CRediT contribution statement
Louisa J Ells (https://orcid.org/0000-0003-0559-4832): Conceptualisation, Supervision, Writing – original draft, Writing – reviewing and editing (lead).
Tamara Brown (https://orcid.org/0000-0003-1285-7098): Data curation, Investigation, Writing – original draft, Writing – reviewing and editing (equal).
Jamie Matu (https://orcid.org/0000-0002-0204-2197): Writing – reviewing and editing (equal).
Ken Clare (https://orcid.org/0000-0001-7054-444X): Conceptualisation, Writing – reviewing and editing (equal), Other – PPIE (lead).
Simon Rowlands (https://orcid.org/0000-0002-5405-9871): Writing – reviewing and editing (equal).
Maria Maynard (https://orcid.org/0000-0002-0011-752X): Writing – reviewing and editing (equal).
Karina Kinsella (https://orcid.org/0000-0001-9510-1952): Project administration (lead), Data curation, Formal analysis, Writing – reviewing and editing (equal).
Kevin Drew (https://orcid.org/0000-0003-0149-2521): Formal analysis, Investigation, Writing – reviewing and editing (equal).
Jordan R Marwood (https://orcid.org/0000-0002-3658-3485): Investigation, Formal analysis, Writing – reviewing and editing (equal).
Pooja Dhir (https://orcid.org/0000-0001-9225-0442): Investigation, Formal analysis, Writing – reviewing and editing (equal).
Tamla S Evans (https://orcid.org/0000-0003-3295-2682): Investigation, Formal analysis, Visualisation, Writing – reviewing and editing (equal).
Maria Bryant (https://orcid.org/0000-0001-7690-4098): Supervision, Writing – reviewing and editing (equal).
Wendy Burton (https://orcid.org/0000-0001-7885-5971): Investigation, Formal analysis, Writing – reviewing and editing (equal)
Duncan Radley (https://orcid.org/0000-0003-3458-7201): Methodology, Investigation, Formal analysis, Writing – reviewing and editing (equal).
Jim McKenna (https://orcid.org/0000-0001-6779-3939): Writing – reviewing and editing (equal).
Catherine Homer (https://orcid.org/0000-0003-2571-6008): Methodology, Investigation, Formal analysis, Writing – reviewing and editing (equal).
Adam Martin (https://orcid.org/0000-0002-2559-6483): Supervision, Methodology, Investigation, Formal analysis, Writing – reviewing and editing (equal).
Davide Tebaldi (https://orcid.org/0000-0001-6450-5487): Investigation, Formal analysis, Writing – reviewing and editing (equal).
Tayamika Zabula (https://orcid.org/0000-0002-1020-6235): Investigation, Formal analysis, Writing – reviewing and editing (equal).
Stuart W Flint (https://orcid.org/0000-0003-4878-3019): Methodology, Investigation, Formal analysis, Writing – reviewing and editing (equal).
Chris Keyworth (https://orcid.org/0000-0002-7815-6174): Methodology, Investigation, Formal analysis, Writing – reviewing and editing (equal).
Mick Marston (https://orcid.org/0009-0008-3520-7083): Visualisation, Writing – reviewing and editing (equal).
Tanefa Apekey (https://orcid.org/0000-0003-1696-0834): Investigation, Formal analysis, Writing – reviewing and editing (equal).
Janet E Cade (https://orcid.org/0000-0003-3421-0121): Methodology, Investigation, Formal analysis, Writing – reviewing and editing (equal).
Chirag Bakhai (https://orcid.org/0009-0008-4708-3305): Validation, Writing – reviewing and editing (equal).
Acknowledgements
We would like to thank colleagues from across NHSE, in particular the LCD project manager Clare Helm for their support throughout this project. We would also like to sincerely thank every member of our fantastic PPI group, and every service user and provider who took part in the evaluation, without whom this work would not have been possible.
All NHS clinical and process data analyses from the LCD MDS were conducted and provided by NHSE.17
We would also like to acknowledge the invaluable contribution of the following team members who moved on prior to the completion of this study: Dr Susan Jones, Pat Watson, Charlotte Freeman, Dr Christiana Duarte, Dr Samuel Frempong and Professor Jennifer Logue.
