There is little research on what happens once interventions
found to be effective in a research setting are implemented in
practice at scale.30 We demonstrate here that the MEND
intervention when delivered at scale is associated with
improved BMI and psychosocial outcomes on average, while
at the same time having the potential to widen inequalities in
these outcomes. We do not know to what extent our findings
can be generalised to other weight management programmes
or to other community-based interventions. However, our
findings suggest that implementation of such interventions
should be accompanied by evaluation not only of sustained
impact but also of equality of impact at both the individual and
population level.