Designing and Developing Community Obesity Interventions

Key Takeaways

Defining Community-Based Obesity Interventions
Community-based interventions are delivered outside formal primary or secondary healthcare settings and typically focus on non-pharmacological, non-surgical approaches to improving health. These interventions are often behavioural, multi-component, and context-dependent, making them complex to design, deliver, and evaluate.

Frameworks for Developing Complex Interventions
The Medical Research Council (MRC) framework provides a widely used structure for developing and evaluating complex interventions. Rather than a linear process, intervention development, feasibility testing, evaluation, and implementation should be iterative, with continuous consideration of context, programme theory, and stakeholder engagement.

Stakeholder Engagement and Lived Experience
Engaging stakeholders – including people with lived experience, healthcare professionals, commissioners, charities, and policymakers – is critical to ensure relevance, acceptability, and feasibility. Meaningful involvement can prevent interventions from being perceived as patronising or misaligned with real-world needs, while still requiring careful judgement about which suggestions are appropriate to implement.

Theory-Informed Intervention Design
Behaviour change theories and taxonomies, such as the Behaviour Change Technique (BCT) taxonomy, provide structured ways to identify intervention components and mechanisms of action. While no single theory explains behaviour fully, theory-informed design supports transparency, replicability, and stronger evaluation.

Feasibility, Evaluation, and Refinement
Feasibility testing should occur early and iteratively to assess acceptability, delivery, and implementation barriers. Robust evaluation goes beyond outcomes alone and should include process and economic evaluations to understand how interventions work, for whom, and whether they offer value for money.

Complementarity with Obesity Pharmacotherapy
Obesity is a complex, chronic, multifactorial disease requiring long-term, comprehensive, and person-centred care across prevention, management, and treatment. Community and behavioural interventions remain important alongside newer obesity medications, particularly as part of integrated care pathways. Emerging evidence highlights the role of supportive, non-stigmatising behavioural interventions in sustaining outcomes.

Future Directions and Next Steps

• Embed stakeholder and lived-experience engagement across all stages of intervention development
• Apply iterative, theory-informed approaches when designing community-based obesity interventions
• Integrate feasibility, process, outcome, and economic evaluations within intervention studies
• Strengthen early-career researchers’ capacity to engage delivery stakeholders through networks and partnerships
• Position community interventions as complementary to pharmacological treatments within comprehensive obesity care pathways

Summaries are AI-generated from meeting transcripts.

Transcripts are auto generated, if you spot an error, please email enquiries@easo.org

Eugenia Romano • 00:00

So welcome everyone to this month’s EASL Early Career Network eLearning Hub event. Thanks for joining. Today’s webinar is about developing and evaluating community-based interventions. Our speaker is Dr. Julia Mueller from the University of Cambridge and she will present how to design, implement and evaluate community-based interventions. The No One Orders Foundation has provided support to EASL for ECN development activities, this webinar series so the No-No Lawyers Foundation has no influence over the content but is just economic support for that. I’m Eugenia and along with Beatriz we’re both ECN members and we’re gonna be hosting today’s event. Just so you know as you might have heard the event is being recorded and the recording and any relevant relevant link will be shared after the event on on the ECN webpage. eLearning Hub’s online events are held by ESO ECN to promote knowledge sharing, skill development among students and early career professionals who are interested in obesity. We just want to remind you that ECN is free to join. So please join if you haven’t already and feel free to invite other early career colleagues to join ECN. And these monthly webinars are also free to join. Just a bit of rules for the webinar. It’s a very informal setting. Questions can be asked in two ways at the end of the presentation. You can either raise your virtual hand and use the microphone once the question session starts in the last 15 minutes of the webinar, or you can post questions in the question and answer chat box below, and they will be answered by us. Also, please complete the feedback form that appears at the end of the webinar your comments are really important for us to create new events that would support your education and skill development. And now I would hand it over to Beatriz for a few more information on our ECN activities.

Beatriz Farinha • 02:08

Thank you Eugenia. So as Liz already shared in the chat, there are several opportunities available for ECN members and you can go through them by the link that is in the chat. We look forward to welcoming you on the European Congress on Obesity, which will take place from 12 to 15 of May in Istanbul in Turkey. Although the abstract submission has already closed, early registration remains open until the 27th of February. So all the ECN members attending ECHO are invited to participate in the ECN activities through the Congress, including networking events in the ECN lounge and the award sessions, such as the ECN Best Thesis Award and the EASO Novo Nordisk Foundation New Investigators Award. Beyond ECHO, we also run the ECN Spotlight feature on the EASO website and social media to highlight ECN members and their research. So if you like to be featured, please get in touch with us or if you know someone that also might be interested, also get in touch with us. Finally, we also have an ECN WhatsApp group for details, updates, sharing, networking across Europe and we are very much delighted for you to join us and to be connected with us and with the news. And I’m going to pass it again to Eugénie to continue with the arena.

