Community Weight Management Program Research Articles

A service evaluation of more than 1 million self-funding adults attending a community weight management programme.

Scaled interventions are required to address levels of overweight and obesity and reduce health inequalities. Little data is available on the effectiveness of community weight management programmes for participants self-selecting to attend across different socio-economic backgrounds. This analysis investigates 3, 6, and 12-month outcomes of adults joining a real-life community weight management programme. Weight, attendance and Indices of Multiple Deprivation (IMD) data from all fee-paying adults joining Slimming World in 2016 were collated. Data were analysed using descriptive and inferential statistics to determine predictors of weight loss. Mean BMI of 1 094 676 adults (7.6% male) was 33.0 ± 6.4 kg/m2. Mean % weight change at 3, 6, and 12 months was -5.0% ± 3.6%, -5.9% ± 5.2%, and -6.0% ± 5.8%. Those attending 75% sessions achieved greater weight loss with mean weight losses at 3, 6, and 12-months of 7.7% ± 3.3%, 11.3% ± 5.2%, and 14.1% ± 7.5%, respectively. Effect sizes from comparison of weight change between deprivation deciles were negligible, with similar outcomes in the most and least deprived deciles at 12-months (-5.7% ± 5.9% vs. -6.2% ± 5.9%). This service evaluation of more than 1 million adults attending a community weight management programme found they were able to achieve and/or maintain an average 6% weight loss at 12 months, with high attenders achieving >14% loss. Men and those with higher levels of deprivation were accessing the support and achieving significant weight losses. Slimming World as a real-life, scalable weight management programme is well placed to help adults manage their weight and address health inequalities.

Assessing the role of biomarker feedback in a 12-week community weight management programme among overweight men: A pilot study.

The primary objective of this study was to examine the feasibility of recruitment, retention, and delivery of biomarker feedback among men partaking in Shape Up, a physical activity for health programme. Secondarily, it explored the potential effects of biomarker feedback on participants' adherence and motivation levels. In this two-arm non-randomised pilot study, 46 men (mean±SD age 46.0±8.6 years) participating in the 12-week Shape Up programme were assigned to a control group or biomarker feedback group. Biomarker feedback consisted of 3 blood test panels: at baseline, 12 weeks, and 24 weeks (follow-up), each with a doctor's report. Both groups completed questionnaires (Short Active Lives Survey [SALS], Treatment Self-Regulation Questionnaire [TSRQ], and EQ-5D-5L) to gauge levels of motivation and engagement. The mean difference was calculated between baseline and programme end. Recruitment, retention, and attendance rates were determined. Mean recruitment (approach-to-consent), retention, and attendance rates were 96.3%, 92.3%, and 83.7% in the control group, and 85.2%, 86.2%, and 81.5% in the biomarker feedback group, respectively. Of biomarker feedback group participants, 86.4% attended their 12-week blood test and 45.5% attended their follow-up blood test. The mean 12-week differences (95% CI) for the control group and biomarker feedback group were 138.1 (2.7, 273.5) and 467.3 (249.4, 685.2) for active minutes per week, 0.2 (-0.8, 1.2) and 0.4 (0.0, 0.8) for autonomous TSRQ domains, 0.2 (-0.3, 0.8) and 0.8 (0.1, 1.4) for controlled TSRQ domains, and 19 (12.7, 26.5) and 27.2 (19.8, 34.6) for EQ-5D-5L scores, respectively. Biomarker feedback was well-received by participants and deemed feasible, with high recruitment and retention rates for the duration of the 12-week programme. Biomarker feedback may affect aspects of motivation but did not appear to influence adherence to the programme. Biomarker data may provide additional evidence of programme efficacy. Important design considerations are provided for definitive larger-scale trials.

Long-term weight loss maintenance in females after participation in a community weight management programme – A feasibility study

Long-term weight loss maintenance in females after participation in a community weight management programme – A feasibility study

“I didn't want to do it on my own”: A qualitative study of women's perceptions of facilitating and risk factors for weight control on a UK commercial community program

Overweight and obesity remain serious public health concerns. Outcomes from community based commercial weight management programmes vary, relapse is common and drop out is high. Outcomes could be improved by better understanding experiences on these programmes. The aim of our study was to generate accounts of people's experience on a commercial weight-management program to identify what experiences were perceived as facilitating, and what posed risks, to programme effectiveness and compliance. We conducted individual, semi-structured interviews with eighteen Caucasian women (mean age 45.4y) who were members of nation-wide UK commercial, fee-paying, community weight management programme. Interview data was analysed via framework analysis. Participants' experiences indicated that the programme helped by triggering several intra- and interpersonal processes that catalysed change across psychological, physiological, dietary and behavioural areas of their life. Risks to program adherence and effectiveness spanned well-known risks such as self-regulation fatigue and the difficulty of recovering from negative self-criticism, as well as new factors such as the confusing nature of weight change, the relatively powerful impact of everyday events, and the difficulty in getting the balance right between personalised support vs. intrusion. The complexity of reported experiences challenges the linear, predictive pathways of change proposed by many health behaviour models of weight management. To improve effectiveness, programmes need to go well beyond behavioural and dietary support. It is recommended that community, commercial programmes educate people about the physiological and psychological tensions they will encounter, why people lose weight at different rates, the likelihood of weight relapse and strategies to manage these, including evidence-based support for managing self-criticism.