Patient data statement
This work uses data provided by patients/service users and collected by the NHS as part of their care and support. Using patient data is vital to improve health and care for everyone. There is huge potential to make better use of information from people’s patient records, to understand more about disease, develop new treatments, monitor safety, and plan NHS services. Patient data should be kept safe and secure, to protect everyone’s privacy, and it’s important that there are safeguards to make sure that they are stored and used responsibly. Everyone should be able to find out about how patient data are used. #datasaveslives You can find out more about the background to this citation here: https://understandingpatientdata.org.uk/data-citation
Data-sharing statement
The NDA and MDS data sets may be obtained from a third party but are not publicly available. Authors obtained access to these data sets via Data Processing Agreement with NHSE. The authors are not permitted to share these data. Code books for all anonymised qualitative data are available on request, please contact L.Ells@leedsbeckett.ac.uk for more information.
Ethics statement
Ethics approval for the study was received from:
• Leeds Beckett University LREC references for WP2 (excl NHS interviews): 79441 (initial approval – January 2021), 80438 (updated STAR-LITE – February 2021), 90148 (updated recruitment strategy – November 2021), 93609 (offline observation methods added – February 2022), 106559 (online interviews with coaches added – December 2022), 107887 (added questions to STAR-LITE – January 2023), WP3 additional cross sectional interviews: 99281.
• University of York Department of Health Sciences Research and Ethics committee (HSRGC/2022/537/A) (WP5).
• Health Research Authority approval (West Midlands – Birmingham board) for WP2 NHS interviews and WP3/4 data collection – granted: IRAS project ID 294667; REC reference: 21/WM/0136 (July 2021).
Information governance statement
Leeds Beckett University (sponsor) and collaborating institutes (Universities of Teesside, Lancaster, York, Leeds and Sheffield Hallam) are committed to handling all personal information in line with the UK Data Protection Act (2018) and the General Data Protection Regulation (EU GDPR) 2016/679.
Under the Data Protection legislation, Leeds Beckett University is the Data Controller for the new primary data collection in WP2 and WP3.
Under the Data Protection legislation Leeds Beckett University is the Data Processor for the secondary data analysis in WP3: anonymised MDS data supplied by NHSE, who is the Data Controller for WP3. We processed personal data in accordance with their instructions. The data controller at Leeds Beckett University is the University secretary who can be contacted at: secretary@leedsbeckett.ac.uk You can find out more about how we handle personal data, including how to exercise your individual rights and the contact details for our Data Protection Officer here: www.leedsbeckett.ac.uk/our-university/public-information/information-compliance/information-management-and-compliance/
Disclosure of interests
Full disclosure of interests: Completed ICMJE forms for all authors, including all related interests, are available in the toolkit on the NIHR Journals Library report publication page. https://doi.org/10.3310/MPRT2139
Primary conflicts of interest: All authors named in this report have been funded by the National Institute for Health and Care Research (Health Services and Delivery Research, NIHR137025 – Evaluation of the NHS England Low-Calorie Diet implementation pilot: a coproduced mixed-method study (apart from Tamara Brown, Jordan R Marwood, Pooja Dhir and Tamla S Evans who were funded by Leeds Beckett University to support this project).
Louisa J Ells has received no other funding for this study but currently holds other NIHR, MRC and Nuffield foundation awards. She is a member of the Office for Life Science and NIHR i4i committee. Louisa is also a study author of the Awareness, Care and Treatment In Obesity maNagement (ACTION) Teens project and the Holbæk Obesity Treatment (HOT) Versus Conventional Obesity Treatment (COT) in Children With Overweight or Obesity trial advisory group member, both of which are funded by Novo Nordisk but LJE role is an independent unfunded external contributor. She is also on the editorial board for the journal Perspectives in Public Health and has previously received funding from the World Health Organization, local and central UK government and Scottish Chief Scientist Office.
Tamara Brown has received no other funding for this study but currently holds other NIHR awards and has held Office of Health Improvement and Disparities awards (formerly Public Health England, 2021–2). Tamara Brown has in the past received consultancy fees from the British Dietetic Association (2020) and the European Association for the Study of Obesity (2021). Tamara Brown has an honorary contract (unpaid) with Office for Health Improvement and Disparities 2022–27.
Ken Clare receives funding from NIHR, Obesity UK, and is a member of Patient Advisory Panel Novo Nordisk and Patient Advisory Board Boehringer Ingelheim. He was also on the Association for the Study of Obesity and European Coalition for People living with Obesity boards.
Maria Bryant is the outgoing Chair for the Association for the Study of Obesity.
