Weight Management Group Research Articles

Service evaluation of attendance at general dietetic outpatient clinics

Background: Service evaluation of general dietetic outpatient clinics is necessary to identify areas of poor attendance because these occurrences may adversely affect clinic waiting lists, efficiency levels, the health outcome of patients and the cost to the National Health Service. Although some studies have looked at increasing attendance of new appointments (Burns et al., 2008), few have explored whether there is a relationship between ‘did not attend’ (DNA) rates and any trends in the type of appointment patients have been referred for. This service evaluation aimed to distinguish subgroups of patients referred to the general clinics in terms of percent attendance and to re-evaluate strategies to improve attendance. Methods: Data were collected on patients attending a general adult dietetic outpatient clinic over a period of 6 months from January to June 2010. The clinic offered an initial dietetic assessment appointment of 30 min in duration and, if required, follow-up appointment(s) of 15 min in duration. Patients were grouped, retrospectively, by the initial presenting referral request, for example weight loss, diet controlled diabetes (including impaired glucose tolerance and impaired fasting glucose), polycystic ovary syndrome (PCOS), women's health (including IVF), liver diet advice, chronic obstructive pulmonary disease, irritable bowel syndrome and general weight gain. The gender, type of appointment and outcome of appointments, including DNA rates, were collected. The total population was then allocated to one of two groups based on their reason for referral into awomen's health (excluding women referred for liver diet advice or gastro) and a weight management group (excluding patients referred for general weight gain (including for IVF), liver diet advice or gastro). Results: The results show that 63% attended the whole clinic, 11% called to cancel and rearranged the appointment and 26% DNA. The highest DNA rate was in the weight management group (27%) and this group also had the lowest percentage of patients cancelling their appointments. Table 1 shows the % DNA and cancellation rates as well as female to male and new to follow-up appointment ratios. Table 1. Characteristics of patients attending a general dietetic outpatient clinic Clinic n Female : Male New : Follow-up % DNA rate F : M % DNA % cancelled n, number; F, female; M, male. *Unable to define new:follow-up data because the general women's health group contains data from multiple sources (e.g. PCOS, IVF, weight management). Total clinic 440 67 : 33 45 : 55 26% 51 : 49 11 Weight management 287 67 : 33 45 : 55 27% 53 : 47 7 General women's Health 234 100% female –* 19% 19 17 Discussion: The DNA rate for general women's health of 19% was lower than the total clinic level of 26% but their cancellation rate was the highest at 17% (versus 11% for the total clinic). Cancellation is an area that requires further investigation because it is unclear whether more cancellations were made more than 24 h before the clinic and whether patients had been selected from an emergency list. The study by Dockerty (1992) showed that long waiting lists followed by a new appointment resulted in a higher likelihood for DNA or cancellation. Encouraging patients to cancel appointments in advance may help reduce waiting lists and cost to outpatient services. Conclusions: In this cohort, 26% of patients DNA and 11% cancelled their appointments, with the women's groups showing the highest cancellation rate (17%) and lowest DNA (19%). Further work needs to be conducted to identify reasons for DNA and clinic cancellations. No difference in DNA rates was found between sexes in the total clinic; however, additional research is needed to assess other factors affecting attendance such as age, language, underlying clinical condition, number of co-morbidities, mobility status, employment status, understanding of reason for referral, expectation of what a dietitian can offer, education of patients, social barriers, physician's age and knowledge, transport, ill-health and financial constraints.

An evaluation of the long-term effectiveness of two adult community-based group weight management interventions

