Wellbeing Mates: A Comprehensive Community Approach to Weight Management and Mental Health 

Wellbeing Mates: A Comprehensive Community Approach to Weight Management and Mental Health 

By Jenny Ward, Unity PCN Dietitian 

Unity Primary Care Network (PCN) in Coventry has launched "Wellbeing Mates," an innovative programme addressing the complex challenges of obesity and mental health.  The PCN covers over 60,000 residents across three GP surgeries. Recognising a critical gap in support for individuals with obesity, particularly those not eligible for existing services, the PCN dietitians developed a six-month, peer-supported group programme that holistically tackles both physical and mental well-being. This initiative aims to empower participants to adopt sustainable lifestyle changes.  

Programme Design and Implementation 

The Wellbeing Mates programme consists of six one-hour monthly sessions held in a community space, emphasising diverse aspects of health. These sessions are led by a multidisciplinary team, including dietitians, occupational therapists, physiotherapists, PCN wellbeing service staff, social prescribers, and mental health nurses. Topics covered include: 

• Healthy Eating and Behavioural Change 

• Physical Wellbeing 

• Mental Wellbeing 

• Social Inclusion 

• Sleep Hygiene 

Participants for the Wellbeing Mates programme were recruited from referrals to the PCN dietitian specifically for weight management. This initiative targeted individuals who expressed a preference for peer support and did not meet the criteria for existing weight management groups or were unable to attend other offered sessions. Potential participants received comprehensive details regarding the timing, dates, and content of the Wellbeing Mates sessions. They had the option to either opt-in for these group sessions or continue to receive one-on-one support with a dietitian, ensuring a patient-centred approach to care. 

Selected participants underwent a pre-assessment to establish baseline measurements for weight, height, body mass index (BMI), the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS), blood tests (HbA1c, lipids, and liver function), blood pressure, hand grip strength, and waist circumference. These measurements are repeated at the programme’s conclusion. 

The first cohort launched with twelve participants in January 2024, followed by Cohort 2 in July 2024. Cohort 3 commenced in January 2025 and is currently running. 

Programme Outcomes and Participant Engagement 

Participant Engagement and Attendance 

An analysis of two cohorts reveals consistent attendance patterns despite variations in recruitment and initial dropout rates. 

Cohort 1: Out of 12 recruited patients, 5 dropped out early (4 before the first session, 1 after). Of the remaining 7 participants, the average attendance was 4 out of 6 sessions, with 2 patients attending all sessions. 

Cohort 2: With 16 patients recruited, 4 dropped out early (2 before the first session, 2 after). Of the remaining 12 participants, the average attendance was also 4 out of 6 sessions, though only 1 patient attended all sessions. 

For both cohorts, illness and work commitments were the primary reasons for non-attendance. All participants consistently received a text message reminder the week before each session. While increased recruitment can compensate for early dropouts, external factors like health and work continue to pose challenges to full participation. 

Data Collection Challenges and Initial Outcomes 

A significant hurdle in evaluating the programme's long-term impact has been the difficulty in collecting comprehensive follow-up data. Low attendance at the final session directly hindered the collection of vital metrics, including physical measurements (weight, grip strength, waist circumference, blood pressure), blood results, and overall feedback. Despite efforts to request this data through digital and paper forms from non-attenders, completion rates remained low. 

However, seven patients across both cohorts completed all requested follow-up data, providing valuable insights into the programme's immediate effects: 

For these participants, key outcomes included: 

• An average 9% increase in their wellbeing scores, indicating a positive impact on mental health. 

• An average 2% weight loss. 

• An average 1% reduction in waist circumference. 

• Grip strength remained consistent on average. 

• Analysis of the blood results and blood pressure is still needed. 

For all these parameters, it will be useful to look at them in the future to see if patients have been able to maintain lifestyle changes over a longer period. 

Patient Insights and Programme Successes 

Participant feedback, gathered both after individual sessions and through a post-programme questionnaire, consistently showed a 100% recommendation rate. This highlights the programme's profound positive impact as a highly valued community initiative. Patients reported a deeper understanding of the crucial roles of diet, sleep, and self-care in maintaining their health. They consistently praised the programme's design and delivery, specifically noting: 

• Well-paced and engaging sessions with ample time for questions. 

• Informative, engaging, and relevant content that provided useful new information. 

• A supportive and welcoming environment, created by friendly staff, fostering a safe space for sharing. 

• Valuable insights from peers and experts, enriched by personal stories and video presentations. 

• Comprehensive coverage of a wide range of relevant topics. 

Tangible Changes  

The true measure of the programme's success lies in the positive behavioural changes reported by participants: 

• Improved Dietary Habits: Many are now cooking meals from scratch, increasing fish consumption, and making healthier food choices. Notably, developing the habit of eating breakfast daily reduced mid-morning snacking for some. 

• Enhanced Sleep and Exercise Routines: Participants reported improving sleep patterns, including better wake and eating times, and increasing physical activity. 

Areas for Future Enhancement and Programme Evolution 

Areas for Future Enhancement 

Participants offered constructive feedback to further improve the programme: 

• Session Accessibility: Inconvenient timing for some due to work commitments. 

• Technical Improvements: Minor technical issues were noted. 

• Deeper Dive into Habits: Interest in more content on ingrained habits and food choices. 

• Extended and Focused Discussions: Suggestions for longer sessions and better guidance to keep discussions on track. 

Programme Changes Between Cohorts 

In response to feedback and to address identified challenges, the Wellbeing Mates programme has implemented several key changes between cohorts: 

• Increased Participant Recruitment: Recognising typical dropout rates, more participants are now recruited per cohort to maintain robust group sizes. 

• Improved Feedback Collection: Providing paper copies of feedback forms has significantly increased completion rates, reflecting participant preference. 

• Preferred Handout Delivery: Educational handouts are now primarily distributed as paper copies, streamlining access to information. 

• Early WhatsApp Support: A WhatsApp group for participants is established from the first session to foster immediate connection and mutual support. 

• Drop-in Support Sessions: New drop-in sessions at the end of educational sessions allow previous participants to connect and offer ongoing support, building a lasting community network. 

These strategic adjustments aim to enhance convenience, strengthen community bonds, and empower participants more effectively in their weight management and overall wellbeing journeys.  

A Holistic Future 

The Wellbeing Mates initiative demonstrates the power of community-based care. By bridging existing service gaps and addressing obesity's multifaceted impacts, PCN multidisciplinary team are reshaping how we tackle public health challenges. Looking ahead, the programme aspires to expand its reach and further refine its approach to support healthier lifestyles in Coventry. 

This work underlines the pivotal role of primary care networks in championing innovative, patient-centred solutions. Dietitians, as advocates for holistic health, remain key in this transformative journey. 

With new guidance on GLP-1 weight loss injections in primary care, the Wellbeing Mates programme is potentially well-positioned to offer crucial complementary behavioural support to patients. This is particularly advantageous as it uses existing PCN staff, avoiding the need for costly outsourced services.