Slimming World Research Articles

Benefits of a leaner workforce

Purpose – This paper aims to review the latest management developments across the globe and pinpoint practical implications from cutting-edge research and case studies. Design/methodology/approach – This briefing is prepared by an independent writer who adds their own impartial comments and places the articles in context. Findings – In total, 243 participants enrolled at a 12-week Slimming World weight management program, either within the workplace or at a regular community group. There were 138 completers (defined as those weighing-in at baseline and attending at least once within the past four weeks). Completers reported changes in both weight loss and body mass index, with benefits to mental and emotional health and feelings of self-worth. Healthier dietary habits – and a reduction in unhealthy dietary habits – were reported, plus an improvement in healthy physical activity. Practical implications – The paper provides strategic insights and practical thinking that have influenced some of the world’s leading organizations. Originality/value – The briefing saves busy executives and researchers hours of reading time by selecting only the very best, most pertinent information and presenting it in a condensed and easy-to-digest format.

Providing weight management via the workplace

Purpose – The purpose of this paper is to assess the feasibility and benefits of providing weight management support via the workplace. Design/methodology/approach – Quasi-experimental design using non-random assignment to a 12-week Slimming World (SW) weight management programme, either within the workplace or at a regular community group. Weight was recorded weekly and a 39-item questionnaire focused on mental and emotional health, self-esteem, dietary habits and physical activity habits administered at baseline, 12 weeks, six and 12 months. Findings – In total, 243 participants enroled (workplace n=129, community n=114) with 138 completers (defined as those weighing-in at baseline and attending at least once within the last four weeks; workplace n=76, community n=62). Completers reported a mean weight change of −4.9 kg±3.4 or −5.7 per cent±3.8. Mental and emotional health scores increased (p < 0.05) from baseline to 12 weeks. Self-worth scores increased (p < 0.05) from baseline to 12 weeks, six and 12 months. Healthy dietary habit scores increased and unhealthy dietary habit scores decreased (p < 0.05) from baseline to 12 weeks, six and 12 months. Healthy physical activity habit scores improved (p < 0.05) from baseline to 12 weeks and six months. There were no significant differences between groups. Research limitations/implications – Participant demographic was predominantly female (94 per cent) aged 42.3 years, with only 13 men participating. Practical implications – The results support the use of a 12-week SW weight management programme as a credible option for employers wanting to support staff to achieve weight loss and improve psycho-social health outcomes which could lead to improvements in quality of life and work performance. Originality/value – Provides evidence for the delivery of weight management support via the workplace.

Changes in Self-esteem in Participants Associated with Weightloss and Maintenance of Commercial Weight Management Programme

Introduction and methods: This study examined associations between weight loss, its maintenance and self-esteem in 292 members of a commercial weight management organisation, Slimming World. Self-esteem was measured with the Rosenberg self-esteem questionnaire adapted to 5-point Likert scales. Associations between dimensions of self-esteem and weight change were examined by correlation and regression using the GENSTAT 5 statistical program. Results: Mean (SD) weight on joining the CWMO was 89.0 (20.0) kg; time taken to reach current weight was 16.3 (13.5) months. Mean (SD) weight change was -15.6 (11.4) kg and BMI change was -5.7 (4.0) (both p < 0.001), maintained for 11.7 (12.8) months. Percent variance in weight change associated with each component of self-esteem is given in parentheses. All weight changes were negative. Participants reported a decrease in sense of failure (3.9%) and an increase in self-respect (3.0%) and self-pride (2.4%). Self-satisfaction (12.8%), feelings of self-achievement (10.6%), positive attitudes towards themselves (9.9%), sense of self-worth (10.6%) and self-efficacy (7.3%) all significantly increased in association with reaching and maintaining their current weight (all p < 0.001). Multiple regression analysis showed that age, gender, height and start weight accounted for 35.4% of the variance in weight change. Self-esteem components of the model accounted for 50.4% of the variance in weight change. Conclusion: Successful weight loss and maintenance was associated with significant reported improvements in self-esteem in members of a Commercial Weight Management Organisation.