Background: National guidance supports the provision of weight loss group programmes in a community setting using behavioural change methods as the first line intervention for adults (NICE, 2006) and post-natal women (NICE, 2010). The evidence base for the long-term effectiveness for such National Health Service-provided interventions is currently limited (Paul-Ebhohimhen & Avenell, 2009). The aim of this service evaluation of two types of community-based, group weight management, 6-week courses in a multicultural deprived inner city area was to determine whether the weight loss achieved over 6 weeks was sustained over the long term, thus demonstrating that these courses are effective. Methods: All 167 clients, who had attended four or more sessions of a 6-week long Size Down or Post-Natal Size Down weight loss course between 6 and 24 months ago, were telephoned with the purpose of completing a telephone questionnaire to determine a recent weight measure. At least two attempts were made to contact each client. In addition, those who had attended the Post-Natal Size Down course were offered a home visit with electronic scales to obtain a weight measure aiming to lend validity to the reported weights from the telephone questionnaire. The weights obtained were compared with the clients’ weights on completion of the course. Verbal consent was obtained. Results: Seventy-four clients (72 female and two male) completed the telephone questionnaire. Ninety-three (56%) clients were noncontactable. Recent weight measures were obtained for 65 clients, 17 of which were obtained by a home visit. Nine clients refused to report their weight. Since completing the course, 31 (42%) clients had continued to lose weight with a mean further weight loss of 5.5% (Size Down, 4.3%; Post-Natal Size Down, 9%) (range 0.1–21.9%), in addition to the mean weight loss of 1.9% (Size Down, 1.7%; Post-Natal Size Down, 2.2%) over the 6-week course. Twenty-one (28%) clients had maintained their weight and 13 (18%) had gained weight. Overall mean weight change for all clients from the beginning of the course to the telephone questionnaire was −3.8% (Size Down, −3.9%; Post-Natal Size Down, −3.6%). Further analysis of all the 38 clients that had completed both courses ≥12 months ago (mean 17.5 months; range 12–25 months) demonstrated a mean −4.1 kg (3.9%) weight change from baseline weight. Discussion: Given that further weight loss or weight maintenance is reportedly unachievable over the long term for the majority of those who attend weight management groups (Wing, 2005), these data suggest a more positive outcome for these two particular interventions, with two-thirds of clients either continuing to lose more weight or being able to maintain the weight initially lost. The further analysis of the group weight change from baseline values compares favourably with a recent Cochrane review on weight loss interventions (Norris et al., 2009) where, after 1 year, baseline weight was reduced by 2.8 kg (3.3%). The limitations of this evaluation are the accuracy of the telephone interview for obtaining weight data because these weights were self-reported; the majority of the clients were female; the sample size used was small with a large number of clients noncontactable. Conclusions: This service evaluation of Size Down and Post-Natal Size Down suggests that the weight loss achieved over 6 weeks was successfully sustained by two-thirds of the clients over the long term, and that these particular interventions are effective. Further evaluation using actual weight measures and including more male clients is needed.

An investigation into how satiety and hunger they influence food choice in slimmers and nonslimmers

Background: Satiety is defined as either a feeling of fullness or the cessation of physical hunger sensations following the ingestion of food (Murray & Vickers, 2009). How the satiating value of foods and their overall satiating effect can be used as a strategy for promoting weight loss has become an area of increasing interest in terms of weight management. This qualitative study investigated the attitudes of individuals who were ‘slimmers’ versus ‘nonslimmers’ about hunger and the different sensations of hunger, satiety and measures taken to stay satisfied and how feeling of hunger influences food choices. Methods: Participants were recruited via community weight management groups (slimmers) and the local community (nonslimmers, screened as not actively losing weight). Four focus groups were held. Participants were asked questions that explored their feelings related to hunger and satiety; whether they perceived there to be different types of hunger; how hunger influences subsequent food choice and whether they considered it important to avoid feeling hungry. The focus group followed a semi-structured format and data were collected until saturation was achieved. The session was recorded and later transcribed verbatim. To ensure consistency, the same moderator facilitated each session. The transcripts were thematically analysed using N-vivo. Results: Sixteen participants; nine slimmers, actively losing weight, and seven nonslimmers were recruited. All subjects considered hunger as a physical sensation that elicits a behavioural response. Common responses included consuming larger volumes of food and selecting convenience food options. For slimmers, these actions were perceived to be detrimental to their efforts. For slimmers, hunger sensations had the potential to initiate a spiral of emotions causing them to perceive their weight loss attempts are futile. Consequently, slimmers felt hunger was something to be avoided and they took active measures to achieve this. Most commonly slimmers incorporate planned ‘snacks’ between meals to curb hunger. Satiety was considered across all groups to be beneficial because it offers increased eating control and, for slimmers, enables them to manage hedonic desires to eat. Another core theme identified was that foods considered to offer increased satiety were ‘carbohydrate-based foods’. Discussion: Avoiding hunger would appear to be an important strategy for slimmers to achieve weight loss success and the strategy of regular snacking may be a beneficial behaviour to support weight loss. The evidence base is mixed, although there is research to suggest snacking can aide slimming success (Waller et al., 2004). Satiating foods have been shown to impact upon reducing intake. What this study shows is the perceived importance of satiety on eating behaviour and the role it can play in controlling eating behaviour for consumers. This indicates that satiety is also an important factor in achieving weight loss success. Conclusions: A dietary approach that emphasises the satiating power of foods alongside a calorie deficit may facilitate more successful weight loss. The insight this study offers into the mentality of a slimmer could also be useful in clinical practice when building rapport and establishing empathy between dietitians and patients.

