Extended and standard duration weight-loss programme referrals for adults in primary care (WRAP): a randomised controlled trial

Abstract

SummaryBackgroundEvidence exist that primary care referral to an open-group behavioural programme is an effective strategy for management of obesity, but little evidence on optimal intervention duration is available. We aimed to establish whether 52-week referral to an open-group weight-management programme would achieve greater weight loss and improvements in a range of health outcomes and be more cost-effective than the current practice of 12-week referrals.MethodsIn this non-blinded, parallel-group, randomised controlled trial, we recruited participants who were aged 18 years or older and had body-mass index (BMI) of 28 kg/m2 or higher from 23 primary care practices in England. Participants were randomly assigned (2:5:5) to brief advice and self-help materials, a weight-management programme (Weight Watchers) for 12 weeks, or the same weight-management programme for 52 weeks. We followed-up participants over 2 years. The primary outcome was weight at 1 year of follow-up, analysed with mixed-effects models according to intention-to-treat principles and adjusted for centre and baseline weight. In a hierarchical closed-testing procedure, we compared combined behavioural programme arms with brief intervention, then compared the 12-week programme and 52-week programme. We did a within-trial cost-effectiveness analysis using person-level data and modelled outcomes over a 25-year time horizon using microsimulation. This study is registered with Current Controlled Trials, number ISRCTN82857232.FindingsBetween Oct 18, 2012, and Feb 10, 2014, we enrolled 1269 participants. 1267 eligible participants were randomly assigned to the brief intervention (n=211), the 12-week programme (n=528), and the 52-week programme (n=528). Two participants in the 12-week programme had been found to be ineligible shortly after randomisation and were excluded from the analysis. 823 (65%) of 1267 participants completed an assessment at 1 year and 856 (68%) participants at 2 years. All eligible participants were included in the analyses. At 1 year, mean weight changes in the groups were −3·26 kg (brief intervention), −4·75 kg (12-week programme), and −6·76 kg (52-week programme). Participants in the behavioural programme lost more weight than those in the brief intervention (adjusted difference −2·71 kg, 95% CI −3·86 to −1·55; p<0·0001). The 52-week programme was more effective than the 12-week programme (−2·14 kg, −3·05 to −1·22; p<0·0001). Differences between groups were still significant at 2 years. No adverse events related to the intervention were reported. Over 2 years, the incremental cost-effectiveness ratio (ICER; compared with brief intervention) was £159 per kg lost for the 52-week programme and £91 per kg for the 12-week programme. Modelled over 25 years after baseline, the ICER for the 12-week programme was dominant compared with the brief intervention. The ICER for the 52-week programme was cost-effective compared with the brief intervention (£2394 per quality-adjusted life-year [QALY]) and the 12-week programme (£3804 per QALY)....

Prevention and reversal of Type 2 diabetes: highlights from a symposium at the 2019 Diabetes UK Annual Professional Conference

“…When GPs did so, 77% of apparently unmotivated patients accepted a referral to a 12-week behavioural weight loss programme and most of those, 40% of the total, started the programme. Those who attended had lost 4.7 kg on average at 1 year follow-up, which is similar to that achieved by apparently motivated people who seek out weight loss support [36,37]. As a result of this, weight loss at 1 year in all those offered support as part of the brief intervention was 2.4 kg, 1.4 kg greater than that achieved by the control group.…”

Lifestyle information and commercial weight management groups to support maternal postnatal weight management and positive lifestyle behaviour: the SWAN feasibility randomised controlled trial

“…If real, this may be because some women had not yet received the full intervention at 6 months, but could reflect the need for women to have longer access to fully adapt to the weight management programme. This would support findings of a general population trial where individuals allocated to a 52‐week open group weight management programme had greater weight loss over a 2‐year period than those randomised to a 12‐week programme or to receive brief advice and self‐help materials …”

“…This would support findings of a general population trial where individuals allocated to a 52-week open group weight management programme had greater weight loss over a 2-year period than those randomised to a 12-week programme or to receive brief advice and self-help materials. 37 Secondary outcomes showed minimal differences. Those which were found (e.g.…”

Beyond lifestyle interventions: exploring the potential of anti‐obesity medications in the UK

“…Commercial lifestyle weight management programmes, such as Rosemary Conley, Slimming World or Weight Watchers, demonstrate proven effectiveness at 12 months and should help people with overweight or obesity to assess their weight and set realistic goals for weight loss, and support them in achieving it through long‐term, steady weight reductions using a multicomponent approach . In 2013, approximately 69 000 adults in UK were referred to Weight Watchers and Slimming World under the NHS schemes .…”

“…In the UK, people with obesity primarily access weight loss interventions through primary care services (24)(25)(26) or by self-referral to commercial slimming organizations. NICE and the Scottish Intercollegiate Guidelines Network (SIGN) provide guidance for multicomponent lifestyle weight management, based on the severity of obesity and the presence of weight-related comorbidities (3,5 (27) and should help people with overweight or obesity to assess their weight and set realistic goals for weight loss, and support them in achieving it through long-term, steady weight reductions using a multicomponent approach (28). In 2013, approximately 69 000 adults in UK were referred to Weight Watchers and Slimming World under the NHS schemes (4).…”