Duncan Radley also receives funding from the Welsh Government and sits on the editorial board for the journal Perspectives in Public Health and organising committee for the Systems Evaluation Network. He was on the advisory group: Towards a Healthy New Towns Guidance: Built Environment, 2017–8, a network member: ESRC Strategic Network, steering committee: NIHR-funded project ‘The Kids Will Eat Better study: how can local authorities improve the efficiency and effectiveness of interventions to address inequality in childhood obesity?’, 2020–3, expert advisor: UK Medical Research Council funded project ‘Participatory systems mapping approaches in population health research: methods guidance and associated implementation toolkit’, 2021–2.
Catherine Homer has received no other funding for this study but currently holds other NIHR awards. She is also on the editorial board for the journal Perspectives in Public Health.
Stuart W Flint reports Investigator-led research grants from the National Institute for Health and Care Research, Office of Health Improvement and Disparities, Doncaster Council, West Yorkshire Combined Authority and Novo Nordisk. He also reports support for attending academic meetings from Johnson & Johnson, UK Parliament, Safefood, Novo Nordisk and Devon NHS Integrated Care Service.
Janet E Cade is Honorary Secretary for Association for Nutrition, Chair of Advisory Committee for British Nutrition Foundation, Chair of Board of Directors for Dietary Assessment Ltd.
Chirag Bakhai is a member of the Expert Advisory Group for the NHS Type 2 Diabetes Path to Remission Programme and committee member for the NICE Type 2 Diabetes Guideline Update.
All remaining authors have no disclosures to declare.
Department of Health and Social Care disclaimer
This publication presents independent research commissioned by the National Institute for Health and Care Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, MRC, NIHR Coordinating Centre, the Health and Social Care Delivery Research programme or the Department of Health and Social Care.
This synopsis was published based on current knowledge at the time and date of publication. NIHR is committed to being inclusive and will continually monitor best practice and guidance in relation to terminology and language to ensure that we remain relevant to our stakeholders.
Study registration
This study is registered as NIHR Clinical Research Network Portfolio reference: CPMS ID 49330 and Research registry reference: researchregistry6614.
Funding
This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR132075.
Additional outputs
Conferences
Oral presentation of study the at the European Congress on Obesity (ECO) online conference (2021).
Oral presentation of the behaviour change work within the Re:Mission study at the British Psychological Society conference (2022).
Poster presentation of the behaviour change work within Re:Mission at UKCO (2022)
Emerging leaning from Re:Mission presented in a poster at UKCO (2022).
Poster presentation on review evidence of T2D and WMS in diverse ethnic groups at UKCO (2022).
Keynote presentation on the Re:Mission study at the Royal Society for Public Health conference – which focused on the importance of coproduction approaches in public health and the importance of this within the Re:Mission study (2022).
Oral presentation on the theoretical underpinnings of the NHS Low-Calorie Diet Programme at the British Psychological Society Division of Health Psychology Annual Conference (2022).
Oral presentation on lessons emerging from studies of dietary control, change and restriction – learning from Re:Mission to the Active Lifestyle Spring online conference (2023).
Poster presentation of the Re:Mission evidence review findings at the European Congress on Obesity (ECO) Conference (2023).
Poster presentation on the observations of service delivery and fidelity of behaviour change techniques Re:Mission at the European Congress on Obesity (ECO) (2024).
Oral presentation on Re:Mission economic analysis at the European Congress on Obesity (ECO) conference (2024).
Oral presentation debate on the benefits of Low Calorie Diet approaches for Type 2 Diabetes, building on learning from the Re:Mission study – ABCD annual conference (2024).
Oral presentations – The Re:Mission study patient perspectives and economic analysis – UK Congress on Obesity (2024).
Seminars, workshops, podcasts and informal presentations and outputs
Webinar (2021) Presentation for the Royal College of Physicians – the presentation was provided as part of CPD accredited webinar specialist series on obesity for the RCP. The series was designed to provide consultants and trainees with the necessary professional knowledge required on the acute medical take.
Podcast for the Leeds Beckett University (15 June 2021) This podcast was disseminated via the Leeds Beckett University social media channels and also feed into the Leeds Beckett University Inclusion, Equality and Inclusion conference Q&A, and has been posted on the Re:Mission study website. The podcast has helped raise awareness of the PPI activity underpinning the Re:Mission study. URL: https://player.captivate.fm/episode/b66828ac-50d3-4ad2-a909-d0463c5f4171
Presentation to the Obesity UK support group (2021) The presentation was about the importance of Patient and Public Involvement and Engagement and how it had been integral in the co-development and conduct of the Re:Mission study.
