Introduction: Obesity is recognised as a significant health concern within the UK, and traditional weight management services have not demonstrated long-term improvements in health or reductions in weight. In response, some services are attempting to balance weight loss with broader wellbeing goals, however, the effectiveness of wellbeing‑focused models remains limited.
Aims: To evaluate the effectiveness and implementation of Feel Good Suffolk’s Healthy Weight pathway, a wellbeing-focused Tier 2 weight management service, to understand the mechanisms through which it operates, and the impact on service users.
Methods: A convergent mixed methods design combined routine outcomes for 1,097 adults with semi‑structured interviews with service users (n = 15) and stakeholders (n = 9). Linear mixed models assessed change in service user weight, body mass index (BMI), wellbeing (SWEMWBS) and physical activity (IPAQ). Reflexive thematic analysis explored experiences and service design.
Results: Weight (‑0.015 kg day⁻¹) and BMI (‑0.005 kg m⁻² day⁻¹) declined modestly (p < .001), whilst Wellbeing (+0.004 points day⁻¹; p = .084) and activity (+0.001 categories day⁻¹; p < .001) remained stable. Gender and disability moderated weight change, with small effect sizes. Thematic analysis revealed that service users identified a supportive scaffold of psychological safety, personalised goals and gentle peer accountability that made incremental change towards health and weight loss feel manageable. Weight loss remained central to the conversations, despite stakeholder attempts to widen the focus with a “healthy weight” reframe. Both groups acknowledged the impact of wider determinants of health, and stakeholders explained how the service plans to address them.
Discussion: Feel Good Suffolk delivers statistically reliable, yet clinically modest, weight reduction, a profile consistent with its wellbeing ethos. Its distinctive contribution lies in a psychologically safe climate that nurtures small, sustainable habit changes, leading to identity shifts. To maximise long-term impact, Tier 2 services should pair this psychologically informed design with extended follow up and outcome measures that identify health gains beyond weight.