Commercial weight‐loss programmes: are they effective for people with type 2 diabetes?

AbstractWeight loss is advocated as a primary therapy for the 90% of people with type 2 diabetes who are overweight or obese, but the capacity of the NHS to provide an integrated, cost‐effective weight management service limits application.It has been reported that conventional weight loss services within the NHS are less effective than group‐based commercial interventions including Rosemary Conley, Slimming World and WeightWatchers. These commercial organisations now offer weight management services in many areas of the UK through slimming on referral. There is evidence from randomised controlled trials and from audit demonstrating the efficacy of commercial groups for people without diabetes, but little evidence for those with diabetes.The aim of this review is to explore the evidence for these commercial providers in people with diabetes. Both Slimming World and WeightWatchers, but not Rosemary Conley, have published evidence of efficacy in their general groups. Only Slimming World has audited those with type 2 diabetes but this was a small, self‐reported study. Independent head‐to‐head trials and audit data from those without diabetes suggest that commercial programmes are effective for weight loss.Extrapolating these data to those with type 2 diabetes suggests that there is little to choose between the main commercial providers, that individuals can expect to lose 3–5kg over 12 weeks, and that attrition rates over 12 months or less are approximately 40–60%.Commercial groups are probably effective for those with diabetes, but there is little published evidence available about the effects on weight loss, glycaemic control and attrition rates. Copyright © 2015 John Wiley &amp; Sons.

Investigating motivations for weight loss and benefits of attending a commercial weight management organisation post-natally

Previous reports have indicated that women feel pressure from celebrity culture andwider society to lose weight swiftly after having a baby (Netmums and The Royal College of Midwives, 2010). The aim of this study was to investigate women’s motivations to lose weight postnatally, weight loss achieved and impact on selfesteem. A survey of women attending Slimming World (SW) who had given birth in the last 2 years was hosted on SWweb-site during September 2013. The survey used quantitative and qualitative questions to determine motivation and lifestyle behaviours and asked for self-reported weight and height. 1015 women responded. The majority of participants (n = 533, 52.5%) had been members for <3months; mean joining BMI was 33.3 kg/m2 (SD 5.85) and mean BMI at time of survey 30.5 kg/m2 (SD 5.86). The main reasons for wanting to lose weight were ‘to improve how I feel about my body size and shape’ (22%), ‘to improve my confidence’ (19%) and ‘to lose weight I gained during pregnancy’ (17%). A combined 3% citedmedia/ social pressure as a reason to lose weight and 31% agreed to feeling under social/media pressure to be an ideal weight post-natally. A range of weight gains in pregnancywere reported, themost common being between 1 and 2 stone. 71% (n = 611) of those who already had children reported having retained weight from a previous pregnancy. 82% said retaining weight postnatally affected their selfesteem. After losing weight with SW, 38% were lighter than their pre-pregnancy weight and 78.6% expressed improvements in selfesteem since joining SW. Social/media pressure plays a minimal role in a woman’s decision to lose weight post-natally. Motivation is more personal. Attendance at SW resulted in weight loss and improved self-esteem in post-natal women.

Pilot analysis exploring the impact of deprivation on engagement and weight outcomes in people attending a commercial weight management organisation

Records for Slimming World members from six postcode areas (Bristol, Chelmsford, Cleveland, Derbyshire, Doncaster and Nottinghamshire), representative of the total dataset for percentage weight (%) and BMI change (kg/m2), were selected from a convenient sample of the main dataset producing 41,371 members (3.1% of the original dataset). IMD scores were assigned using postcodes and records quintiled (ranked 1=most deprived to 5=least deprived).