Eugenia Romano • 03:43

Thank you Beatriz. I think we’re ready to start. So everyone welcome Dr. Muller and I’m ready to listen to this very interesting presentation.

Dr. Julia Mueller • 03:56

Okay, I will share my screen. So, sorry, one second. Okay, hopefully, yes, I’m seeing a thumbs up. So that’s, that’s got to be a good sign. Okay, so hi, everyone, and thank you so much for joining. I will be talking about developing and evaluating community obesity interventions. And I thought I’d first tell you a little bit about my research, because throughout this presentation, I will be using examples from my research to hopefully make this a bit more illustrative and interesting, a bit less dry. So I work on the development and evaluation of scalable behavioral weight management programs. So my research is very pragmatic. It’s all about identifying and developing interventions that can actually be used in practice, hopefully. I focus on digital health interventions. And in my previous research, I focused on respiratory conditions before I moved into the field of obesity research. So I’ll be using a few examples from that as well, because really the same principles apply regardless of what specific health condition you’re developing interventions for. There’s sort of common principles across. Okay, so first of all, what do I mean when I talk about community-based interventions? So what I mean with that is interventions that are delivered outside of formal primary or secondary healthcare settings. So essentially interventions to target health conditions or improve health that are not pharmaceutical or surgery type interventions. They’re usually more complex interventions, often behavioral, involving multiple components and interacting elements and various mechanisms of change to try and improve health overall. So these types of interventions are usually quite complex, which makes them more challenging to develop and also evaluate. And one of the most important and commonly used frameworks for developing and evaluating such complex interventions is from the Medical Research Council, the MRC framework. So some of you might already be familiar with this framework. This is what it looks like in its current iteration. Didn’t always look like this in its first iteration in 2000. it was a lot more sort of prescriptive and linear, which it was basically like, okay, if you want to develop and evaluate a complex intervention, these are the steps that you need to do in this order. And this was based off of pharmaceutical research. But what people very quickly found was that this doesn’t work as well for more complex interventions, this kind of very linear prescriptive approach. So framework. And currently it looks like this. It’s much less linear, as you can see. And as you can see with the various arrows pointing back and forth, there’s no prescribed order in which you do these things. But essentially, the framework suggests that there’s a few key elements to developing and evaluating interventions. And you would usually cycle through these iteratively. So there’s developing the intervention or identifying an existing intervention because you don’t always need to develop something new. There’s feasibility testing evaluation and implementation. And then throughout these different elements, there’s a few core elements that should ideally form part of all of those different stages. like considering the context, developing and refining a program theory, which I’ll talk a bit more about in a moment, engaging stakeholders. So these are all kind of things that should form part of each stage, whether you’re developing or feasibility testing or evaluating, for example. I want to talk a bit more now about developing the intervention, because I feel like that’s something that often gets skipped over. So I’ve often read research papers where they just kind of say, well, we developed an intervention. And I’m often thinking, yes, but how? How did you do it? So I spent a lot of time trying to unpick that. And I will share some of my learnings. And hopefully that’s useful. So I think initially, the most important thing to do is sort of to plan that development process and to really actually understand the problem that you’re trying to address. To understand the problem and understand the context and really take time to figure out what matters to the people that are living with this health condition, what would help them to lead better lives and sort of how does living that health condition, what does that look like in an everyday context? Yeah, really sort of trying to understand what’s actually going on. And I think there’s two key things that will really help you with understanding the problem in the context. And that’s first of all, reviewing published evidence, what’s already known, and then engaging with stakeholders. And stakeholders can be anyone who has some sort interest in the health condition that you’re wanting to target or anyone who would be involved in the delivery of an intervention. So for example people with lived experience of the health issue, healthcare professionals, commissioners of services, who would basically be deciding what money gets spent on, charities and policy makers and various others. And involving stakeholders is really useful because it can help you identify priorities and really figure out what’s important. It helps ensure feasibility and acceptability. So for example it’s happened to me several times in past research that we’ve come up with ideas for interventions in the research team that we thought were really brilliant and that everyone would love. And then we brought it to our panel of lived experience people, and they’ve absolutely hated it and said, no, this is patronizing. It’s dismissive. It’s not addressing the problems that we really struggle with. So really, really valuable. And there’s different ways, different methods that can be used to involve stakeholders, which you can tailor to the context, to each group. You have things like your formal focus groups, which can be really useful. Sometimes one-to-one interviews are better, for example, if it’s a sensitive issue. And it doesn’t always have to be formal meetings. Sometimes