What Motivates Engagement in a Community-Based Behavior Change Strategy for Overweight Children?

Introduction. The success of family-based community programs for childhood obesity may be increased by promoting social-cognitive factors that influence motivation and participant engagement. Incentivizing behavior can potentially enhance engagement and encourage behavior change. This research investigated motivators to engagement with a multicomponent incentive-based strategy to improve attendance and health-related behavior change in a family community-based weight management program for overweight and obese children. Method. Qualitative analysis combining; demographic data (n = 512), survey of parents (n = 273), and stakeholder (n = 10) and family interviews (n = 24). Participants were selected from program providers and families participating in an Australian community weight management program during a randomized controlled trial (n = 512 children). Maximum variation sampling (demographics and group characteristics) and inductive thematic analysis were used. Results/Conclusion. Four factors influencing engagement were (1) personal value, (2) achievement, (3) support, and (4) overwhelm. These themes corroborated with social-cognitive factors, fostered by a combination of behavior change components in the program that increased participant accountability and intrinsic motivation. Focusing on autonomous goal planning with parental involvement, tracking of goals, and reviewing of goals may complement existing strategies in child-focused treatment programs. Low-value noncash incentives linked to goal setting for encouraging healthy eating and physical activity were well accepted and may enhance family engagement and attendance.

The Northumberland Exercise Referral Scheme as a Universal Community Weight Management Programme: A Mixed Methods Exploration of Outcomes, Expectations and Experiences across a Social Gradient.

Exercise referral schemes (ERS) are internationally recognised, yet little attention has been paid to discrete referral groups or the influence of wider social determinants of health. The primary quantitative element of this mixed methods study used a mixed effects linear model to examine associations of sociodemographic predictors, obesity class and profession of referrer on weight and physical activity (PA) variables for weight-related referrals (n = 3624) to an established 24-week ERS. Chained equations modelling imputed missing data. The embedded qualitative element (n = 7) used individual semi-structured interviews to explore participant weight-related expectations and experiences. Age, gender and profession of referrer influenced weight loss. PA increased and was influenced by age and gender. The weight gap between the most and least obese narrowed over time but the PA gap between most and least widened. Age, employment and obesity class were most predictive of missing data but would unlikely alter overall conclusions. Qualitative themes were weight-loss support, personal circumstances and strategies, and weight expectations versus wellbeing rewards. This ERS worked, did not widen existing obesity inequalities, but demonstrated evidence of PA inequalities for those living with deprivation. To improve equity of experience, we recommend further stakeholder dialogue around referral experience and ongoing support needs.

4225Effectiveness of a behavioural incentive scheme linked to goal achievement in overweight children: a multicenter cluster randomized controlled trial

Abstract Background The prevalence of childhood overweight and obesity is becoming an increasing concern worldwide and management is vital for primary prevention of cardiovascular disease. Studies in adults have shown that provision of incentives may facilitate behaviour change but there are no similar studies targeting weight management in children. Purpose To determine effectiveness of a structured goal setting incentive scheme, delivered within a community program, on health outcomes (with a focus on cardiovascular risk factors) in overweight children at 6 and 18 months. Methods Single-blind, multicenter, cluster randomized controlled trial with 10 weeks, 6 and 18 month follow-up. Eligible sites had to be delivering the standard children's weight management program and enrol at least 10 children per term. Eligible children had to be 7–13 years and have a body mass index (BMI) >85th percentile. Recruited sites were randomized to (i) standard weight management program plus incentive scheme (intervention) or (ii) standard program alone (control). The intervention group participated in the standard program plus received milestone based incentives for achievement of goals. Incentives were practical, and healthy in nature such as fun vegetable slicers, sports store vouchers, sport equipment and family zoo passes. Primary outcome was mean BMIz score at 18 months. Secondary outcomes included anthropometric (body weight, waist circumference), behavioural (physical activity, nutrition) and self-esteem (Physical Activity Enjoyment Scale, Rosenberg Self Esteem Scale) measures. Results A total of 37 sites (33 urban and 4 regional) and 512 children were recruited. There were no significant differences between the control and intervention groups at any follow-up time-points. There were significantly more participants in the intervention than control group who completed 10 sessions of the weight management program (23% v 13%, p=0.015). Compared to baseline, at 18 month follow-up, the total cohort achieved significant reductions in the mean BMIz score (1.7 v 1.0, p<0.001), median screen time (16.5 v 15.8 hours/week p=0.0414), median number of fast food meals per week (1.0 v 0.7, p<0.001) and significant increases in physical activity (6.0 v 10.0 hours/week, p<0.001) and self-esteem score (20.7 v 22.0, p<0.002). Conclusions The incentive scheme, delivered in addition to a standard community weight management program, did not have a significant impact on health outcomes in overweight children. However, the intervention increased program attendance and overall cohort achieved sustained improvements in clinical and lifestyle outcomes. The results of this study suggest that extrinsic rewards may not provide added value to current community weight management programs however, participation in such programs is likely to support primary prevention of cardiovascular disease. Acknowledgement/Funding This work was supported by National Heart Foundation (Australia) pilot funding as part of JR's Future Leader Fellowship, in-kind contributions from th