Patient reported outcome measures in weight management service evaluation

Background: Changes to National Health Service (NHS) commissioning (Department of Health, 2010) will increase the need for weight management services to demonstrate service effectiveness far beyond traditional variables of anthropometry and eating behaviours. Patient reported outcome measures (PROMs) can offer additional evidence of a service's effectiveness by measuring quality from the patient's perspective (The Information Centre for Health and Social Care, 2010). The aim of this study was to evaluate the use PROMS as a method of demonstrating effectiveness of a group weight management intervention. Methods: Participants who enrolled on a 10-week group weight management intervention (n = 38) between June to December 2010 were asked to select or report three goals (excluding weight loss) that they wished to achieve within the next 3–6 months of commencing the intervention. At completion of the intervention, participants were asked to rate how they progressed on achieving these goals on a five-point Likert item, ranging from ‘Not started’ to ‘Completed’. Results: Thirty-seven participants (97%) documented goals, with 110 goals reported in total. Participants rated their progress of achievement against 100 goals providing a 90% completion rate. Collectively, 18 different goals were nominated, with the five most common being: clothing to fit better (15%), feeling less tired/having more energy (15%), reduced joint pain (13%), decreased cholesterol (9%) and feeling better about myself (9%). In terms of goal progression and attainment, by the conclusion of the intervention, 12% rated as ‘not started’, 21% had ‘started but not half way’, 42% were ‘halfway there’, 17% were ‘nearly completed’ and 8% rated their goal as ‘completed’. Overall, 67% of participants rated that they were between ‘half-way there’ to ‘completed’ with their goals. Discussion: In this study, PROMs have been shown to be an effective method of demonstrating nontraditional variables of weight loss from the patient's perspective. A structured approach to gathering and analysing patient led goals, coupled with attainment scaling, has highlighted additional nonweight-related values experienced by patients. This is demonstrated by the 67% of participants who made adjustments to their lives throughout the 10-week programme reporting positive shifts in attainment of their personal goals. PROMs could also be considered a future tool to promote further innovations targeting user need more effectively. Conclusions: In the current NHS climate, with strong drives for the commissioning of patient centred, efficient and effective services, the use of PROMs within weight management services should be embraced. PROMs enhance the ability of services to demonstrate effectiveness to users and commissioners alike.

A systematic type review of attrition in weight reduction groups that fulfil BDA Weight-Wise criteria

Background: In 2007 nearly two thirds of the UK adult population were classified as obese or overweight (GOS 2007). Weight reduction groups are recommended by Obesity Guidelines (NICE 2006) to tackle this, but attrition poses a serious threat to the efficiency of these strategies. The aim of this systematic type review was to determine the level of attrition in weight loss groups, and to determine reasons for attrition. Methods: The review process was systematic and in line with guidance from the Centre for Reviews and Dissemination (2009). Relevant studies were identified by a methodical search of six bibliographic databases (Academic Search Complete, Cinahl, Medline, PsycInfo, Cochrane, and Scopus). The Mesh terms used were obesity, weight control, weight-reduction programs, research dropouts, patient dropout, and program evaluation. It was a poorly defined topic and the final search contained many key words with truncations, to yield sensitive search results. Reference and citation lists were searched and key journals hand-searched for relevant articles. The grey literature was searched using online databases (Zetoc, Biosis Preview, networked digital library of thesis and dissertations, Cinahl dissertations database, and Pro-quest). The inclusion criteria were; the intervention fulfilled BDA Weight Wise criteria (BDA 2006), adult participants (aged 18 years or more), overweight or obese subjects (BMI >25 kg m−2), validated questionnaires used, quantified attrition, evaluated reasons for patterns of attrition. The exclusion criteria were; other co-morbidities as the focus of the study, anti-obesity agents used. The results were assessed for quality using an appropriate tool (CASP, 2004). The discounted studies were documented, with reasons, to increase transparency (CRD, 2009). Results: Eight cohort studies and one qualitative study were evaluated (2251 participants) with levels of attrition ranging between 6.5 and 76.6%; however definitions of attrition varied (differing levels of attendance/absence), preventing reliable comparisons of the data. Quality assessment of the studies indicated studies were well conducted, however, some techniques were used (such as subgroup analysis) which threatened internal validity. Patterns of attrition were found indicating non-completers were likely to lose less weight during the programme and have higher goals (Table 1). Cited reasons for non-completion were practical issues, lost motivation, unsatisfactory results or previous failures. Table 1. Comparison of weight loss and goal attainment of completers and non-completers Non-completers Completers Statistical Significance % weight lost <5% >5% P ≤ 0.05 Rate of weight loss 0.4 kg per week 0.6 kg per week P ≤ 0.05 Participant goals –% weight loss target 30–58% 25–38% P ≤ 0.001 Discussion: A standard definition of attrition from weight management groups is needed to facilitate better analysis of the literature. Greater consideration should be given to client motivation during group programmes and to whether attrition can be reduced by assessing in-programme motivation and implementing strategies to address lost motivation (Teixeira et al., 2004). Further investigation into the characteristics of non-completers and reasons cited would strengthen knowledge of how best to support those at risk of non-completion to optimise the effectiveness of group programme interventions (Garaulet et al., 1999). Conclusion: The level of attrition varied greatly between different but suitable weight reduction programmes, and further research into strategies, which improve support given to potential non-completers, could decrease these levels.

