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 trialBMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d6500 (Published 03 November 2011) Cite this as: BMJ 2011;343:d6500
- Kate Jolly, clinical senior lecturer in public health and epidemiology1,
- Amanda Lewis, NIHR NSPCR research fellow1,
- Jane Beach, health visitor adviser2,
- John Denley, associate director of public health3,
- Peymane Adab, clinical senior lecturer in public health1,
- Jonathan J Deeks, professor of biostatistics1,
- Amanda Daley, senior lecturer in health psychology1,
- Paul Aveyard, senior lecturer in health psychology1
- 1School of Health and Population Sciences, University of Birmingham, Birmingham B15 2TT, UK
- 2Nursing and Midwifery Council, 23 Portland Place, London W1B 1PZ, UK
- 3NHS South Birmingham, Birmingham B38 5SR
- Correspondence to: A Daley
- Accepted 14 September 2011
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 or overweight men and women with a comorbid disorder identified from general practice records.
Interventions Weight loss programmes of 12 weeks’ duration: Weight Watchers; Slimming World; Rosemary Conley; group based, dietetics led programme; general practice one to one counselling; pharmacy led one to one counselling; choice of any of the six programmes. The comparator group was provided with 12 vouchers enabling free entrance to a local leisure (fitness) centre.
Main outcome measures The primary outcome was weight loss at programme end (12 weeks). Secondary outcomes were weight loss at one year, self reported physical activity, and percentage weight loss at programme end and one year.
Results Follow-up data were available for 658 (88.9%) participants at programme end and 522 (70.5%) at one year. All programmes achieved significant weight loss from baseline to programme end (range 1.37 kg (general practice) to 4.43 kg (Weight Watchers)), and all except general practice and pharmacy provision resulted in significant weight loss at one year. At one year, only the Weight Watchers group had significantly greater weight loss than did the comparator group (2.5 (95% confidence interval 0.8 to 4.2) kg greater loss,). The commercial programmes achieved significantly greater weight loss than did the primary care programmes at programme end (mean difference 2.3 (1.3 to 3.4) kg). The primary care programmes were the most costly to provide. Participants allocated to the choice arm did not have better outcomes than those randomly allocated to a programme.
Conclusions Commercially provided weight management services are more effective and cheaper than primary care based services led by specially trained staff, which are ineffective.
Trial registration Current Controlled Trials ISRCTN25072883.
Contributors: JD and JB designed the Lighten Up service. KJ, AD, PAveyard, JD, JB, and PAdab designed the study and wrote the initial protocol. KJ, AL, AD, PAveyard, JD, JB, and PAdab were on the trial management committee. AL coordinated the study with supervision from KJ. JJD and KJ did the analysis. KJ drafted the manuscript with contributions from the other authors. PAveyard did the years of life lost analysis. All authors read and approved the final manuscript. KJ is the guarantor.
Funding: The study was funded by NHS South Birmingham. PAveyard is supported by a National Institute for Health Research (NIHR) career scientist award. AD is supported by a senior research fellowship award from the NIHR. KJ was part funded by the NIHR through the Collaborations for Leadership in Applied Health Research and Care for Birmingham and Black Country (CLAHRC-BBC) programme. The views expressed in this publication are those of the authors and not necessarily those of the NIHR, the Department of Health, NHS South Birmingham, the University of Birmingham, or the CLAHRC-BBC Steering Group. JD and JB were employed by the sponsoring organisation. Their roles are outlined above. The writing of the report and the decision to submit the article for publication rested with the authors from the University of Birmingham.
Conflicts of interest: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: PAveyard and AL have received hospitality from Weight Watchers on one occasion; JD and JB were employed by the funding organisation and managed the service.
Ethical approval: South Birmingham Research Ethics Committee (08/H1207/331) granted ethical approval.
Data sharing: Additional data can be obtained from the corresponding author for the purposes of secondary research.
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