Long-term outcomes of attending a community weight management programme

Searchable abstracts of presentations at key conferences in obesity ISSN 2632-9808 (online)

Behaviour change and weight and outcomes in patients referred to a community weight management programme

Searchable abstracts of presentations at key conferences in obesity ISSN 2632-9808 (online)

Development and Feasibility of a Pacific-Focused Community Weight Management Program

Development and Feasibility of a Pacific-Focused Community Weight Management Program

Evaluating factors influencing the delivery and outcomes of an incentive-based behaviour change strategy targeting child obesity: protocol for a qualitative process and impact evaluation

IntroductionCommunity-based weight management programmes are important in addressing childhood obesity. However, the mechanisms that lead to behaviour change within the programmes are rarely studied within the context of the programmes...

Outcomes of a community-based weight management programme for morbidly obese populations.

Morbid obesity is an ongoing concern worldwide. There is a paucity of research reporting primary care outcomes focussed on complex and morbidly obese populations. The National Institute for Health and Care Excellence (NICE) recommends a specialist, multidisciplinary weight management team for the successful management of such populations. This is the first service evaluation reporting both primary (weight change) and secondary [body mass index (BMI), waist circumference, physical activity levels, fruit and vegetable intake, Rosenberg self-esteem score] outcomes in these patients. The present study comprised a prospective observational study of a cohort data set for patients (n = 288) attending their 3-month and 6-month (n = 115) assessment appointments at a specialist community weight management programme. Patients had a mean (SD) initial BMI of 45.5 (6.6) kg m- ²; 66% were females. Over 80% of patients attending the service lost some weight by 3 months. Average absolute weight loss was 4.11 (4.95) kg at 3 months and 6.30 (8.41) kg at 6 months, equating to 3.28% (3.82%) and 4.90% (6.26%), respectively, demonstrating a statistically significant weight change at both time points (P < 0.001). This meets NICE best practice guidelines for the commissioning of services leading to a minimum of 3% average weight loss, with at least 30% of patients losing at ≥5% of their initial weight. Waist measurement and BMI were reduced significantly at 3 months. Improvements were also seen in physical activity levels, fruit and vegetable consumption, and self-esteem levels (P < 0.001). This service was successful in aiding weight loss in morbidly obese populations. The findings of the present study support the view that weight-loss targets of 3% are realistic.

Preliminary Outcomes from a Community Weight Management Program

s / Can J Diabetes 39 (2015) S38eS74 S72 (N1⁄424) were allocation concealed and randomized. The implementation process and context was evaluated by a qualitative study (interviews, field notes) analyzed by thematic analysis. The quantitative outcome measure of the number of weight management visits per full time equivalent RN/NP was blinded and collected over 1 year. Results: Qualitative results have revealed interacting contextual factors influencing the implementation of the intervention. These include the complexity and embedded nature of obesity, multidisciplinary team factors, provider relationship with patients, individual ability and work environment. These factors will enhance understanding of the primary outcome. Qualitative results have identified changes in provider behavior such as a reduction of patient weight bias, improved use of 5As of Obesity Management tools, and efficient obesity assessment. Summary: Tailoring weight interventions to primary care context may be a necessary step in overcoming barriers to implementation and effective change.