just, if you meet someone somewhere and have an informal chat with them and they start telling you about some sort of issue from their perspective, that can be a form of stakeholder involvement that can give you valuable inputs. So I thought I’d share with you an example where, in my past research, we’ve engaged with stakeholders in a meaningful and fruitful way. So in one study, for example, we were looking to develop an app for people living with chronic obstructive pulmonary disease. And so we basically sat down with people, and we’d had these cutouts of smartphone screens. And then as they were telling us their ideas, we kind of scribbled on like these printouts to sort of check if we were capturing what they wanted and what they meant. You know, we were sort of sticking things on there and going, is this what you mean? And is this what you were picturing? And then by the end, we had some sort of prototypes that we could hand over to the software engineers for them to get started with. I should caveat this by saying we didn’t start off with immediately the idea of developing an app. At this point, we’d already had several focus groups where we’d first really taken time to understand the issues. And the idea for developing an app actually came from the group of– from the patient and public involvement group. I do also think it’s worth considering that sometimes not all ideas that come out of focus groups and stakeholder groups are feasible or useful. So I think it’s really helpful to think of some criteria in advance of which suggestions you want to incorporate and which ones maybe not. I quite like this list from Curtis et al that suggests you should incorporate suggestions that are relevant to the target behavior, technically feasible, easy to implement, aligned with established usability recommendations, and with theory and evidence. Sorry, I’m recovering from a cold, hence a bit of coughing. So one example that I always think of is I worked on a study previously where we were developing an app for women at risk of breast cancer for weight gain prevention. And we did a focus group with women at risk of breast cancer and they discussed it among themselves and decided that this app should be called Don’t Get Fat. And we discussed it afterwards in the research team and we were like, well, we can’t call the app that even though they unanimously decided because we know that first of all, sort of language that’s kind of fat shaming, stigmatising doesn’t work. And it’s obviously also ethically questionable. So I think just worth considering that it’s really, really good to involve people. But you might need to think about which suggestions to incorporate. Another really useful resource to draw on when you’re just starting to think about developing an intervention is behavior change theories. So there’s various theories of human behavior out there. And they’re often they’re built off of decades of psychological research. They’re not perfect, they often explain quite a small amount of variance in behavior. But they can be really useful in terms of starting to identify what’s important and what determinants you might want to target in your intervention. So an example, classic example, theory of planned behaviour, not, I’m not suggesting, suggesting that this necessarily the best one, I think, theory of planned behaviour has come under some criticism, because it does actually only explain a very small amount of variation in actual behaviour. But just for the purpose of sort of illustrating what kind of theories you can use to inform your intervention development. So the theory of planned behavior, for example, suggests that behavior is influenced by intention to perform that behavior. And intention is influenced by attitudes, norms and perceptions, and those in turn are influenced by beliefs. So this theory suggests that if you want to change behavior, then you need to target people’s beliefs and trying to change those beliefs. So I use this, for example, in my PhD research, many moons ago, where I was developing an intervention to support help seeking for lung cancer symptoms. And from looking at the literature, I identified that help-seeking for lung cancer symptoms is quite heavily influenced by people’s normative beliefs. So their beliefs about what others think about the behavior. And specifically, people were quite concerned about what their doctors would think if they went to the GP with a symptom like a niggly cough. They were quite worried that their doctors would be annoyed and view them as time wasters. So in the intervention that I developed, I included some basically stock images of doctors, along with a quote from real doctors saying that, you know, they were supportive of people seeking help for symptoms like a prolonged niggly cough. Speaking of cough. So basically trying to change this belief that, you know, the doctor is just going to view you as waste your time trying to change that more into a belief that actually your doctors want you to seek help. This didn’t work, by the way, my intervention was not successful. But I just thought it would be useful to illustrate like how you can use a theory to inform your intervention development. And if you’re interested in looking some other theories and models, I find this book quite useful from Connor and Norman. So that might be a useful resource. Another really useful resource is the behavior change technique taxonomy. So this was developed by researchers from UCL. And what they basically did, they looked at a whole bunch of behavior change interventions, and then broke them down into their most basic building blocks into kind of like the key ingredients of what makes these interventions effective. So things like goal setting or self monitoring, and they organize all these different behavior change techniques into a wider taxonomy. So this is really useful when you’re developing an intervention, you kind of go can go to this taxonomy and pick out which building blocks you want to use to build your intervention. And they’ve also mapped these behavior change techniques onto wider constructs. So basically, say if you’re, if you want to develop an intervention that changes normative beliefs, then you