Abstract
BackgroundObesity is a rising global threat to health and a major contributor to health inequalities. Weight management programmes that are effective, economical and reach underprivileged groups are needed. We examined whether a multi-modal group intervention structured to cater for clients from disadvantaged communities (Weight Action Programme; WAP) has better one-year outcomes than a primary care standard weight management intervention delivered by practice nurses (PNI).MethodsIn this randomised controlled trial, 330 obese adults were recruited from general practices in London and allocated (2:1) to WAP (N = 221) delivered over eight weekly group sessions or PNI (N = 109) who received four sessions over eight weeks. Both interventions covered diet, physical activity and self-monitoring. The primary outcome was the change in weight from baseline at 12 months. To indicate value to the NHS, a cost effectiveness analysis estimated group differences in cost and Quality-Adjusted Life-Years (QALYs) related to WAP.ResultsParticipants were recruited from September 2012 to January 2014 with follow-up completed in February 2015. Most participants were not in paid employment and 60% were from ethnic minorities. 88% of participants in each study arm provided at least one recorded outcome and were included in the primary analysis. Compared with the PNI, WAP was associated with greater weight loss overall (− 4·2 kg vs. − 2·3 kg; difference = − 1·9 kg, 95% CI: -3·7 to − 0·1; P = 0·04) and was more likely to generate a weight loss of at least 5% at 12 months (41% vs. 27%, OR = 14·61 95% CI: 2·32 to 91·96, P = 0·004). With an incremental cost-effectiveness ratio (ICER) of £7742/QALY, WAP would be considered highly cost effective compared to PNI.ConclusionsThe task-based programme evaluated in this study can provide a template for an effective and economical approach to weight management that can reach clients from disadvantaged communities.Trial registrationISRCTN ISRCTN45820471. Registered 12/10/2012 (retrospectively registered).
Highlights
Obesity is a rising global threat to health and a major contributor to health inequalities
The most recent meta-analyses of behavioural approaches reported a pooled mean difference in weight loss for intervention versus control comparisons at 12 months of 2·8 kg [11], while in trials conducted in an ‘everyday context’ via commercial weight loss programmes the difference in weight loss was 2·2 kg [12]
Participants were recruited from September 2012 to January 2014 with 1-year follow-ups completed in February 2015
Summary
Obesity is a rising global threat to health and a major contributor to health inequalities. The most recent meta-analyses of behavioural approaches reported a pooled mean difference in weight loss for intervention versus control comparisons at 12 months of 2·8 kg (95% CI 2.1 to 3·6 kg) [11], while in trials conducted in an ‘everyday context’ via commercial weight loss programmes the difference in weight loss was 2·2 kg (95% CI 1·5 to 2·9 kg) [12]. These effects are modest but sustainable, and they are sufficient to lead to long-term health improvements [13]
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