The healthy eating and lifestyle in pregnancy (HELP) feasibility study

Obesity and excess gestational weight gain (GWG) are linked to increased complications during pregnancy, birth and postpartum. This study aimed to explore the feasibility of group-based weight management for obese pregnant women. At booking, pregnant women with a body mass index (BMI) &gt;30 kg/m2 were invited to weekly weight management groups, facilitated by a midwife and Slimming World consultant, providing diet and lifestyle, goal setting and general pregnancy advice. Attendance was until 6 weeks postpartum. 148 women with a mean age of 32 years (5.3 SD) and BMI of 37.4 kg/m2 (5.5 SD) attended. 85% (n=126) went to &gt;3 and 65% (n=96) &gt;6 sessions. The mean birth weight for 132 newborns was 3.53 kg (0.49 SD) and for the 39 women losing weight, 3.59 kg (0.35 SD). Of the 132 births, 48% were spontaneous vaginal delivery; 89% (115) initiated breastfeeding; 70% were still breastfeeding 28 days post-delivery. The healthy eating and lifestyle in pregnancy (HELP) group proved to be an acceptable intervention providing women with the ability to control weight gain during pregnancy, as well as maintaining a healthy lifestyle postpartum. Although the study was underpowered and exploratory, restricting GWG did not have a negative impact on the birth weights or other birth outcomes. Indeed, more babies were born in the healthy weight range to those women who lost weight during pregnancy.

Healthy eating and lifestyle in pregnancy (HELP): a protocol for a cluster randomised trial to evaluate the effectiveness of a weight management intervention in pregnancy.

BackgroundApproximately 1 in 5 pregnant women in the United Kingdom are obese. In addition to being associated generally with poor health, obesity is known to be a contributing factor to pregnancy and birth complications and the retention of gestational weight can lead to long term obesity.This paper describes the protocol for a cluster randomised trial to evaluate whether a weight management intervention for obese pregnant women is effective in reducing women’s Body Mass Index at 12 months following birth.Methods/designThe study is a cluster randomised controlled trial involving 20 maternity units across England and Wales. The units will be randomised, 10 to the intervention group and 10 to the control group. 570 pregnant women aged 18 years or over, with a Body Mass Index of +/=30 (kg/m2) and between 12 and 20 weeks gestation will be recruited. Women allocated to the control group will receive usual care and two leaflets giving advice on diet and physical activity. In addition to their usual care and the leaflets, women allocated to the intervention group will be offered to attend a weekly 1.5 hour weight management group, which combines expertise from Slimming World with clinical advice and supervision from National Health Service midwives, until 6 weeks postpartum.Participants will be followed up at 36 weeks gestation and at 6 weeks, 6 months and 12 months postpartum. Body Mass Index at 12 months postpartum is the primary outcome. Secondary outcomes include pregnancy weight gain, quality of life, mental health, waist-hip ratio, child weight centile, admission to neonatal unit, diet, physical activity levels, pregnancy and birth complications, social support, self-regulation and self-efficacy. A cost effectiveness analysis and process evaluation will also be conducted.DiscussionThis study will evaluate the effectiveness of a theory-based intervention developed for obese pregnant women. If successful the intervention will equip women with the necessary knowledge and skills to enable them to make healthier choices for themselves and their unborn child.Trial registrationCurrent Controlled Trials: ISRCTN25260464Date of registration: 16th April 2010.

The cost‐effectiveness of the LighterLife weight management programme as an intervention for obesity in England

LighterLife Total is a very low calorie diet total dietary replacement weight reduction programme that provides Foodpacks, behavioural change therapy and group support appropriate for people with a body mass index of 30 kg m(-2) or above. A model was built to assess the cost-effectiveness of LighterLife Total, compared with (i) no treatment, Counterweight, Weight Watchers and Slimming World, as a treatment for obesity in those with a body mass index of 30 kg m(-2) or above, and (ii) no treatment, gastric banding and gastric bypass in those with a body mass index of 40 kg m(-2) or above. Change in body mass index over time was modelled, and prevalence of comorbidities (diabetes, coronary heart disease and colorectal cancer) was calculated. Costs (of intervention and treatment for comorbidities) and quality-adjusted life years were calculated. LighterLife Total was cost-effective against no treatment, Counterweight, Weight Watchers and Slimming World in the 30+ kg m(-2) group (incremental cost-effectiveness ratios: £11 895, £12 453, £12 585 and £12 233, respectively). In the 40+ kg m(-2) group, LighterLife Total was cost-effective against no treatment (incremental cost-effectiveness ratio: £4356), but less effective than gastric banding and bypass.