can check which behavior change techniques are most likely to change normative beliefs and then select those. So once you have, once you’ve sort of done your homework, and you have a good idea of what’s the actual problem, what’s the context, what’s the evidence, and you know, you’ve got your stakeholder input, and you’ve got a good idea of what you want your intervention to be. It’s really useful to put together a program theory and or a logic model. And these terms sometimes get used interchangeably and kind of inconsistently. But I would say broadly, a program theory or a theory of change is sort of a model of how you think change in the health problem that you’re targeting, how change would occur, and what different factors would lead to change. So it’s kind of like the bigger picture. And like a causal model, whereas a logic model is more descriptive, it’s kind of a script, it’s a description of how you think your intervention works, and often depicted, depicted in form of a flowchart. And these things are useful of like a blueprint that you can keep going back to or like a guiding principle. So if you, for example, get to designing the study to evaluate the intervention, you can go back to your logic model and say, OK, which outcomes, which primary outcomes and which secondary outcomes do we need to measure? Well, we need to measure exactly things that we said our intervention was going to change. Yeah, so I think these, it’s a little bit of extra work, but I think pays off very well. Okay, so we’ve talked about developing an intervention. I’d now like to talk a bit about feasibility testing. And I do think that it’s a bit kind of artificial separate these things into different elements, because I think, for example, intervention development and feasibility testing, they’re often they occur at the same time, they’re often kind of part and parcel. So yeah, it’s kind of artificial to separate them. So say, for example, if you’re developing an intervention, I would usually always be testing that iteratively, as I go along and sort of show very early prototypes to, for example, my lived experience group to check if they’re if they’re happy with it, and it’s very like it as, as I’m developing, because what you want to avoid is that where you is that where you get to having a finished product and then showing it to people and then they say they hate it. So I would view these very much as sort of part of TARCEL. But if we’re talking about more formal feasibility testing, I thought I’d show you a bit of an example of how you can do that. So in feasibility testing, you’re looking at is the intervention acceptable? Can it be delivered as intended? Are there any barriers, facilitators? And how could the intervention be improved. So I thought I’d share with you an example from some past research. So within my research team over the past few years, we’ve been developing an intervention called SWIM, which stands for supporting weight management. And this is a weight loss maintenance intervention. So it’s intended for people who’ve already lost weight to help them maintain that weight loss. And it consists of a web-based platform where people click their way through different sessions. They have one session every week. So for example, session one is all about planning and tracking. So they learn how to set up a weight maintenance plan, and how to do things like set smart goals that are easier to stick to. And then the intervention also includes contact with a health coach. So at regular intervals throughout the intervention, a trained lay health coach will give them a call and sort of see how they’re getting on with the programme. And what we did in our research team, so we co-developed this intervention together with stakeholders and a lived experience panel. And then once we had a sort of relatively stable version of the web platform and the plan for the coach contact, we then conducted a small scale feasibility study with just 61 people that we randomized either to swim or to a control group. And then we also did interviews with participants and with the coaches who delivered the intervention to sort of see what their experiences were of it. And we also kept very detailed study coordination records. And then the coaches also kept very detailed logs of the calls that they made, so that we could then evaluate, you know, what, how did it actually work? How were they able to deliver the intervention as planned? And based on that, we were then able to make some refinements of the intervention. So one example of a thing that we changed was so on the left, you can see the the images that we used in the first iteration of the intervention, we have this kind of kind of orangey person with blue hair. And what we intended was that this should be perceived as gender neutral and also ethnically neutral. But when we talked to people in the interviews afterwards, they agreed unanimously that this is actually a middle-aged white man. So that didn’t work out. And then also people fed back that they felt like the graphics were a little bit juvenile and sometimes maybe a Our second iteration of the intervention is instead of trying to create like a gender neutral, ethnically neutral character, instead we’ve just created more characters with more diversity. And then we’ve also updated the graphics a bit to be a bit more sort of adult feeling. So hopefully that gives a good example of how important feasibility testing is. So we talked about feasibility, I’d now like to talk a little bit about evaluation. And again, just to emphasize that I do think kind of the separation into, you know, feasibility and evaluation is a bit artificial and I’ll talk about that in a moment. So why do evaluations? Well, I think the main purpose that comes to mind is to assess whether the intervention works, but there’s also other aims of evaluation such as to assess whether the intervention can be implemented as planned and also for whom does it work, how does it work and also is it cost effective, is it good value for money. So based on this, there are different types of evaluations depending on your aims. And I think that a comprehensive intervention evaluation package should include all of these