Evaluation of activ8: the effectiveness of a joint dietetic and physiotherapy weight management group intervention in children and adolescents

Background: With the prevalence of overweight and obesity in the under 18 s on the rise, there are increasing numbers of weight management programmes offering treatment within and outside of the NHS, however only a few are formally evaluated (Aicken et al., 2008). Activ8 is a 6-week community based group intervention targeting overweight and obese children aged between 5 and 18 years. The course consists of weekly 1-h sessions that combine game based physical activities and nutritional education sessions. The aim of this study was to evaluate the effect of the Activ8 intervention on anthropometry and body composition. Methods: Routinely collected data was pooled from all children attending Activ8 during 2009. Information recorded included gender, date of birth and measurements for weight, height and body fat percentage (%BF), measured using bioelectrical impedance analysis. Patients with only a single measurement, missing birth date and attending siblings under the 91st percentile for BMI for age were excluded. The prevalence of co-morbidities such as type 2 diabetes and sleep apnoea were not assessed. Statistical analysis was carried out using SPSS comparing anthropometric and body compositional variables before and after attendance and examining the effect of age and gender on outcomes. Ethical approval was received from the Research Ethics Review Panel of the London Metropolitan University prior to the commencement of data collection. Results: In 2009, 15 courses were organised. Of the 133 children starting, 70 completed the course. All but two of the participants were clinically obese at the start of the course (mean BMI centile = 99.69 (0.60). Mean age was 10.62 (2.97) years. Girls represented 52.9% of the sample, whilst 86.7% were from ethnic minority backgrounds. The results indicated that at the end of the intervention average absolute BMI decreased by −0.29 kg m−2 (SD = 0.49, P = 0.000, CI = 95%), which remained significant when converted to z-scores and percentiles. Whilst %BF decreased on average by −0.79%, this did not reach statistical significance (SD = 2.43, P = 0.080, CI = 95%). Reduction in z-BMI, but not absolute BMI or BMI centile, was significantly greater (P = 0.046) in boys compared with girls. Some differences in outcomes stratified by age were also observed with the younger age groups achieving significantly greater reductions in absolute BMI (P = 0.003), z-BMI (P = 0.000) and BMI centile (P = 0.009). No significant differences were observed according to age group or gender in the reduction of %BF. Discussion: The results are in line with the findings of other, similar interventions (Oude Luttikhuis et al., 2009). In line with NICE guidelines, the results indicate that Activ8 appears to be successful in achieving a decrease in adiposity as indicated by BMI, at least in the short term. Whether these results are sustained should be examined in a longer-term follow up study. It is recommended that the reasons behind the relatively high drop out and low uptake rates should be investigated through the adoption of a robust evaluation process. Conclusion: This audit of Activ8 has shown that it compares favourably to similar interventions, however further studies are required to evaluate long term efficacy, to eliminate the possible confounding effect of factors such as ethnicity and co morbidities and to strengthen the quality of the evidence by the use of randomisation and a control group.