Which weight-loss programmes are as effective as Weight Watchers®?

Three randomised controlled trials have provided strong evidence that Weight Watchers(®) is an effective weight-loss programme but there is insufficient evidence to determine whether three other weight-loss programmes are also effective. To examine whether other group-based weight-loss programmes were not inferior to Weight Watchers. A prospective cohort study using a non-inferiority analysis of 3290 adults referred through primary care. METHOD Participants who met the eligibility criteria for primary care obesity management treatment chose a free programme (Weight Watchers, Rosemary Conley Diet and Fitness Clubs, Slimming World or a NHS group programme) lasting 3 months; they were weighed at 3 months (programme end) and self-reported their weight at 12 months. At 3 months, weight loss achieved through Rosemary Conley and Slimming World was not inferior to Weight Watchers. The NHS group programme was inferior. At 12 months Slimming World and Rosemary Conley were not inferior to Weight Watchers, although participants using Slimming World lost significantly more weight than those using Weight Watchers. Data on the NHS group programme were inconclusive. In the short term all commercial weight-loss programmes appear to result in similar weight loss but the NHS alternative appears to produce less weight loss. At 12 months Slimming World led to greater weight loss but the differences between commercial programmes was small and of minor clinical importance.

Public health economics of body and mind: a health economist's perspective

BackgroundIf public health is the science and art of how society collectively aims to improve health, and reduce inequalities in health, then public health economics is the science and art of how we choose to do this with limited resources. The spectrum of public health activities is broad; for example, environmental policy, infectious disease control, individual behaviour change, and informing government legislation. I draw together key methodological considerations for the design, undertaking, and analysis of economic assessment alongside trials of public health interventions spanning environmental change and behaviour change relating to the body and mind. The discipline of health economics has grown up alongside a medical model of health. Many public health practitioners and health economists interested in public health are realising that emphasis is shifting from traditional behaviour-change interventions towards interventions that aim to change physical environments and social norms and that might need government legislation. This shift means that health economists need to approach the economic assessment of the broad spectrum of public health interventions in a more creative way. Quality-adjusted life-years may not fully capture diverse benefits of public health interventions but are useful for benchmarking the cost effectiveness of public health against clinical services. Health economists who have focussed on notions of efficiency need now to think more about equity, in view of public health goals of reducing inequalities in health. The aim is to convey to a public health science audience the challenges and opportunities facing health economists interested in public health today. MethodsI show these challenges and suggest solutions by drawing on recent published and ongoing trials of public health interventions with a health economics component. Changing the environment was investigated in the CHARISMA trial by improvement of heating and ventilation in homes of children with asthma. Changing individual physical behaviour was investigated by assessment of a national exercise referral scheme in the NERS trial. Changing individual mental behaviour was assessed by bringing mindfulness into the workplace in the Gwynedd trial. FindingsEmerging lessons include (1) the need to think about how evidence of cost effectiveness is going to be used by government and local commissioners of services, within what time horizon, and what the expected interplay may be between stakeholders; (2) mounting evidence that the government needs to focus on altering physical environments (eg, local planning laws, speed limits) and social environments (eg, school and workplace culture); and (3) a readiness to recognise where behaviour change has proved successful in the commercial sector, delivered in groups or online (eg, Slimming World). These three examples of economic analysis highlight thinking on design of economic assessment, power calculation issues relating to economic analysis, micro-costing techniques, and choice and range of outcome measures. InterpretationFaced with real public health challenges, we are beginning to learn how to design, undertake, and analyse economic assessments of public health interventions. We are learning how to provide clear evidence-based information to policy makers. Concrete recommendations to ensure funding streams for health economists, such as through the public health research programme, will help to support a methodological advancement in this field. FundingPublic Health Wales.