Blog (2021) Re:Mission study patient and public involvement blog to promote the importance of PPIE in the Re:Mission study, which has been published on the study website. URL: https://remission.study/news/kens-blog
Yorkshire Obesity Research Alliance – A PPIE presentation (2021) The Re:Mission PPI Lead Ken Clare delivered a presentation at YORA to share his experience of PPIE, to encourage more effective PPIE in obesity research across the region. URL: https://drive.google.com/file/d/1zgNYTe3rqmgJI0zamXa5Cv_X-yXqGw-Y/view
Webinar (2021) PPI in the Re:Mission study and the importance of ethnic diversity in research. Re:Mission study PPIE members Jenny Teke and Abi Ojo shared their insights from the Re:Mission study PPIE on the importance of ethnic diversity at the Association for the Study of Obesity – Webinar: The importance ofPatient and Public Involvement from a research and public perspective. This presentation was to raise awareness of the Re:Mission study and share learning from how our ethnically diverse group has helped shape the study. URL: https://aso.org.uk/resource/aso-webinar-importance-public-and-patient-involvement-research-and-public-perspective
Presentation about progress to date to researchers across Teesside University (2021). Researchers from across Teesside University attended. Awareness was raised around the work being carried out and the topic under evaluation which led to a general discussion of some of the public perceptions of the issues being targeted by this intervention. When colleagues are looking for expertise on the skills employed in this project, they now know who to approach.
Presentation to the UK Society of Behavioural Medicine Early Career Network (2021) Tamla Evans one of the funded Re:Mission PhD students presented at was the UK Society of Behavioural Medicine Early Career Network on 9 December 2021. The presentation was titled ‘The NHS low calorie diet programme: theoretical underpinnings and behaviour change fidelity’.
Presentation Carnegie School of Sport Active Lifestyles Café (2022) to share Re:Mission learning at the school of sport lifestyle cafe.
Presentation of the Re:Mission study at Leeds Beckett School of Health seminar (2022).
Presentation – emerging learning from the Re:Mission study presented at the Sheffield Hallam University sport and physical activity research centre seminar series (2022).
Presentation of early Re:mission learning to Leeds LCD group (2022).
Presentation of Re:Mission learning to DUK research group of practitioners, academics and DUK members (2022).
Poster presentation of the Re:Mission systematic review findings at the EASO Winter School ECR event (2022).
Clinical magazine article (NHD) ‘Obesity: A multifactorial disease’ (2022).
Presentation of the overview and early learning from the Re:mission to the Sense nutrition group (2023).
European association for the study of obesity ECR workshop on good PPIE- sharing learning from the Re:Mission study (2023) URL: www.youtube.com/watch?v=pnKWzm8-jzs
Clinical magazine article about ethnicity and its impact on those living with obesity including barriers to healthy eating, adherence to interventions, nutrition management, communication and recommendations for policy and practice (NHD). ‘Obesity and ethnicity’ (2023).
Presentation ‘Does the design of the NHS Low Calorie Diet Programme have fidelity to the service specification?’ at the UK Society of Behavioural Medicine Annual Scientific Meeting (2023).
Presentation to share learning from the Re:Mission study with the Leeds University nutrition group (2024).
Presentation to share Re:Mission study learning with Leeds Beckett University MSc dietetic students (2024).
ABCD webinar – Re:Mission study learning from staff and service user insights from the NHS Low Calorie Diet pilot (2024). URL: https://abcd.care/resource/current/demand-webinar-remission-study-learning-staff-and-service-user-insights-nhs-low
A short highlight notice about the new Path to Remission programme for GP surgeries. URL: https://remission.study/gp-video
A patient experience film – which explains the patient journey through the programme. URL: https://remission.study/patient-journey
An illustrated summary of what we have learnt from the Re:Mission study. URL: https://remission.study/summary
Patient and practice engagement resources
A short highlight notice about the new Path to Remission programme for GP surgeries. URL: https://remission.study/gp-video
A patient experience film – which explains the patient journey through the programme. URL: https://remission.study/patient-journey
An illustrated summary of what we have learnt from the Re:Mission study. URL: https://remission.study/summary
About this synopsis
The contractual start date for this research was in November 2020. This article began editorial review in January 2024 and was accepted for publication in October 2024. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The Health and Social Care Delivery Research editors and publisher have tried to ensure the accuracy of the authors’ article and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this article.
Copyright
Copyright © 2025 Ells et al. This work was produced by Ells et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0 licence, which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed. See: https://creativecommons.org/licenses/by/4.0/. For attribution the title, original author(s), the publication source – NIHR Journals Library, and the DOI of the publication must be cited.
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