Weight Loss, Exercise, or Both and Physical Function in Obese Older Adults

Obesity exacerbates the age-related decline in physical function and causes frailty in older adults; however, the appropriate treatment for obese older adults is controversial. In this 1-year, randomized, controlled trial, we evaluated the independent and combined effects of weight loss and exercise in 107 adults who were 65 years of age or older and obese. Participants were randomly assigned to a control group, a weight-management (diet) group, an exercise group, or a weight-management-plus-exercise (diet-exercise) group. The primary outcome was the change in score on the modified Physical Performance Test. Secondary outcomes included other measures of frailty, body composition, bone mineral density, specific physical functions, and quality of life. A total of 93 participants (87%) completed the study. In the intention-to-treat analysis, the score on the Physical Performance Test, in which higher scores indicate better physical status, increased more in the diet-exercise group than in the diet group or the exercise group (increases from baseline of 21% vs. 12% and 15%, respectively); the scores in all three of those groups increased more than the scores in the control group (in which the score increased by 1%) (P<0.001 for the between-group differences). Moreover, the peak oxygen consumption improved more in the diet-exercise group than in the diet group or the exercise group (increases of 17% vs. 10% and 8%, respectively; P<0.001); the score on the Functional Status Questionnaire, in which higher scores indicate better physical function, increased more in the diet-exercise group than in the diet group (increase of 10% vs. 4%, P<0.001). Body weight decreased by 10% in the diet group and by 9% in the diet-exercise group, but did not decrease in the exercise group or the control group (P<0.001). Lean body mass and bone mineral density at the hip decreased less in the diet-exercise group than in the diet group (reductions of 3% and 1%, respectively, in the diet-exercise group vs. reductions of 5% and 3%, respectively, in the diet group; P<0.05 for both comparisons). Strength, balance, and gait improved consistently in the diet-exercise group (P<0.05 for all comparisons). Adverse events included a small number of exercise-associated musculoskeletal injuries. These findings suggest that a combination of weight loss and exercise provides greater improvement in physical function than either intervention alone. (Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT00146107.).

Systematic review comparing the effectiveness of self help v. group weight management programme in weight loss

Systematic review comparing the effectiveness of self help <i>v</i>. group weight management programme in weight loss

Maternal perceptions of overweight and obesity in children: A grounded theory study

To develop a theoretical framework for understanding maternal perceptions of overweight and obesity in children. Semi-structured interviews with 12 mothers of overweight or obese children recruited via the paediatrician or local weight management group. Interviews were transcribed and analysed using Grounded Theory methodology. Using Grounded Theory, a theoretical understanding of maternal perceptions of overweight and obesity in children was developed using the two over-arching core categories of 'Good mum/bad mum' and 'Resilience'. Results supported findings uncovered in previous research and also expand on these findings by offering explanations about the psychological mechanisms that may mediate maternal misperceptions of overweight.

A behavioral weight-loss intervention for persons with serious mental illness in psychiatric rehabilitation centers

ObjectiveOverweight and obesity are epidemic in populations with serious mental illnesses. We developed and pilot tested a behavioral weight loss intervention appropriately tailored for persons with serious mental disorders.MethodsWe conducted a single arm pilot study in two psychiatric rehabilitation day programs in Maryland and enrolled 63 overweight or obese adults. The six-month intervention provided group and individual weight management and group physical activity classes. The primary outcome was weight change from baseline to 6 months.ResultsSixty-four percent of those potentially eligible at the centers enrolled. The mean age was 43.7 years; 56% were women, 49% were white and over half had a schizophrenia or schizoaffective disorder. One third had hypertension and one fifth had diabetes. Fifty-two (82%) completed the study; others were discharged from psychiatric centers before study completion. Average attendance across all weight management sessions was 70% (87% on days participants attended the center) and 59% for physical activity classes (74% on days participants attended the center). From a baseline mean of 210.9 lbs (SD 43.9), average weight loss for 52 participants was 4.5 pounds (SD 12.8) (p<0.014). On average, participants lost 1.9% of body weight. Mean waist circumference change was 3.1 cm (SD 5.6). Participants on average increased the distance on the six minute walk test by eight percent.ConclusionThis pilot documents the feasibility and preliminary efficacy of a behavioral weight loss intervention in adults with serious mental illness who were attendees at psychiatric rehabilitation centers. The results may have implications for developing weight loss interventions in other institutional settings such as schools or nursing homes.