PSY46 - A Cost-Utility Analysis of Lighterlife Total as a Treatment for Obesity in the United Kingdom

LighterLife Total (LLT) is a weight loss programme for the obese (BMI ≥30kg/m2) combining a very low calorie diet (VLCD) with weekly support groups for behaviour modification. This study evaluated the cost-effectiveness of LLT compared with dietary and surgical interventions. This is the first study assessing the cost-effectiveness of a VLCD. A cohort model was developed to assess the reduction in BMI in the first 12 months following intervention with LLT, gastric banding, gastric bypass, Weight Watchers, Counterweight, Slimming World and no treatment, and the subsequent yearly BMI increase. Published all cause-mortality was applied by age and BMI. Co-morbidity prevalence (diabetes, colorectal cancer, CHD) was applied by BMI. Costs were applied for each intervention and for co-morbidities, from a UK health care perspective. Utilities were calculated by BMI with an additional decrement for co-morbidities. A 10 year time horizon was used. Analyses were run for two subgroups: BMI 30-40 in and BMI >40. BMI 30-40: compared against no treatment, Counterweight, Weight Watchers and Slimming World, LLT was associated with higher costs, but also greater QALYs and was cost-effective against all, with incremental cost-effectiveness ratios of £14,937, £16,004, £16,182, and £19,840, respectively. BMI >40: compared against no treatment LLT incurred higher costs, but also greater QALYs and was cost-effective (ICER = £5,349). LLT was less effective than banding and bypass. The budget impact of uptake of LLT across the UK was assessed for both BMI 30-40 and BMI >40 groups. BMI 30-40: LLT was more costly than dietary interventions, but lead to increased QALYs and was estimated to be cost-effective. BMI >40: LLT resulted in a lower initial BMI reduction than gastric banding and bypass. LLT was estimated to be cost-effective against no treatment in both groups.

Service evaluation of weight outcomes as a function of initial BMI in 34,271 adults referred to a primary care/commercial weight management partnership scheme

BackgroundIt is not clear if behaviour change programmes are more or less effective for weight management in people with high BMIs than for those who are moderately overweight. An earlier service evaluation reported on the rate and extent of weight loss in a primary care/commercial weight management organisation partnership scheme, in 34,271 patients were referred by their health care professionals to a UK commercial weight management organisation, Slimming World for 12 weekly sessions. This project updated that service evaluation by examining weight loss outcomes as a function of initial BMI in the same 34,271 patients.FindingsPatients referred to the scheme (n = 34,271) were categorised by BMI groups <30 kg/m2, 30-34.9 kg/m2, 35-39.9 kg/m2 and to ≥ 40 kg/m2. Mean weight losses after 12 weekly sessions were 2.9, 3.6, 4.1, and 4.8 kg for each BMI category respectively. Regression analysis showed that after adjusting for age and gender, relative to the <30 kg/m2 group, absolute weight losses were 0.8, 1.4 and 2.4 kg more for the 30-34.9 kg/m2, 35-39.9 kg/m2 and to ≥ 40 kg/m2 groups, respectively (all p<0.001). Percent weight loss was similar in each BMI category: 3.7%, 4.0%, 4.0% and 3.9%, respectively (p<0.001).ConclusionsThis service evaluation demonstrates that 12 week referral to a commercial organisation is as effective for people with high BMIs as for those who are moderately overweight.

Slimming World in Stop Smoking Services (SWISSS): study protocol for a randomized controlled trial