types of evaluations. So first of all, outcome evaluations. So these are evaluations focusing on whether the intervention produces the desired outcome in the target population. So this is where you do your hypothesis testing, and you’re comparing before versus after the intervention, ideally also comparing the intervention with comparison groups. And here you would usually, if possible involve experimental designs with randomization. So the gold standard for outcome evaluations would be the randomized control trial, where you essentially randomize people to either your intervention group or at least one control group, and then you would compare them on the outcome afterwards. And any differences that you measure between the groups would then be attributable to your intervention. Obviously, randomized controlled trials are quite expensive and lengthy, so they’re not always possible. Sometimes you might need to consider alternatives like a simple pre-post study, but this would be the gold standard. Now, as I just mentioned, randomized controlled trials are often quite resource intensive. So you really want to try and make sure that by the time you get to doing a definitive RCT, you’ve got a really strong, stable intervention, and you’ve refined it as much as possible. So one strategy for refining your intervention is the multi-phase optimization strategy or MOST. The basic idea here is that you first you do your preparation, you select your intervention components, it’s usually based on things like literature, PPI, clinical experience, etc. Then you have an optimization stage where you would test the effects of each component using a series of randomized experiments. And you would test whether each component meets some sort of minimum criteria, for example, in terms of effects on an outcome or in terms of cost. So this is why I said, I feel like separating, for example, evaluation and development can be a bit artificial, because here you’re doing it kind of concurrently, you’re kind of evaluating individual components of the intervention. And then as you find that they don’t meet certain criteria, you would remove them. So you’re kind of doing evaluation and development and refinement all as one. And then only once you have a stable intervention package, you would move on to the evaluation phase where you do a definitive randomized controlled trial. So, if outcome evaluations are looking at whether the intervention works, process evaluations delve more deeply into sort of how the intervention works. Things like who took part, when and where did intervention activities actually take place, any barriers that were encountered. And this is really important, because this helps to contextualize your findings. So if you do say a larger randomized trial to figure out if your intervention has a certain effect on your primary outcome or not. If you find that there’s no effect, for example, your process evaluation can help you try and elucidate why that is. Is that because the intervention actually didn’t work? Or is it maybe because it wasn’t possible to implement the intervention as intended? And are there some barriers to implementation that you would need to address? So it gives you a good idea of what you might need to do differently in future. And this is very similar to what I was mentioning before with regards to feasibility testing. So you can do feasibility testing before you do your definitive RCT to help refine your intervention, but also during your definitive RCT. So most of the studies that I’ve worked on, if we’re evaluating an intervention, we would do a larger RCT and then embedded within that we’ll have a process evaluation, where we’re doing things like qualitative interviews to try and figure out the actual context and understand people’s experiences. And there’s also a very useful resource from the Medical Research Council on process evaluations. They’ve developed a framework for that as well. I won’t go into detail, but if you are interested in process evaluations, I would recommend this. And then finally, economic evaluations. So, as I said before, I think a comprehensive intervention evaluation should involve not just outcome and process evaluations, but also economic evaluations. So trying to figure out not just whether the intervention works, but also is it good value for money and who would potentially pay. To have this intervention implemented. So I would always recommend, if possible, to work together with health economists for evaluating interventions. So I just thought I’d show you an example from a trial that I’m working on currently. So this is the trial design for the SWIM study, where we’re evaluating SWIM intervention that I mentioned before. what we’re doing is we’re essentially randomizing to the intervention group or to a standard care control group. We’re following people up over 6, 12 and 24 months and then embedded within this larger RCT. We have also some qualitative interviews and a process evaluation. And then we also were taking recordings of the coach call sessions to then check calls as intended and whether they were sticking to the coach manual and to the intervention protocol. And then we’re working together with a team of health economists to model the cost effectiveness of the intervention over a lifetime. So I think I would consider this a very comprehensive evaluation. So why does this all matter? And what are the take home messages. So I think developing evidence-based interventions requires a structured approach, taking into account empirical evidence, theory, stakeholder needs and preferences. Also, I think a key take-home message is that evaluating interventions should involve not only outcome evaluation, but also process and economic evaluation. And why is this important? Well, I think without such considerations, researchers risk wasting resources and reinventing the wheel, kind of duplicating existing efforts. And I think with research, we always want to make sure that we’re contributing something new. So that’s why I think it’s quite useful to use this kind of frameworks and structured approaches. So that’s it from my side. you all so much for listening and I’m very happy to answer any questions.

