Abstract

BackgroundGuidelines recommend that clinicians should make brief opportunistic behavioural interventions to patients who are obese to increase the uptake of effective weight loss programmes. The objective was to assess the effect of this policy on socioeconomic equity.MethodsOne thousand eight hundred eighty-two consecutively attending patients with obesity and who were not seeking support for weight loss from their GP were enrolled in a trial. Towards the end of each consultation, GPs randomly assigned participants to one of two 30-s interventions. In the active intervention (support arm), the GP offered referral to a weight management group. In the control intervention (advice arm), the GP advised the patient that their health would benefit from weight loss. Agreement to attend a behavioural weight loss programme, attendance at the programme and weight loss at 12 months were analysed by socioeconomic status, measured by postcode using the Index of Multiple Deprivation (IMD).ResultsMean weight loss was 2.43 kg (sd 6.49) in the support group and 1.04 kg (sd 5.50) for the advice only group, but these effects were moderated by IMD (p = 0.039 for the interaction). In the support arm, weight loss was greater in higher socioeconomic groups. Participants from lower socioeconomic backgrounds were more likely to accept the offer and equally likely to attend a weight loss referral but attended fewer sessions. Adjusting for these sequentially reduced the gradient for the association of socioeconomic status with weight loss from + 0.035 to − 0.001 kg/IMD point. In the advice only arm, 10% took effective action to promote weight loss. The decision to seek support for weight loss outside of the trial did not differ by socioeconomic status, but weight loss among deprived participants who used external support was greater than among more affluent participants (p = 0.025).ConclusionParticipants’ responses to GPs’ brief opportunistic interventions to promote weight loss differed by socioeconomic status and trial arm. In the support arm, more deprived people lost less weight because they attended fewer sessions at the programme. In the advice arm, more deprived people who sought and paid for support for weight loss themselves lost more weight than more affluent people who sought support.Trial registrationThis trial is registered with the ISRCTN registry, number ISRCTN26563137. Date of registration: January 3, 2013; date of first participant recruited: June 4, 2014

Highlights

  • The history of economic development shows that, broadly speaking, the prevalence of obesity rises with national wealth very probably because, as populations shift from rural to urban areas, the variety and amount of food available increases and manual tasks are replaced by automation [1, 2]

  • Analyses within the support arm Within the support arm, we examined whether the proportion of people accepting a referral when offered one by the GP differed by Index of Multiple Deprivation (IMD) score

  • The denominator was everyone in that arm. Among those who accepted a referral, we examined whether the proportion that attended at least one session and the number of sessions attended were associated with IMD score

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Summary

Introduction

The history of economic development shows that, broadly speaking, the prevalence of obesity rises with national wealth very probably because, as populations shift from rural to urban areas, the variety and amount of food available increases and manual tasks are replaced by automation [1, 2]. Obesity emerges first in the most affluent parts of society, but when a large proportion of the population become obese, a new trend is evident in which the most deprived have the highest prevalence of obesity [3]. This gradient contributes to the observed inequities in economic productivity, health outcomes and life expectancy. This situation calls for a wide-ranging and comprehensive policy response, designed to bring proportionally greater benefits to the most deprived groups. The objective was to assess the effect of this policy on socioeconomic equity

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