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Men With Multiple Long-Term Conditions Show Variable Retention and Outcomes in UK Weight Management Trial
In a UK-based weight management trial involving 585 men with obesity, retention at 12 months ranged from 65% among men with diabetes to 76% among men with disability, with self-reported weight stigma and quality-of-life measures generally stable or improved for those with multiple long-term conditions (MLTCs), but anxiety and depression screening results showing no consistent pattern. The heterogeneity of outcomes across subgroups suggests that a single programme design may not serve equally well across the spectrum of men living with complex health circumstances.
What Was Studied
This evaluation examined how men living with multiple long-term conditions and/or disability fared within the Game of Stones weight management randomised controlled trial — specifically looking at their retention in the programme, their health outcomes across several validated measures, and the lived experiences that shaped their engagement with or disengagement from weight loss efforts.
How It Was Studied
This was a mixed-methods process evaluation embedded within a randomised controlled trial conducted across three UK centres: Belfast, Bristol, and Glasgow. A total of 585 men with obesity (mean age 50.7 years) were randomised to one of three arms: behavioural text messages combined with financial incentives, text messages alone, or a waiting-list control group. Quantitative outcomes at 12 months included the Weight Self-Stigma Questionnaire, the EuroQol EQ-5D-5L (covering quality of life, anxiety, and depression), and the Patient Health Questionnaire-4, alongside retention data. To capture experiential detail, semi-structured interviews were conducted with 54 participants from the two intervention arms and analysed using the framework method.
What Was Observed
- MLTCs were common among participants: 40% of men (235 of 585) lived with multiple long-term conditions, 31% had a single condition, and 29% had no conditions. Additionally, 29% (165 of 585) had a disability. Among those with MLTCs, 99 were also disabled and 93 lived in areas classified as deprived, indicating a concentration of socioeconomic disadvantage in this subgroup.
- Retention varied meaningfully by health status: Men with a disability or no long-term conditions had the highest 12-month retention (76% and 75%, respectively), while men with diabetes had notably lower retention (65%). This gap suggests that certain conditions may create specific barriers to sustained programme engagement.
- Self-reported wellbeing and quality-of-life outcomes were broadly stable or positive for men with MLTCs in the intervention groups, but results for anxiety and depression screening scores were inconsistent across this subgroup, preventing any clear conclusion about mental health benefit or harm from the intervention in this population.
- Qualitative findings revealed a complex picture of motivation: Health concerns could serve as a driver for weight loss in some men, while hospitalisation, poor mobility, and the inability to exercise were identified as demotivating factors that made meeting weight loss targets feel unachievable for others. Social and life circumstances further shaped whether the programme felt relevant or accessible.
Why This Matters
The fact that 40% of trial participants lived with MLTCs — and that nearly a third also had a disability — illustrates that men with obesity in real-world settings frequently carry substantial health complexity. The variation in retention and outcomes across these subgroups points to the limitations of uniform weight management programmes when applied to populations with differing physical capacities, social circumstances, and health priorities. Understanding who disengages and why is essential for designing approaches that can reach and retain men most in need of support.
How to Read This Result
Because this is a process evaluation rather than a trial powered to detect subgroup differences, and because anxiety and depression results were inconsistent while self-reported measures may introduce bias, causal conclusions about outcomes for men with MLTCs or disability cannot be drawn from these findings alone.
Limitations
The inconsistency in anxiety and depression screening results limits conclusions about mental health outcomes for this subgroup. As a process evaluation, the study was not statistically powered to formally test differences across subgroups, meaning observed differences in retention or outcomes may reflect chance rather than true effects. Reliance on self-reported measures introduces the possibility of recall or social desirability bias. Finally, recruitment across only three UK centres — Belfast, Bristol, and Glasgow — may limit how broadly the findings apply to other settings or populations.