Eugenia Romano • 35:43

Thank you so much Julia. We already have questions in the Q&A box, yeah because the raising hand apparently doesn’t work so I’ll just read the questions to you if that’s okay. So the first one is, we have three so far, the first one is can you give any example of feedback people living with obesity gave to support your intervention development? So this is the first

Dr. Julia Mueller • 36:07

question. Yes, that’s a great question. I’ve done many, many sort of focus groups around developing interventions with people with lived experience of obesity. So let me think of maybe, Yeah, so I’ve done actually recently some PPI. And a key message that I keep hearing over and over is that people are saying many of the existing interventions aren’t addressing mental well being. And they feel like that’s really at the core. That’s kind of like part of the root cause of what makes weight management challenging. So I feel like what I’m hearing from listening to people is that there’s like a real need, a real unmet need for more psychological support and support for mental well being. And that’s, that’s influencing a lot of the work that we do within my research team. So that’s influenced why we’re developing the swim intervention, because that’s based on a psychological therapy method called acceptance and commitment therapy. And that’s also still influencing some of our ongoing work. So hopefully that addresses that question.

Eugenia Romano • 37:34

As a psychologist, I thoroughly agree. Next question is, do you have any advice for how early career researchers can effectively engage stakeholders who influence community intervention delivery like local authorities, school communities

Dr. Julia Mueller • 37:50

organizations? That’s a big question. Yeah, that’s an excellent question. So basically, how do you engage those kind of stakeholders?

Eugenia Romano • 38:10

I think, apart from reaching out to them, I guess.

Dr. Julia Mueller • 38:15

I think realistically what I found in my experience what works best is building relationships and then going via a kind of snowballing technique whereby you start building relationships and that helps you to reach out to other people. So I think building your networks, connecting with other researchers, but also connecting more widely is quite key. So I think avoiding that kind of siloed working where you just focus on your research, and sort of trying to build wider networks is quite important. Kind of think if I have some more practical advice on that, but I think yeah, what’s worked for me is being sort of actively involved in the community, for example, being involved with the Association for the Study of Obesity or with EA. So that’s how you kind of, I think that’s how you get to meet people with really diverse backgrounds and you meet not just other researchers but also clinicians and commissioners and policymakers and people who lead charities. And then I think once you get to know people personally then they are going to be more likely to want to support you in your research.

Eugenia Romano • 39:53

Yeah that makes sense. We have more questions coming. Patrick do you want to add something this question or is like the Q&A tricking me into reading that? Maybe not, no.

Beatriz Farinha • 40:09

I’m checking the messages.

Eugenia Romano • 40:11

Okay, sorry, because it says you want to answer the question from my perspective.

Beatriz Farinha • 40:18

I’m concluding that we have answered the question.

Eugenia Romano • 40:20

So, no, thank you. Thank you. Okay, next question is, can you give us more insight into the SWIM intervention, please. What’s the format? How long it is? Has it been successful? What are the outcome measures? Do people in Wittobese interview positively? Thank you. We have two more questions.

Dr. Julia Mueller • 40:43

Yes, so with the SWIM intervention, where we’re currently at is that we’re running the trial. So we don’t know yet if it works. We have to recruit almost 2000 participants Before I can answer that question, well, I think we’ve got a couple of hundred, so we’re on our way. But when we did the feasibility study with 61 people, I have to say those findings were very promising. And we, the difference between the intervention and the control group were all in the hypothesized direction. So they had less weight regain than the control group. They had better mental health outcomes, better eating behavior outcomes, better well-being, higher self-reported physical activity. Yeah, so very, very promising, I thought. And in terms of the experiences that people described in the qualitative interviews that we did afterwards, it was also very promising. And with some of the critical feedback that we got, we’ve now incorporated that, and we’ve really worked on refining the intervention. So, yeah, it’s currently being rolled out, well, rolled out as part of the trial. and we are working with weight loss programs across the country. So basically, we’re recruiting people who have already completed a weight loss program and have lost weight using a previous weight loss program. And then the idea is that something like SWIM would help them to maintain that weight loss.

Eugenia Romano • 42:38

OK, next question is from Francisco Arceñadis. I hope I read it right. Hi Julia, great presentation. To what extent do you consider framing a question before you pose it during PPI or evaluation activities, for example, clarifying realistic weight loss thresholds before asking participants about how satisfied they are with their weight loss? Sorry, I think, can you repeat that? To what extent do you consider framing a question before you pose it during PPI or evaluation activities. So for example, clarifying realistic weight loss goals before asking participants about their satisfaction for their weight loss.