BackgroundQuitting smokers gain weight. This deters some from trying to stop smoking and may explain the increased incidence of type 2 diabetes after cessation. Dieting when stopping smoking may be counterproductive. Hunger increases cravings for smoking and tackling two behaviours together may undermine quitting success. A meta-analysis of randomized controlled trials (RCTs) showed individualized dietary support may prevent weight gain, although there is insufficient evidence whether it undermines smoking cessation. Commercial weight management providers (CWMPs), such as Slimming World, provide individualized dietary support for National Health Service (NHS) patients; however, there is no evidence that they can prevent cessation-related weight gain.Our objective is to determine whether attending Slimming World from quit date, through referral from NHS Stop Smoking Services, is more effective than usual care at preventing cessation-related weight gain.MethodsThis RCT will examine the effectiveness of usual cessation support plus referral to Slimming World compared to usual cessation support alone. Healthy weight, overweight and obese adult smokers attending Stop Smoking Services will be included. The primary outcome is weight change in quitters 12 weeks post-randomization. Multivariable linear regression analysis will compare weight change between trial arms and adjust for known predictors of cessation-related weight gain.We will recruit 320 participants, with 160 participants in each arm. An alpha error rate of 5% and 90% power will detect a 2 kg (SD = 2.5) difference in weight gain at 12 weeks, assuming 20% remain abstinent by then.DiscussionThis trial will establish whether referral to the 12-week Slimming World programme plus usual care is an effective intervention to prevent cessation-related weight gain. If so, we will seek to establish whether weight control comes at the expense of a successful quit attempt in a further non-inferiority trial.Positive results from both these trials would provide a potential solution to cessation-related weight gain, which could be rolled out across England within Stop Smoking Services to better meet the needs of 0.75 million smokers stopping with NHS support every year.Trial registrationCurrent Controlled Trials ISRCTN65705512

Faecal calprotectin levels before and after weight loss in obese and overweight subjects

Faecal calprotectin (FCP) is a non-invasive biomarker of intestinal inflammation, levels of which are reported to be elevated in individuals with increased body mass index (BMI). We investigated whether weight loss (WL), induced by dietary and behavioural change in a community weight loss programme (Slimming World), was associated with a reduction in FCP in a longitudinal cohort study. We obtained paired stool samples at the start and 11-15 weeks into the weight loss programme in 40 individuals with a BMI >25 kg m(-2) and no known colorectal or systemic inflammatory condition. Eight of 40 (20%) 'healthy' participants had a baseline FCP greater than 50 μg g(-1) (the accepted adult cutoff value for FCP), termed FCP(high). Although the degree (%) of WL was similar (5.1 FCP(high) versus 6.1 FCP(normal); P=0.63), only FCP(high) individuals, but not FCP(normal) participants, demonstrated a reduction in FCP level (median 0.3-fold versus 1.0-fold (that is, no change) during the study period (P=0.065). A large prospective cohort study of FCP(high) and FCP(normal) obese individuals is now required to determine the relationship between local mucosal inflammation and the systemic inflammatory state associated with obesity, as well as understand the relationship between FCP levels, WL and future risk of colorectal neoplasia.

Attendance and weight outcomes in 4754 adults referred over 6 months to a primary care/commercial weight management partnership scheme.

• There is growing evidence of the effectiveness of commercial weight management programmes in the community. A recent randomized controlled trial has shown commercial providers to be more effective than NHS providers for weight management solutions in primary care. Some commercial weight management providers have established national slimming on referral schemes for weight management, which result on average in weight losses of 4-5% over a 12-week referral period. A recent randomized controlled trial of a similar scheme over 12 months yielded similar weight loses. Another RCT comparing commercial providers over 6 months showed average weight losses of ∼6.6% across providers. • The present study shows that when local primary care practitioners target resources to where they, as health professionals, felt they would have the most beneficial effect in their local communities, greater weight losses can be achieved. • Different NHS Trusts extended 12-week referrals by an additional 12 weeks in a total of 4754 patients. • Mean weight losses of 8.6% were achieved suggesting that local targeting of primary care resources can maximize returns for NHS investments in commissioning the services of commercial weight management organizations. This project audited attendance and weight loss in a primary care/commercial weight management partnership scheme in patients who participated over 6 months. 4754 adult patients (575 men, 4179 women) were referred to Slimming World for 24 weekly sessions. Data were analysed using individual weekly weight records. Mean (standard deviation, SD) body mass index (BMI) change was -3.3 kg m(-2) (2.2), weight change -8.9 kg (6.0), percent weight change -8.6% (5.3) and number of sessions attended 21.3 (3.2) of 24. For patients attending at least 20 of 24 sessions (n = 3626 or 76.3%), mean (SD) BMI change was -3.6 kg m(-2) (2.2), weight change -9.6 kg (6.1), percent weight change -9.3% (5.3). Weight loss was greater in men than women (P < 0.001). 74.5% of all patients enrolled, and 79.3% of patients attending 20 or more sessions achieved at least 5% weight loss. 37.3% of the whole population lost ≥10% of their weight. Weight gain was prevented in 96.3% of all patients referred. Referral to a commercial organization for community-based lifestyle intervention is a practical option for longer-term National Health Service weight management strategies.

