young males, and estimated their BMI, classified their weight status, and reported whether they would be likely to make a brief intervention for weight loss with that person., Results: The sample of GPs and trainee GPs correctly classified a mean of 4.0/5.0 of the healthy weight males, a mean of 2.4/5.0 of the overweight, and a mean of 1.7/5.0 of the obese males. For each 1 kg/m(2) increase in actual BMI, participants underestimated BMI by -0.21 (95% CI = -0.22 to -0.18), meaning that participants would underestimate the BMI of a man of 30 kg/m(2) by approximately 2.5 kg/m(2), but were more accurate for lower body weights. Participants were more likely to intervene with those with a higher estimated BMI (OR 1.53, 95% CI = 1.49 to 1.58)., Conclusion: This sample of predominantly trainee GPs perceived overweight and obese weights as being of lower BMI and weight status than they actually are, and this was associated with a lower intention of discussing weight management with a potential patient. This was found to be true for trainee and fully qualified GPs who participated in the study. Healthcare professionals should not rely on visual judgements when identifying patients who may benefit from weight management treatment., (© British Journal of General Practice 2014.)