A weight management group programme for adults with complex and severe obesity

 The STEPS programme has been developed on the behavioural approach to weight management, reflecting adult philosophy of learning and patient empowerment as per NICE obesity guidelines (2006). The generic CBT techniques integrated into the programme included:

• Building a collaborative relationship with participants.
• Assessment and formulation.
• Cognitive techniques (addressing unhelpful thoughts).
• Integrating the Socratic Method during the course of the intervention.
• Follow-up.

The programme is offered to adults over the age of 16 with severe and complex obesity living in  south and wedy devon

1. BMI is greater than 40 kg/m², or they are more than 100 pounds (45 kg) over their ideal body weight.
2. BMI is greater than 35 kg/m² with an existing comorbidity such as diabetes or hypertension.

To be eligible to participate in the STEPS programme, individuals must be committed to achieving and maintaining a healthy weight and to attending regular appointments as part of the STEPS weight management service. Potential users of the service must also score highly in confidence and motivation to make a change. A crude estimate of patient’s readiness to change is obtained from self-assessment ratings of importance of change (0–10) and confidence to change (both scaled from 0–10, 10 being extremely confident to change). Those scoring between 6 and 10 are deemed motivated enough to begin the programme.

People with severe and complex obesity who have previously attended the STEPS programme can be referred back to the weight management service after 6 months. People re-attend the programme if they did not complete it previously or for reasons such as “missing sessions the first time around”; “being in a better frame of mind”; and “wanting to refresh knowledge”.

All adults with eating disorders, unstable cardiac condition or psychiatric condition are not eligible to participate in the programme. Other reasons for exclusion from the STEPS programme include already attending a different weight management group, having dropped out of the STEPS programme in the last 6 months and being pregnant or breastfeeding. Participants are also required not to be consuming over the recommended weekly alcohol limit prior to the STEPS programme commencing.

Before the STEPS programme begins, written information about the group programme is sent to all consenting participants to manage their potential anxiety and expectations.