Comparison of range of commercial or primary care led weight reduction programmes with minimal intervention control for weight loss in obesity: Lighten Up randomised controlled trial

Objective To assess the effectiveness of a range of weight management programmes in terms of weight loss.Design Eight arm randomised controlled trial.Setting Primary care trust in Birmingham, England.Participants 740 obese...

Demographic factors do not predict weight loss maintenance in members of a commercial weight loss organisation

Demographic factors are important correlates of predisposition to obesity but much less is known about how they relate to weight loss and its maintenance. This analysis examined the demographic predictors of weight loss maintenance (WLM) in 1428 participants of a slimming organisation, who had been members for a mean_SD of 16_16 months, had lost 13.8%_9.2% weight and were trying to maintain, or increase, their weight loss during a subsequent 6 month study period. Data were collected as part of the DiOGenes study(1). Ethical approval was given by the University of Surrey Ethics Committee. Adults were recruited between August 2006 and July 2008 from Slimming World at group meetings and by email. Participants’ weights (using calibrated scales) were taken from group records at four time points, measurement 1 (M1) at the start of the study period, nominally six months later (measurement 2 (M2)), six months before M1 and when they initially enrolled with Slimming World. Participants were free to continue following the weight-loss programme as they wished during this study, and there was no intervention other than completing the questionnaires. Participants completed a general screening questionnaire at M1 relating to age, gender, marital status, education level achieved, employment status, number of adults and children in the household, monetary expenditure on food, number of siblings, weight history, weight history of parents and siblings, medical history (whether a doctor had told them they have had obesity, diabetes, cancer, high blood pressure, high cholesterol, heart disease or stroke), medical history of parents and siblings, alcohol intake, smoking status, and birth weight. Linear regression analysis was used to identify the associations between questionnaire responses and weight change (as % M1 weight) over the 6 month study period. Mean age was 46.8 years for women, 50.8 years for men; 95% were women. There was no association between age, sex, marital status or family structure and subsequent WLM. Heavier people lost a greater percentage of their weight during the study period than did lighter people (p<0.001), presumably because they had more to lose. People who were unemployed and “other” lost considerably more weight during the study than those who were employed, or not working for other reasons. However, there were only 37 and 58 people in these first two groups respectively. The percentage of respondents who reported being told by a doctor they had medical conditions was as follows: high blood pressure 30%, high cholesterol 16% and obesity 36%. Fewer than 5% of respondents answered yes for the other conditions. Being told by their GP that they were obese, either currently or in the past, significantly correlated with respondents’ WLM (p = 0.007). All significant associations explained a very small percentage of the variance in WLM. No other demographic variables were associated with WLM. In this study demographic measures were used as baseline indicators of subsequent outcome. They did not change in the time course of the study. While demographic factors are likely to be important in predisposing people to weight gain and in accessing the means to lose weight, it is likely that individual changes in eating and activity behaviour are more important in determining successful weight loss and its maintenance. This work was part of the Diet, Obesity and Genes project (www.diogenes-eu.org) funded by the European Commission (contract #: Food-CT-2005- 513946) in the Food Quality and Safety Priority of the Sixth Framework Program.

