It is remarkably difficult for people with obesity to maintain a new lower weight following weight loss. The aim of the present study was to examine the immediate and longer-term effects of a new cognitive behavioural treatment that was explicitly designed to minimise this post-treatment weight regain. One hundred and fifty female participants with obesity were randomized to the new treatment, behaviour therapy (the leading alternative psychological treatment) or guided self-help (a minimal intervention). Both of the main treatments resulted in an average weight loss of about ten percent of initial weight whereas weight loss was more modest with guided self-help. The participants were subsequently followed-up for three years post-treatment. The great majority regained almost all the weight that they had lost with the new treatment being no better than the behavioural treatment in preventing weight regain. These findings lend further support to the notion that obesity is resistant to psychological methods of treatment, if anything other than a short-term perspective is taken. It is suggested that it is ethically questionable to claim that psychological treatments for obesity “work” in the absence of data on their longer-term effects.

Patients like dietitians to adopt a patient-centred approach, which might be either patient- or practitioner-led, and to take account of what they wanted from consultations, adapting these to meet their individual requirements.

Background: Evidence suggests that education alone is unlikely to elicit dietary-behavioural change (Contento, 1995). Consequently, many dietitians are moving from a traditional advice-giving role to one which utilises Ôbehav-iour change skillsÕ (BCS) in dietary counselling. BCS is an umbrella term used to cover a wide range of skills and techniques drawn from the fields of counselling, motivational interviewing (MI) and cognitive behavioural therapy (CBT). In order to assess the efficacy of this approach, a means of quantifying BCS-use is required. This two-stage study aimed to validate a newly-devised scale to assess dietitiansÕ BCS-use in one-to-one dietary counselling. Methods: Items for the scale were generated by drawing on the literature, syllabi for training in BCS and its parent disciplines (counselling, MI and CBT), and specialist dietitians. The resulting scale and manual were revised following assessment of content validity by expert panel and piloting. In stage one, 21 dietetic consultations were audiotaped and rated for BCS-use by three BCS-trained dietitians. Inter-rater agreement was calculated using the kappa statistic and intra-class correlation (ICC), to give a Ôchance correctedÕ measure of agreement. Validity was tested using a psychologist's subjective assessment of BCSuse as a proxy Ôgold-standardÕ compared with the dietitiansÕ ratings, again using kappa and ICC. In stage two the scale was further revised before an additional 20 audiotaped consultations were analysed using the same procedure. Ethical approval for the study was given by the appropriate NHS and university research ethics committees. Results: At stage one, although kappas were fairly poor for agreement on individual criteria, the ICC for overall scores indicated a ÔfairÕ level of agreement, according to Shrout's (1998) classifications: ICC = 0.584 (CI 0.339-0.784). Results for validity were poor with the psychologist frequently rating higher than the dietitians. At stage two, following scale revision, results for inter-rater agreement improved with more criteria showing ÔmoderateÕ or ÔsubstantialÕ agreement. Ten out of the 21 criteria achieved levels of agreement classified as ÔfairÕ or higher for all three rater pairs. The ICC for overall scores improved to indicate ÔmoderateÕ agreement: ICC = 0.640 (CI 0.404-0.821). Validity results remained poor. Discussion: The moderate level of overall inter-rater agreement observed in the revised scale is considered acceptable (Jones, 2006) and indicates this tool is useful. This measure is more relevant to the purpose of the tool than agreement on individual criteria given it is intended to

treatment (P < 0.001) with a mean weight loss of 2.8 kg (0.6). BMI was significantly lower after 6 months (P < 0.001) with a mean reduction of 1.5 kg m )2 (1.9). HbA 1C was also significantly reduced after 6 months (P < 0.001) with a mean reduction of 1.7% (1.5). Changes in weight, BMI and HbA 1C were not significantly different between genders, time since diagnosis or age. The audit identified that the Diabetes team were following NICE guidelines for the majority of the time. When starting the drug, 100% of patients were commenced as a third line therapy, 96% of patients had a HbA 1C ‡7.5%, and 77% had a BMI ‡35 kg m )2 . Eighty seven percent of patients had associated psychological or medical problems and 38% were started on Byetta due to occupational implications of insulin or to promote weight loss. Of those patients that continued the drug after 6 months, 60% had achieved the recommended 1% reduction in HbA 1C and 89% had shown a 3% reduction in weight. Conclusion: After 6 months, Byetta therapy was associated with significant reductions in weight, BMI and HbA 1C , which supports the findings of previous research (Buse et al., 2004; DeFronzo et al., 2005). This audit did not include a control group, and future studies could compare the outcomes of treatment with Byetta against outcomes after conventional treatment. The management of patients on Byetta followed the NICE guidance for the majority of the time. However, data for some patients was missing from 'Diabeta', suggesting that staff were not always recording information after each consultation with the patient. In future, a larger sample size would increase the validity of results, and future audits within the hospital could focus on record keeping. References: Buse J.B., Henry R.R., Han J. et al. (2004) Effects of exenatide (exendin-4) on glycaemic control over 30 weeks in sulfonylurea-treated patients with type 2 diabetes. Diabetes Care 27, 2628-2635. DeFronzo R.A., Ratner R.E., Han J. et al. (2005) Effects of exenatide (exendin-4) on glycaemic control and weight over 30 weeks in metformin-treated patients with type 2 diabetes.