Re: 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 trial
Reaching the parts that health services weight management resources cannot reach.
Wendy L Wrieden, Lecturer in Nutrition, Robert Gordon University, Aberdeen, Alison Avenell, Clinical Senior Lecturer, University of Aberdeen
We welcome the publication of recent results of “Lighten up”, a randomised trial in a UK setting (Birmingham) that demonstrated the effectiveness of commercial weight management programmes (CWMP).1 This provides further evidence for the NHS to implement further partnerships with CWMP that follow NICE2 guidelines. The proportion of obese adults continues to increase and with it a massive burden of health and social care costs due to associated chronic disease.3
In Scotland, to our knowledge the only health board that has reported on such a collaboration is NHS Ayrshire and Arran.4 We requested details of lifestyle weight management programmes available across Scotland from individual health board areas and evidence informed CWMP (following NICE2 and Scottish5 national guidelines). Over the period requested (2008 – 2009) programmes that were available through the commercial sector in Scotland had a far greater reach than programmes run by the NHS.6 Reach was calculated as the number of people recruited onto the programmes, or for commercial programmes which are ongoing the maximum number of people attending weekly as a % of the target population (overweight and obese) in an area. For example, for CWMP this was 1.6% compared with 0.15% for NHS led Counterweight, taking figures from across Scotland.
As Truby points out in her editorial, the NHS can learn lessons from the commercial companies both on the level of investment in the workforce and how to deliver services more acceptable to consumers.7 NHS led programmes such as Counterweight and NHS Size Down can be effective.1,8 The ‘Lighten up’ results and others show that the commercial programmes, particularly Weight Watchers, can have better success than primary care at one year.1,9 It may be that using NHS resources to develop many individual local programmes might be better directed to help people who are more obese with existing comorbidities. Use of the commercial sector, either through slimming on referral schemes or by advising and providing information as to where such groups are available, is an avenue that must now be developed.
1. Jolly K, Lewis A, Beach J, Denley J, Adab P, Deeks JJ, et al. 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 trial. BMJ 2011;343:d6500.
2. National Institute for Health and Clinical Excellence. Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and children;2006.
3. UK Government Office for Science. Foresight. Tackling obesities: future choices - project report;2007.
4. Smith F. NHS Ayrshire and Arran Report on Weight Watchers on referral pilot in East, North and South Ayrshire;2009.
5. Scottish Intercollegiate Guidelines Network. Management of obesity: a national clinical guideline;2010. Report No.115.
6. Wrieden W, Avenell A. A review of lifestyle weight management options in Scotland which meet best practice. Proc Nutr Soc 2010;69 (OCE6):E449.
7. Truby H, Bonham M. What makes a weight loss programme successful? BMJ 2011;343:d6629.
8. Ross H, Laws R, Reckless J, Lean M, Counterweight Project Team. Evaluation of the Counterweight Programme for obesity management in primary care: a starting point for continuous improvement. Br J Gen Pract 2008; 58:548-54.
9. Jebb SA, Ahern AL, Olson AD, Aston LM, Holzapfel C, Stoll J, et al. Primary care referral to a commercial provider for weight loss treatment versus standard care: a randomised controlled trial. Lancet 2011;378:1485-92.
Competing interests: WW has an outstanding request with a commercial weight management company with regard to potential funding for a Slimming on Referral trial