Patients with type 2 diabetes achieve similar weight loss in a community weight management programme compared to those without type 2 diabetes

Patients with type 2 diabetes achieve similar weight loss in a community weight management programme compared to those without type 2 diabetes

Changes in Abdominal Adiposity in Overweight and Obese Subjects Following an 8-Week Community Weight Management Program

INTRODUCTION: Centers for Disease Control and Prevention estimated that 68% of the Americans are either overweight or obese. Adiposity has been linked with increased risk of heart disease, diabetes mellitus, hypertension, high cholesterol, respiratory disease, and stroke. Specifically, visceral adiposity has been reported to increase the risk of these comorbidities. PURPOSE: To examine changes in visceral and subcutaneous abdominal fat stores, body mass, and body mass index (BMI) following an 8-week community weight management program. METHODS: Over the last nine years (2000-2009), 231 subjects, 175 females and 56 males (mean ± SEM, age: 50.5 ± 0.7y; height: 1.6 ± 0.005m; body mass: 95.6 ± 1.4kg; BMI: 34.2 ± 0.45 kg/m2) participated in an 8-week community based weight management program consisting of a low-calorie diet (1200 kcal/day) and moderate physical activity. Subjects participated in weekly group meetings where they received education on the food exchange system and were counseled on behavior modification strategies related to diet and exercise adherence. Fat distribution was estimated using anthropometric sagittal diameter and predictive equations. Percent body fat was measured using bioelectric impedance, Tanita BF-350 (Arlington Heights, IL). Self-reported data was used to monitor adherence to diet and exercise. Two test periods (pre-post) were analyzed using paired sample T-test to determine changes in body mass, BMI, percent fat, visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT) and total adipose tissue (TAT). RESULTS: Significant decreases (p<0.001) in body mass, BMI, VAT, SAT, TAT, and percent body fat (p<0.01) were found from pre-to-post test. Relative reductions were 6% for percent body fat, 18% for VAT, 9% for SAT, and 10% for TAT at the end of the 8-week intervention. CONCLUSION: The significant decrease in body mass as well as percent body fat contributed to significant losses in VAT, SAT, and TAT. In addition, there was greater relative loss of VAT than SAT. Our results show that an 8-week community based weight management program consisting of a low-calorie diet and moderate physical activity led to significant positive changes in body composition.

Effect of reimbursement incentive on enrollment in weight control

Although much research addresses the effects of various obesity treatment strategies, little is known about factors that influence choices to enter treatment programs. Objective: to determine whether the prospect of partial fee reimbursement for a university-sponsored community weight management program, contingent on individual performance, influences the proportion of program inquirers who enroll. Methods: EatRight Program (www.uab.edu/eatright) inquirers between June and November 2004 (Control period) were given a different message by phone than were inquirers between January and September 2005 (Intervention period). Control-period inquirers who asked about reimbursement were told its availability depended on their insurance provider. Intervention-period inquirers with self-reported BMIs 30 kg/m2 were told that the Program would reimburse half of the $270 fee if they 1) paid the full EatRight fee, 2) attended 10 of 12 classes, and 3) lost 6% of initial body weight. Results: during the Control period, 139 potential subjects inquired and 48 enrolled (34.5%); during the Intervention period 234 inquired and 79 enrolled (33.8%). Conclusions: the prospect of partial reimbursement for the cost of a weight control program, contingent on individual performance, did not appear to affect program enrollment. This could be influenced by the subjects’ SES and other variables. Additional variables (class attendance, weight loss, health care costs, second control period, seasonality) will be examined. Supported by NIH grants DK067357 and DK056366.

Effects of outcome-driven insurance reimbursement on short-term weight control.

Although most health insurers exclude coverage of weight control therapy, one local insurer offered partial reimbursement of the cost of a weight control program, using an incentive plan. To determine whether outcome-driven insurer-based reimbursement improves participation in a weight control program and short-term weight loss outcomes. Cohort follow-up study between January 1998 and February 2001. Community weight management program operated by an academic medical center. Obese participants who had the potential for reimbursement (Group A, n=25) and participants in the same program classes (Group B, n=100) who had no possibility for reimbursement. Subjects in Group B were selected from among 206 potential participants using a propensity score to match them with subjects in Group A on age, gender, ethnicity, starting BMI, starting weight, and educational, economic, and demographic variables. Group lifestyle-based weight management program. The insurer reimbursed half the cost of the program to obese participants who met minimum weight criteria, paid the program fee at enrollment, attended > or =10 of the 12 classes, and lost > or =6% of initial body weight after 12 weeks. Participation rates and weight loss outcomes. Group A subjects attended significantly more classes (mean+/-s.d.: 10.1+/-1.8 vs 8.2+/-2.5, P<0.001) and lost more weight than Group B subjects (6.1+/-3.1 vs 3.7+/-3.6%, P=0.002). While 84% of Group A subjects attended > or =10 classes, only 37% of Group B subjects did so (P<0.001); 56% of Group A subjects lost > or =6% of body weight, but only 20% of Group B subjects did so (P<0.001); 56% of Group A subjects achieved both the class attendance and weight loss goals, but only 14% of Group B subjects did so (P<0.001). Logistic regression estimated that Group A subjects had 8.2 times the odds of attending > or =10 classes and 4.5 times the odds of losing > or =6% of body weight of Group B subjects, after controlling for class attendance. Insurer-based reimbursement that is contingent upon initial financial commitment on the part of the patient, consistent program participation, and successful weight loss is associated with significantly better short-term weight control outcomes.