Updated: Aug 16
The National Institute for Health and Care Excellence (NICE) has approved four digital programmes that can be used to help the NHS deliver specialist weight management services to support the use of medication in England, according to the latest draft guidance.
People being referred to these services will meet the criteria for accessing weight management medication: they have at least one weight-related comorbidity such as diabetes or high blood and a body mass index (BMI) of at least 35.0kg/m2 or at a lower threshold in certain circumstances.
Patients will have a clinical assessment before starting treatment and a team of specialists will provide care virtually using the platforms Liva, Oviva, Roczen or Second Nature via an app or computer. The platforms include support from a multidisciplinary team of healthcare professionals, including psychological support and monitoring to reduce the risk of harm, such as from eating disorders and mental health issues.
“Traditional face to face services treating people living with obesity are unable to keep up with demand. Waiting lists are long, some areas don’t have a service, and patients need a solution” said Mark Chapman, interim director of medical technology and digital evaluation at NICE. “These four platforms could provide an option to accessing weight management support to those people who live in an area with no specialist weight management services or for those who are on a waiting list and are happy to be treated safely outside a hospital setting. By using these platforms over the next four years, NICE can learn from the evidence generated to ensure that when we carry out a full assessment, we can ensure that we are balancing delivering the best care and getting value for money for the taxpayer.”
Some of the digital programmes include the ability to prescribe weight management medication such as semaglutide (Wegovy, Novo Nordisk) or liraglutide (Saxenda, Novo Nordisk), to people who are eligible. The medications must be delivered alongside a package of care alongside a reduced-calorie diet and increased physical activity in adults.
Other programmes can collect and share data about weight medication use with an NHS team to support weight-management medication prescribing, as well as providing the same wraparound service involving diet and exercise.
Clinical experts told the independent NICE committee there is an unequal distribution of these specialist services in England, with some people living in areas where there is no service at all and a long waiting list to be seen. The ability to use digital enabled services will also help those who cannot or do not wish to travel for appointments, and those who are happy to be treated virtually.
“Technology is transforming healthcare and helping to cut NHS waiting times – one of the government’s five priorities. The use of apps in weight management services will improve access to support that, alongside life-changing drugs, can help tackle obesity – which costs the NHS billions every year and is the second biggest cause of cancer,” said Health and Social Care Secretary, Steve Barclay. “The newest obesity medicines have the potential to help patients lose significant amounts of weight and reduce related conditions, but it’s vital they are used alongside diet, physical activity, and wider behavioural support to help stop people regaining weight.”
In the 2021 Health Survey for England, published by NHS Digital, 25.9% of adults in England were living with obesity and a further 37.9% were overweight.
Over the next four-years, evidence will be generated on their long-term cost effectiveness. Early results from the economic modelling show that the technologies could be cost effective, but the results are uncertain. An independent NICE committee will review the evidence generated after this period and produce new guidance.
Calculations by NICE show that up to 48,000 people would be able to access the virtual services and if all those eligible enrolled up to 145,000 hours of clinician time would be saved. Early evidence suggests that weight loss of those using these digital platforms is similar at 2 years, compared with face-to-face specialist weight management services. Liva is available to be deployed into use by the NHS while Oviva, Roczen and Second Nature can be used once they have appropriate Digital Technology Assessment Criteria approval from NHS England.
A consultation on the recommendations have now begun via nice.org.uk and comments must be submitted by Friday 25 August 2023.