Changes in lifestyle habits and behaviours are associated with weight loss maintenance in members of a commercial weight loss organisation

This analysis examined the lifestyle correlates of weight loss maintenance in 1428 participants of a slimming organisation, who had been members for a mean SD of 16 16 months, had lost 13.8% 9.2% weight and were trying to maintain, or increase, their weight loss during a subsequent 6 month study period. Data were collected as part of the DiOGenes study(1). Ethical approval was given by the University of Surrey Ethics Committee. Adults were recruited between August 2006 and July 2008 from Slimming World. Subjects completed lifestyle measures at two time points, measurement 1 (M1) at the start of the study and nominally six months later (measurement 2 (M2)). Participants’ weights (using calibrated scales) were taken from group records for M1, M2, six months before (measurement 0) and when they initially enrolled. They were free to continue following the weight-loss programme as they wished during this study, and there was no intervention other than completing the questionnaires. At M1 and M2 meal frequency (breakfast, lunch and dinner) and snacking between meals were assessed using a 5-point Likert scale (daily to <once/week). Physical activity was assessed using the Baecke Physical Activity Questionnaire(2), which assesses three areas of habitual physical activity level from the previous 12 months, occupational physical activities, physical exercises in leisure (sports), leisure physical activities and a total score. A further question about physical activity level at work was included. Lifestyle habits were assessed using questions adapted from the Self Report of Habit Index(3), which measured the strength of important behaviours relating to weight control, (being physically active, frequent consumption of fruits and vegetables, following a healthy diet and consumption of low fat foods). Regular lunch consumption was associated with further weight loss (p = 0.002). Borderline evidence suggested snacking between meals was associated with weight regain (p = 0.057). Dietary habits relating to “eating a healthy diet” or “eating low-fat foods” were related to weight loss when reported at the second measurement, but not at the first and were related to Weight loss maintenance over the six months. The reported strengths of these two habits explained 3.8% and 0.7% of the variance in change in percentage body weight, respectively. When looking at change in habit strength over the six months, people for whom “eating a healthy diet”, “eating low fat foods” or “eating fruits and vegetables” had become stronger habits tended to have more successful weight changes. The correlations were significant, but very weak (R2 = 0.03, 0.019 and 0.01 respectively). People who were more active at the first measurement went on to lose less or gain more weight over the following six months (p = 0.035). In contrast, higher “being physically active” habit scores at the second measurement correlated with more weight loss (p = 0.013). All significant effects only explained a small proportion of the variance in weight loss maintenance. These and other data suggest that the habits of successful weight loss maintainers are heterogeneous because people adopt individual lifestyle behaviour profiles. Specific correlates while significant, only explain a small proportion of the variance in weight outcomes for the whole group. This work was part of the Diet, Obesity and Genes project (www.diogenes-eu.org) funded by the European Commission (contract #: Food-CT-2005- 513946) in the Food Quality and Safety Priority of the Sixth Framework Program.

Weight Outcomes Audit for 34,271 Adults Referred to a Primary Care/Commercial Weight Management Partnership Scheme

Objective: This project audited rate and extent of weight loss in a primary care/commercial weight management organisation partnership scheme. Methods: 34,271 patients were referred to Slimming World for 12 weekly sessions. Data were analysed using individual weekly weight records. Results: Average (SD) BMI change was –1.5 kg/m² (1.3), weight change –4.0 kg (3.7), percent weight change –4.0% (3.6), rate of weight change –0.3 kg/week, and number of sessions attended 8.9 (3.6) of 12. For patients attending at least 10 of 12 sessions (n = 19,907 or 58.1%), average (SD) BMI change was –2.0 kg/m² (1.3), weight change –5.5 kg (3.8), percent weight change –5.5% (3.5), rate of weight change –0.4 kg/week, and average number of sessions attended was 11.5 (0.7) (p < 0.001, compared to all patients). Weight loss was greater in men (n = 3,651) than in women (n = 30,620) (p < 0.001). 35.8% of all patients enrolled and 54.7% in patients attending 10 or more sessions achieved at least 5% weight loss. Weight gain was prevented in 92.1% of all patients referred. Attendance explained 29.6% and percent weight lost in week 1 explained 18.4% of the variance in weight loss. Conclusions: Referral to a commercial organisation is a practical option for National Health Service (NHS) weight management strategies, which achieves clinically safe and effective weight loss.