The place and promotion of well‐being in mental health services: a qualitative investigation

The study investigated the place and promotion of well-being from the perspectives of services users and mental health professionals. * Data from focus groups and interviews were analysed and found that well-being promotion was available, for example weight management groups in mental health services. However, they also found that there were some contradictions between the groups of people interviewed about what was available and what to promote in the future. * The study concludes suggesting partnerships with local communities to further develop well-being services, such as opportunities for physical activity, for people with mental health problems. Abstract This study explored service users' and mental health professionals' understandings, experiences and opinions of well-being and its promotion within mental health services. A qualitative case study methodology included nine participants (five adult service users, three mental health professionals, one senior manager) who were purposively sampled from a Mental Health Trust in England. Service users participated in a focus group, while individual semi-structured interviews were held with the mental health professionals and senior manager. Interpretative phenomenological analysis of the data revealed five main themes including well-being as a holistic concept; well-being promotion; the place, promotion and position of well-being; role of mental health services in well-being promotion; and areas for further improvement. Findings revealed evidence of well-being promotion; however, there were contradictions regarding what was known between the groups of participants and what could be provided in the future. Implications for practice include the need to establish more effective partnership working between mental health services and local communities, especially in light of financial constraints within health services at large. This could assist the increased provision of therapeutic services for well-being promotion.

A randomised controlled trial of a community-based healthy lifestyle program for overweight and obese adolescents: the Loozit study protocol.

BackgroundThere is a need to develop sustainable and clinically effective weight management interventions that are suitable for delivery in community settings where the vast majority of overweight and obese adolescents should be treated. This study aims to evaluate the effect of additional therapeutic contact as an adjunct to the Loozit® group program – a community-based, lifestyle intervention for overweight and lower grade obesity in adolescents. The additional therapeutic contact is provided via telephone coaching and either mobile phone Short Message Service or electronic mail, or both.Methods and designThe study design is a two-arm randomised controlled trial that aims to recruit 168 overweight and obese 13–16 year olds (Body Mass Index z-score 1.0 to 2.5) in Sydney, Australia. Adolescents with secondary causes of obesity or significant medical illness are excluded. Participants are recruited via schools, media coverage, health professionals and several community organisations. Study arm one receives the Loozit® group weight management program (G). Study arm two receives the same Loozit® group weight management program plus additional therapeutic contact (G+ATC). The 'G' intervention consists of two phases. Phase 1 involves seven weekly group sessions held separately for adolescents and their parents. This is followed by phase 2 that involves a further seven group sessions held regularly, for adolescents only, until two years follow-up. Additional therapeutic contact is provided to adolescents in the 'G+ATC' study arm approximately once per fortnight during phase 2 only. Outcome measurements are assessed at 2, 12 and 24 months post-baseline and include: BMI z-score, waist z-score, metabolic profile indicators, physical activity, sedentary behaviour, eating patterns, and psychosocial well-being.DiscussionThe Loozit® study is the first randomised controlled trial of a community-based adolescent weight management intervention to incorporate additional therapeutic contact via a combination of telephone coaching, mobile phone Short Message Service, and electronic mail. If shown to be successful, the Loozit® group weight management program with additional therapeutic contact has the potential to be readily translatable to a range of health care settings.Trial registrationThe protocol for this study is registered with the Australian Clinical Trials Registry (ACTRNO12606000175572).

Addressing male obesity: an evaluation of a group-based weight management intervention for Scottish men

Background Male obesity is increasing and, despite well-established links between obesity and ill-health, men appear reluctant to engage in weight loss programmes. This reticence may reflect a general failure to recognise gender issues in weight management. Community nurses working in partnership with a community dietitian in Camelon, a deprived area of Scotland, have developed a group-based weight management programme specifically for obese men. This paper provides an evaluation of the first 4 years of the Camelon model's operation. Methods Anonymised databases from local Men's Health Clinics and the weight management programme were consulted to determine the reach and weight loss outcomes of the Camelon model. These databases also provided the demographic and health characteristics of weight management participants. Finally, focus groups obtained the views of participants and their wives. Results The majority (76.2%) of the obese men who enrolled in a weight management group completed the 12-week programme: of these, 44.3 % achieved ≥5% weight loss. The model's reach was 11.4% and participants were highly representative of the target population. Health risks and being described as “obese” were the main motivators reported for joining. Participants appreciated the flexible approach to weight management, the humour, the rapport with the nurses and other men, and found advice about positive food and exercise choices useful. Conclusion The Camelon model offers a gender-specific intervention for obesity that could be adopted in other primary care settings. Whilst a single approach to weight management is unlikely to appeal to all men, the model engaged a significant number of a traditionally hard-to-reach population.