Dr. Julia Mueller • 43:24

– Right. I think it really depends on the context and on your aims. I guess my only thought there is that you wanna try and make the PPI process as open as possible, because you want to make sure that people can make recommendations and suggestions that you can actually incorporate, rather than you already have your fixed ideas, and you’re just sort of looking for them to approve them. Or yeah. So I think– I’m not sure if that answers the question. think you can certainly go into PPI sessions with some like, specific questions in your mind that you want to check in with people about, I think just making sure that the questions are open, and not too close so that people can actually sort of contribute freely and creatively. I think, yeah, and I

Eugenia Romano • 44:29

think in specifically in case of weight loss thresholds and PPI patients. I mean, working with eCPO, you just realize that, especially when BPI, these people come from networks of patients, they are very well aware of how tricky it is, and that the expectations have too much many other aspects of the journey. So I think it’s really a collaboration in the end, don’t you think? Yes. Yeah. Next question is from Laura Kudlek. Hi, Julia, thank you so much for the great presentation. I was wondering how your experience has been regarding planning in work packages for stakeholder engagement and process evaluation when applying for grants. That’s a good one. I absolutely agree with the importance of cost effectiveness analysis, for example. Is this something you see increasingly requested from funding bodies as well? That’s a very useful question.

Dr. Julia Mueller • 45:27

So the first part of the question was around basically applying, when you’re applying for funding and you’re describing your process evaluation. And what packages as well. I’m not sure if I’ve got what specific insights I can offer there. I think sometimes it can be a bit challenging because. On the one hand, you’re trying to tell the funder exactly what you’re going to do and they want to know what you’re going to do, because, you know, if they’re going to give you money, they want to know. But also when you do something like stakeholder engagement, you need to keep things sort of open and flexible and you can’t have already decided things. So I think–

Eugenia Romano • 46:29

– The part of the question was about cost effectiveness as well, I’m not sure if it helps. – Yeah, can you read that part again? – So for example, Laura says that she agrees it’s important to consider cost effectiveness when working with stakeholder engagement and applying for grants.

Dr. Julia Mueller • 46:50

Yeah, yeah. Yeah, absolutely. And I mean, I guess that’s one of the things, one of the common themes when we do speak to stakeholders, such as commissioners, that they’re always, pointing out the resource constraints, especially in something like the UK system where we have a national health system and it’s very resource constrained. But I think in general funders are very receptive to including stakeholder engagement. So I think that would usually strengthen any grant application. I think as long as you can be specific about what you’re going to do. Something that we’ve done in the past that I think is quite, quite nifty and I think funders like it, well, they gave us the money so they seemed to like it, was done some, we work with health economists to do like a some modelling for a justifiable cost, where they’ve kind of modelled, okay, if we if we think this intervention could have this, roughly this effect size, what would be a justifiable cost. So for example, for the swim intervention, if I remember correctly, they came up with something around 100 pounds, so it shouldn’t cost more than 100 pounds to deliver this for each person. So that gave us like a ballpark of okay, whatever we develop, you know, needs to try and stay within those parameters. And I think that funders quite like that as well, that we’ve thought about that in advance. And I think for stakeholders, that’s also really helpful, because then if you can, when you’re talking to stakeholders about implementing this intervention in practice, you can already say, OK, we’ve considered this and this is the approximate cost of the intervention. And then they can, it gives a much better steer of how it could be incorporated into practice. So I’m not sure if I answered your question, Laura, but you can tell me afterwards if I didn’t.

Eugenia Romano • 49:05

One advice I was always given about applying for staff is always under plan, as in, even consider the cost of pens and paper and all of that stuff. There’s one question that batteries wanted to read and then we have two more.

Beatriz Farinha • 49:24

So could you tell us about your experience of PPEI for community interventions? The idea is this person has heard of ECPO and national patient groups, so do you have any advice on how best to engage with patient groups?

Eugenia Romano • 49:44

Yeah, I’ll join it with one of the next questions because it says, it’s similar, it says, do you have any thoughts on community obesity intervention in the context of new obesity management medications? I think they can be answered together. Sorry, can you read the second question? So specifically, another person asked about your thoughts on community obesity interventions in the context of new obesity management medications. So maybe they can be answered together. Maybe. But it’s not the other side, it’s not going to be discussed in protocol.

