Extended and standard duration weight-loss programme referrals for adults in primary care (WRAP): a randomised controlled trial
<p>BACKGROUND: Evidence 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-manageme...
| Main Authors: | , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Journal article |
| Language: | English |
| Published: |
Elsevier
2017
|
| _version_ | 1797087726112079872 |
|---|---|
| author | Ahern, AL Wheeler, GM Aveyard, P Boyland, EJ Halford, JCG Mander, AP Woolston, J Thomson, AM Tsiountsioura, M Cole, D Mead, BR Irvine, L Turner, D Suhrcke, M Pimpin, L Retat, L Jaccard, A Webber, L Cohn, SR Jebb, SA |
| author_facet | Ahern, AL Wheeler, GM Aveyard, P Boyland, EJ Halford, JCG Mander, AP Woolston, J Thomson, AM Tsiountsioura, M Cole, D Mead, BR Irvine, L Turner, D Suhrcke, M Pimpin, L Retat, L Jaccard, A Webber, L Cohn, SR Jebb, SA |
| author_sort | Ahern, AL |
| collection | OXFORD |
| description | <p>BACKGROUND: Evidence 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.</p><p> METHODS: In 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/m(2) 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.</p><p> FINDINGS: Between 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). </p><p>INTERPRETATION: For adults with overweight or obesity, referral to this open-group behavioural weight-loss programme for at least 12 weeks is more effective than brief advice and self-help materials. A 52-week programme produces greater weight loss and other clinical benefits than a 12-week programme and, although it costs more, modelling suggests that the 52-week programme is cost-effective in the longer term. </p><p>FUNDING: National Prevention Research Initiative, Weight Watchers International (as part of an UK Medical Research Council Industrial Collaboration Award).</p> |
| first_indexed | 2024-03-07T02:39:46Z |
| format | Journal article |
| id | oxford-uuid:aa09d555-e75b-4996-97d9-e1faf7ffef46 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T02:39:46Z |
| publishDate | 2017 |
| publisher | Elsevier |
| record_format | dspace |
| spelling | oxford-uuid:aa09d555-e75b-4996-97d9-e1faf7ffef462022-03-27T03:12:34ZExtended and standard duration weight-loss programme referrals for adults in primary care (WRAP): a randomised controlled trialJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:aa09d555-e75b-4996-97d9-e1faf7ffef46EnglishSymplectic Elements at OxfordElsevier2017Ahern, ALWheeler, GMAveyard, PBoyland, EJHalford, JCGMander, APWoolston, JThomson, AMTsiountsioura, MCole, DMead, BRIrvine, LTurner, DSuhrcke, MPimpin, LRetat, LJaccard, AWebber, LCohn, SRJebb, SA<p>BACKGROUND: Evidence 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.</p><p> METHODS: In 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/m(2) 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.</p><p> FINDINGS: Between 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). </p><p>INTERPRETATION: For adults with overweight or obesity, referral to this open-group behavioural weight-loss programme for at least 12 weeks is more effective than brief advice and self-help materials. A 52-week programme produces greater weight loss and other clinical benefits than a 12-week programme and, although it costs more, modelling suggests that the 52-week programme is cost-effective in the longer term. </p><p>FUNDING: National Prevention Research Initiative, Weight Watchers International (as part of an UK Medical Research Council Industrial Collaboration Award).</p> |
| spellingShingle | Ahern, AL Wheeler, GM Aveyard, P Boyland, EJ Halford, JCG Mander, AP Woolston, J Thomson, AM Tsiountsioura, M Cole, D Mead, BR Irvine, L Turner, D Suhrcke, M Pimpin, L Retat, L Jaccard, A Webber, L Cohn, SR Jebb, SA Extended and standard duration weight-loss programme referrals for adults in primary care (WRAP): a randomised controlled trial |
| title | Extended and standard duration weight-loss programme referrals for adults in primary care (WRAP): a randomised controlled trial |
| title_full | Extended and standard duration weight-loss programme referrals for adults in primary care (WRAP): a randomised controlled trial |
| title_fullStr | Extended and standard duration weight-loss programme referrals for adults in primary care (WRAP): a randomised controlled trial |
| title_full_unstemmed | Extended and standard duration weight-loss programme referrals for adults in primary care (WRAP): a randomised controlled trial |
| title_short | Extended and standard duration weight-loss programme referrals for adults in primary care (WRAP): a randomised controlled trial |
| title_sort | extended and standard duration weight loss programme referrals for adults in primary care wrap a randomised controlled trial |
| work_keys_str_mv | AT ahernal extendedandstandarddurationweightlossprogrammereferralsforadultsinprimarycarewraparandomisedcontrolledtrial AT wheelergm extendedandstandarddurationweightlossprogrammereferralsforadultsinprimarycarewraparandomisedcontrolledtrial AT aveyardp extendedandstandarddurationweightlossprogrammereferralsforadultsinprimarycarewraparandomisedcontrolledtrial AT boylandej extendedandstandarddurationweightlossprogrammereferralsforadultsinprimarycarewraparandomisedcontrolledtrial AT halfordjcg extendedandstandarddurationweightlossprogrammereferralsforadultsinprimarycarewraparandomisedcontrolledtrial AT manderap extendedandstandarddurationweightlossprogrammereferralsforadultsinprimarycarewraparandomisedcontrolledtrial AT woolstonj extendedandstandarddurationweightlossprogrammereferralsforadultsinprimarycarewraparandomisedcontrolledtrial AT thomsonam extendedandstandarddurationweightlossprogrammereferralsforadultsinprimarycarewraparandomisedcontrolledtrial AT tsiountsiouram extendedandstandarddurationweightlossprogrammereferralsforadultsinprimarycarewraparandomisedcontrolledtrial AT coled extendedandstandarddurationweightlossprogrammereferralsforadultsinprimarycarewraparandomisedcontrolledtrial AT meadbr extendedandstandarddurationweightlossprogrammereferralsforadultsinprimarycarewraparandomisedcontrolledtrial AT irvinel extendedandstandarddurationweightlossprogrammereferralsforadultsinprimarycarewraparandomisedcontrolledtrial AT turnerd extendedandstandarddurationweightlossprogrammereferralsforadultsinprimarycarewraparandomisedcontrolledtrial AT suhrckem extendedandstandarddurationweightlossprogrammereferralsforadultsinprimarycarewraparandomisedcontrolledtrial AT pimpinl extendedandstandarddurationweightlossprogrammereferralsforadultsinprimarycarewraparandomisedcontrolledtrial AT retatl extendedandstandarddurationweightlossprogrammereferralsforadultsinprimarycarewraparandomisedcontrolledtrial AT jaccarda extendedandstandarddurationweightlossprogrammereferralsforadultsinprimarycarewraparandomisedcontrolledtrial AT webberl extendedandstandarddurationweightlossprogrammereferralsforadultsinprimarycarewraparandomisedcontrolledtrial AT cohnsr extendedandstandarddurationweightlossprogrammereferralsforadultsinprimarycarewraparandomisedcontrolledtrial AT jebbsa extendedandstandarddurationweightlossprogrammereferralsforadultsinprimarycarewraparandomisedcontrolledtrial |