Service redesign: the experience of Newcastle Diabetes Service 2001–2007

AbstractThe prevalence of diabetes is projected to rise substantially. National policy has introduced drivers to promote service redesign around patient needs. This paper describes how we have developed an integrated local diabetes service based on the community delivery of diabetes care, supporting primary care and interfacing with specialist care.The diabetes service is located in the Primary Care Trust and is based at the Newcastle Diabetes Centre. There is a service delivery plan agreed with all stakeholders for people with type 2 diabetes. The service supports primary care to deliver high quality care, provides community care in close proximity to patients' homes and delivers specialist care.Pathways of care for people with type 2 diabetes are based on level 1 primary care, level 2 community care and level 3 specialist care. Agreed district‐wide guidelines, with referral criteria, support integrated pathways of diabetes care. Level 1 (primary care) is supported by district‐wide podiatry, digital retinal screening and health care provider education. Level 2 (community‐based service) includes a pathway for newly‐diagnosed type 2 diabetes encompassing structured group education and a pathway for continuing care of more complex type 2 diabetes, supported by additional community services such as weight management groups, and community‐based group insulin starts. Level 3 (specialist services) provided at the Diabetes Centre include preconception care, a medical foot clinic, a young adults clinic, an insulin pump service and a diabetes renal clinic.This paper shows how the redesigned service supports primary care to provide care closer to patients. Copyright © 2009 John Wiley &amp; Sons.

Morality and Accountability in a Commercial Weight Management Group

Talk about food and eating behaviours invariably contains some reference to morality or accountability. However, there are very few studies that focus upon ;mundane dieting'. This research addresses this by examining 37.83 hours of naturally occurring interaction of how women construct and orient to food and their dieting practices within an everyday type setting. Group members produced accounts with reference to a moral evaluation, such as blame or culpability. It became apparent that both the group leaders and group members could not orient to their behaviour or food without reference to a moral or accountable framework. Implications for health promotion literature and programmes, along with weight management groups are considered.

Programme for Lifestyle, Activity &amp; Nutrition (PLAN): an effective and feasible inter-disciplinary group weight-management approach in the primary care setting

Programme for Lifestyle, Activity &amp; Nutrition (PLAN): an effective and feasible inter-disciplinary group weight-management approach in the primary care setting

A well-being programme in severe mental illness. Baseline findings in a UK cohort

Introduction:Patients with severe mental illness (SMI) have higher rates of cardiovascular disease (CVD) morbidity and mortality than the general population. In the UK, data were limited regarding the known prevalence of physical health screening of SMI patients.Aims:A total of 966 patients with SMI from seven geographically varied regions in the UK agreed to participate in a 2-year nurse-led intervention (Well-being Support Programme), designed to improve their overall physical health by providing basic physical health checks, health promotion advice, weight management and physical activity groups in secondary care.Results:At baseline, only 31% of participants had undergone a recent physical health check. There were high rates of obesity (BMI > 30 in 49%), glucose abnormalities (12.4%), hypertension/prehypertension (50%), hyperlipidaemia (71%), poor diet (32%), low exercise levels (37.4%) and smoking (50%).Conclusions:Patients with SMI where healthcare professionals have concerns regarding their physical health, have potentially modifiable risk factors for CVD, which remain undiagnosed. Programmes designed to address the physical health problems in SMI need to be implemented and evaluated in this already marginalised group of people.

Effects of a Weight Management Program on Body Composition and Metabolic Parameters in Overweight Children