Dr. Julia Mueller • 50:14

So the first one was around experiences of conducting PPIE. Yeah, I think there’s actually like quite a few really useful resources by now that you can potentially tap into. For example, in the UK, we have Obesity Voices, which is like a network of people with lived experience and you can contact them and you can tell them about the study that you want to do and what sort of PPI you want to include and then they’ll kind of advertise it to that network and we’ve had really fantastic experiences with that. The only slight challenge is that you need some funding to support you with that because you do need to reimburse people for the time that they offer you when they’re coming to contribute to your study and they’re, you know, reviewing study materials, etc. So I’m not sure how it’s handled in other countries, but in the UK, you would usually be expected to reimburse people. And I think it’s around I think it’s now 27 pounds 50 per hour. So it might be different elsewhere. But yeah, I do think, you know, if people are contributing to your research, then they should be reimbursed for their time. So, yeah, we’re thinking about funding pots, any smaller pots that you can apply for, or that you can somehow access by your department, or maybe that your, the PI that you’re working with, maybe they have something within their grant. So yes, certainly thinking about that, the financial aspect of it is quite important. Second question was around community interventions in the context of new obesity medications. Yeah, I think this is a great question. And I think sometimes there’s like a slight tendency, some people will think, well, we have the obesity medications now, do we even need something like community-based interventions, behavioral interventions? And I think what we’re seeing increasingly with the evidence that’s emerging is that yes, we absolutely do still need these kinds of interventions. There was a systematic review published in the BMJ last week or the week before, where they showed the rapid weight regain that people experience once they stopped these medications. And they showed that weight regain was less rapid after a behavioral weight management intervention, regardless of the initial amount of weight lost. And they also showed that people lost substantially more weight when they did, when they took obesity medications alongside a behavioral intervention than when it was on their own. And then also some research from some of my colleagues that was published, I think last week, was around nutritional deficiencies and showing that there is a risk when people are taking these new obesity medications and they get no support in terms of what sort of nutrition they should be having alongside the medication. There is a risk of nutritional deficiencies, for example, people not taking in enough protein. So I think absolutely, there’s still lots and lots of scope for having behavioral interventions, supporting people with things like healthy nutrition, and supporting people also with the psychological challenges of weight management. And in some of the recent PPI work I’ve done, lots and lots of people have said, oh yes, I was taking the weight loss meds for a while, but then they had to stop because they couldn’t afford them any longer and their weight went straight back up and they felt like the root causes, like their mental well-being, were not really addressed. So yeah, I think there’s, I think it’s a really good new development that we have these medications available, but saw a silver bullet. And I think there’s still space for behavioral interventions and and support from a psychosocial perspective.

Eugenia Romano • 54:48

– Especially as we always say, obesity is complex, multifaceted, chronic. I mean, it would be great if there was just one snap and it’s solved, but there’s so many aspects to it. I think there’s just one last question and you can quickly give some details ’cause we have five minutes left, which is asking a bit more about the SWIM intervention, about how was planned, what the goal was. So like, if you wanna talk a little bit more about it, if you wanna show the slides again, that’s the last question we have so far.

Dr. Julia Mueller • 55:28

– Yeah, I can talk a little bit more about it. So, as I was mentioning, we’re currently running a large randomized controlled trial to evaluate the SWIM intervention supported by an NIHR programme grant. And we’re aiming to recruit, I think, 1,840 participants. So quite an ambitious project. But yeah, I think it will be really, really useful. And we’re recruiting at the moment from various weight loss programmes that are commissioned within the NHS in the UK. So we’re recruiting people who have completed a behavioral weight loss program, things like Slimming World or More Life. And we’re aiming to see whether SWIM can help people maintain weight loss better. at the moment within the UK system, we have, so you can get a referral to the behavioural weight management programme via the NHS, if it’s available in your location. But then once you’ve completed that programme, there’s nothing afterwards to help people maintain the weight loss. And that is the main struggle. Usually the weight is regained within one or two years. So we’re hoping that if we can show that SWIM is effective, then we would hope that that might be something that could be added on to help people with longer term weight loss maintenance.

Eugenia Romano • 57:15

Okay, and since there doesn’t seem to be more questions, the last one pops up. Just to conclude, I’d like to ask you, in the end about developing interventions and evaluations and all the great work you do, what do you think is the biggest challenge when it comes to this kind of activities?

Dr. Julia Mueller • 57:38

I think really the biggest challenge is implementation and making sure that all these great ideas that we come up with in research and that we find to be effective making sure that they somehow find their way into practice. I think that’s a big challenge. I mean, also often, you know, in terms of what gets funded by research funders, it’s more around development and evaluation of interventions less about actually getting them implemented in practice. So I think a lot of projects kind of will end with, okay, we did a trial and we found it was effective. And then, yes, really challenging trying to make sure that that gets used afterwards still. So yeah, I can’t really offer a solution. But yeah, I think that would be the biggest challenge, in my view.

Eugenia Romano • 58:41

Okay, we’re one minute from concluding. So I think we’re in perfect time. And thank you again, Julia, for your great presentation. Thanks for everyone attending, please remember to fill in the feedback form. We really need your opinion on this and thanks again Julia for joining us today it was a great webinar. Awesome thank you so much for having me. Thank you Julia. Thanks everyone. .