Improving support for adolescents living with excess weight

One in three UK adolescents is above a healthy weight, and roughly 80% of those with obesity will carry it into adulthood. Clinical guidelines recommend behavioural programmes to help, but the reality falls short: uptake is low, drop-out rates are high, and outcomes vary. Meanwhile, parents, teachers, and health professionals often avoid raising the subject altogether, worried about triggering stigma or harming a young person's mental health.

The result is a significant gap between what policy recommends and what young people actually experience. Opportunities for early support are routinely missed – and adolescents themselves are rarely asked what would help.

Our approach

This research set out to understand how adolescents think and feel about weight and weight support, and to identify what better services might look like. The team used complementary methods – in-depth interviews with young people and parents, analysis of the large-scale OxWell school survey, and a feasibility trial of a digital weight management tool – shaped throughout by engagement with young people, schools, youth organisations, and commissioners across the Thames Valley.

What we found – and why it matters

Three findings stand out:

1. Adolescents want support that is confidential, non-stigmatising, and self-directed – not funnelled through a parent or GP. This was reinforced by practical experience during the research, where recruitment through health professionals proved challenging.
2. Weight concern and mental health are tightly intertwined. Around 40% of young people surveyed reported significant worries about their weight, and interviews consistently described weight concern as a source of anxiety.
3. School-based and digital approaches emerged as more accessible and acceptable alternatives to traditional clinic-based services.

These findings are already reaching people who can act on them. Results have been shared with commissioners in four local authorities, informing how weight management services are designed and promoted – with greater emphasis on self-referral routes and school-based provision. Findings were presented to over 300 young people and youth service providers at the Buckinghamshire Youth Summit and published on the Youth Voices website. Insights from the feasibility trial have been shared with digital weight management providers to inform the development of youth-friendly apps and programmes.

The project also built research capacity by supporting training for a dietitian through an NIHR-funded research internship.

What this means

Around one third of adolescents in the OxWell survey said they would like help with their weight. Current services are not meeting that demand.

This research provides the evidence base for a different approach – one that puts young people's preferences at the centre, integrates weight support with mental health, and reaches adolescents through channels they actually find accessible.

What needs to happen next

The priority is to move from evidence to action. Local authorities, schools, and digital providers need to work together to pilot adolescent-centred support models, followed by evaluation of their effectiveness and cost-effectiveness. Practical guidance for professionals on discussing weight with young people – supportively and without stigma – would help bridge the gap between research and everyday practice.

The overlap between excess weight, weight concern, and disordered eating that this project uncovered points to a pressing need for interventions that address these issues together. Building on this, the lead researcher has secured an NIHR SPARC grant for a placement focused on the mental health dimensions of obesity, and is now co-applicant on an NIHR Programme Grant application exploring weight concern, obesity, and mental health in young people.

Lessons for future research

Recruiting adolescents for weight-related research through health professionals proved difficult – reinforcing the finding that young people want routes into support that do not depend on clinical gatekeepers. Researchers working in this area should consider school-based and community recruitment from the outset.

The close link between weight and mental health that emerged across every strand of this work suggests that future interventions must be designed to address both. Treating weight management in isolation risks missing the factors that matter most to young people.