Pediatric obesity has escalated to epidemic proportions, leading to an array of comorbidities, including type 2 diabetes in youth. Since most overweight children become overweight adults, this chronic condition results in serious metabolic complications by early adulthood. To curtail this major health issue, effective pediatric interventions are essential. To compare effects of a weight management program, Bright Bodies, on adiposity and metabolic complications of overweight children with a control group. One-year randomized controlled trial conducted May 2002-September 2005. Recruitment and follow-up conducted at Yale Pediatric Obesity Clinic in New Haven, Conn, and intervention at nearby school. Random sample of 209 overweight children (body mass index [BMI] >95th percentile for age and sex), ages 8 to 16 years of mixed ethnic groups were recruited. A total of 135 participants (60%) completed 6 months of study, 119 (53%) completed 12 months. Participants were randomly assigned to either a control or weight management group. The control group (n = 69) received traditional clinical weight management counseling every 6 months, and the weight management group (n = 105) received an intensive family-based program including exercise, nutrition, and behavior modification. Intervention occurred biweekly the first 6 months, bimonthly thereafter. The second randomization within the weight management group assigned participants (n = 35) to a structured meal plan approach (dieting), but this arm of the study was discontinued while enrollment was ongoing due to a high dropout rate. Change in weight, BMI, body fat, and homeostasis model assessment of insulin resistance (HOMA-IR) at 6 and 12 months. Six-month improvements were sustained at 12 months in weight management vs control, including changes in the following (mean [95% confidence interval]): weight (+0.3 kg [-1.4 to 2.0] vs +7.7 kg [5.3 to 10.0]); BMI (-1.7 [-2.3 to -1.1] vs +1.6 [0.8 to 2.3]); body fat (-3.7 kg [-5.4 to -2.1] vs +5.5 kg [3.2 to 7.8]); and HOMA-IR (-1.52 [-1.93 to -1.01] vs +0.90 [-0.07 to 2.05]). The Bright Bodies weight management program had beneficial effects on body composition and insulin resistance in overweight children that were sustained up to 12 months. clinicaltrials.gov Identifier: NCT00409422.

The effect of herd of origin by year on post-weaning traits of young beef bulls at centralized testing centres in South Africa

The effects of herd of origin by year on the average daily gain (ADG), average daily feed intake (DFI), shoulder height (SDH) and scrotal circumference (SCR) of beef bulls at centralized test centres in South Africa were investigated using data of Bonsmara cattle. Data consisted of post-weaning traits of beef bulls tested between 1990 and 2003, with available weaning weight (WWT) and weaning management group information as well as weaning weights of their contemporaries. A multiple-trait animal model including ADG, DFI, SDH and SCR, together with WWT was used. The model for WWT (adjusted to 205 days of age and age of dam by sex of calf classes) included the fixed effect of management group and random effects of direct additive genetic and dam effects, while the model for post-weaning traits included fixed effects of test group and age of the bull at the end of test (fitted as linear and quadratic regressions) and random effects of direct additive genetic and herd of origin by year (HY) effects. Variance components were estimated using REML procedures. Heritability estimates were 0.27, 0.34, 0.36, 0.51 and 0.46 for WWT, ADG, DFI, SDH and SCR, respectively. The contribution of HY effects to the phenotypic variance of ADG, DFI, SDH and SCR were 9%, 10%, 6% and 5%, respectively. Inclusion of HY effect resulted in the re-ranking of sires, with rank correlations ranging from 0.86 to 0.98 among the top sires, across traits. These results suggest that the HY effect should be included in the model for the national genetic evaluation of post-weaning traits of beef bulls measured at centralized testing centres in South Africa. South African Journal of Animal Science Vol. 36(1) 2006: 33-39

Feasibility and benefits of implementing a Slimming on Referral service in primary care using a commercial weight management partner

To assess participation in a costed Slimming on Referral service and identify factors associated with success. Simple intervention offering participation in a new service to 100 eligible patients. The setting was two Derby general practices, one inner city and one suburban. One hundred and seven patients (mean age 50 years) attending general practice for non-obesity reasons. BMI > or = 30, age > or = 18 years, not pregnant, no recent commercial weight management group membership, willingness to attempt weight loss. Patients were offered free attendance at a local Slimming World group for 12 consecutive weeks. Body weight and height were measured at baseline, and questionnaires established perceived health, motivation to lose weight, employment, concerns, responsibilities and well-being. Weight was measured at each group visit. The main outcome measures were: (1) changes in body weight at 12 and 24 weeks, (2) social and demographic factors associated with barriers to enrolment, continued attendance and successful weight loss. Ninety-one (85%) patients attended a group, with 62 completing 12 weeks. Average weight loss in participants was 5.4 kg (6.4% baseline weight). Forty-seven then chose to self-fund, with 34 (37% original group) completing a further 12 weeks. Average weight loss over the total 24 weeks was 11.1 kg (11.3% baseline weight). Regular attendance was affected by income, financial concerns (independent of actual income), age, perceived importance of weight loss and initial weight loss success. Well-being of patients significantly improved between baseline and both 12 and 24 weeks. Collaboration with an appropriate commercial weight management organization offers a feasible weight management option that is either similar to, or better than, other options in terms of attrition, efficacy and cost.