NHS Glos. CCG: Obesity

Kirstie Tew, MSc., Abby Barton, BSc., & Sophie Middleton

Executive Summary

Background

Reducing body weight is crucial for obese individuals to lower their risk of many co-morbidities alongside gaining other physiological and psychological health benefits that come with losing weight. Physical activity is key for weight loss as it increases metabolic rate, which results in increased energy expenditure and thus, negative energy balance (Van Baak, 1999). NHS Gloucestershire Commissioners felt that KiActiv^® Health could be a valuable tool to support obese individuals with a body mass index (BMI) greater than 30.0 kg/m², in order to better self-manage their condition and reduce the likelihood of complications which could lead to hospital admission.

Innovation

KiActiv^® Health is a personalised and guided online behaviour change service that empowers participants to optimise everyday physical activity in the context of their condition. KiActiv^®’s patented technology evaluates minute-by-minute physical activity data from a validated wearable monitor, which is displayed instantly in the user’s personalised online dashboard, and is available 24/7 to provide meaningful and actionable feedback. Patients are also supported remotely by phone calls with a dedicated KiActiv^® Mentor at 6 key time points during the 12-week programme, to help them build an understanding of the value of their daily activities and the confidence to plan, monitor and improve. At the end of the 12-weeks, the patients retain access to their personal dashboard and activity monitor, enabling them to continue their self-management using the technology if desired.

Purpose/objective

To provide an accessible service to enable obese patients to improve self-care through the optimisation of their everyday physical activity.

Methodology

Eligible patients were invited to participate in KiActiv^® Health via a letter sent out by their GP practice. Enrolled patients were sent a wearable activity monitor, before participating in the 12-week KiActiv^® Health programme. They were supported at key time points throughout by a trained KiActiv^® Mentor. Data was analysed from a range of sources: the KiActiv^® Health platform, KiActiv^® Mentor calls, and a self-administered online questionnaire. 

Key Findings

• Demographics: 393 patients started KiActiv^® Health (208 females, 185 males), average age = 59 years, average body mass index (BMI) = 36.4kg/m².
• Completion: 303 patients (77.1%) (161 females, 142 males) have completed the 12-week programme.
• Engagement: The use of the technology was excellent and included 91% of days being classed as having complete data sets.
• PROMS: A self-administered online questionnaire was completed on completion of the 12-weeks of KiActiv^® Health.
  • 96.1% of respondents felt that their understanding of physical activity had improved as a result of participation in KiActiv^® Health
  • 92.1% of respondents felt confident that they could manage their physical activity for their overall health now and in the future
  • 86.8% of patients felt that KiActiv^® Health had benefitted them in some way
  • 93.4% of patients stated that they would recommend KiActiv^® Health to a family member or friend
• Patient reported benefits included:
  • An increased awareness of all movement, not just exercise
  • Understanding the accessibility of everyday physical activity, and finding more enjoyment in daily activities
  • Weight loss (for those who set out to achieve this)
  • Benefits to other aspects of lifestyle such as improved sleep, and healthier eating habits.
  • Reduced blood sugar levels
  • The ability to plan, self-manage, and improve daily physical activities
  • The desire to sustain the positive changes that have been made to their lifestyle
• Weight Loss:
  • Of the patients who reported their weight pre- and post-programme, 80% reported a weight loss
  • The average weight loss recorded was 3.8 kg, equivalent to an average reduction of 3.6% of overall body weight
  • 27.3% of people who reported a weight loss were able to lose at least 5% of their body weight during the 12-weeks
• Physical Activity Data:
  • 100% of patients improved their physical activity in 1+ dimensions
  • 100% of patients improved their physical activity in 3+ dimensions
  • 86% of patients improved their physical activity in 4+ dimensions
  • The average increases in physical activity from baseline (i.e., physical activity dose) across an average of 66 complete days were:
    • Non-Sedentary Time: +27hrs 28mins (+14%)
    • Moderate Activity: +12hrs 12mins (+31%)
    • Moderate Bouts: +9hrs 34mins (+843%)
    • Calorie Burn: +6,203kcals (+3%)

Amongst the 90 patients who did not complete the full 12-week programme, some patients indicated that significant injury or ill health was the reason for withdrawing. Others cited difficulties or a lack of confidence with technology and some stated that they lacked motivation or were simply too busy to find the time to engage with the programme.

Conclusion

It is essential to incorporate physical activity into everyday life as it increases metabolic rate, which results in increased energy expenditure (Van Baak, 1999). For some patients, weight loss was a key goal for them whilst on the programme. Of those who did report weight pre- and post-programme, 80% of patients reported an average weight loss of 3.8 kg. 27.3% of people who reported a weight loss were able to lose at least 5% of their body weight during the 12-weeks.

Having said this, physical activity is a recommended intervention under the NICE guidelines for people with obesity, even if they do not lose weight as a result, because of the other health benefits it can bring (NICE CG189). Therefore, the impressive level of physical activity behaviour change amongst this cohort will carry tangible health benefit. Patients also displayed a remarkable appetite to self-manage their physical activity, demonstrated by the high levels of engagement for all aspects of KiActiv^® Health.

KiActiv^® Health increased self-management skills and participants received person-centered care along with tailored individual advice on managing their daily activity to best support their condition. The remote nature of KiActiv^® Health overcomes the travel barrier; ensuring participants are supported from the safety of their own homes. Not only is this particularly pertinent due to ongoing COVID-19 restrictions, reducing our reliance on transport to receive care will also reduce carbon emissions, supporting the vision for a healthier planet.

26th January 2022