Extended and standard duration weight-loss programme referrals for adults in primary care (WRAP): a randomised controlled trial
| Autor: | Laura Webber, Laura Pimpin, Amy L Ahern, Emma Boyland, Melina Tsiountsioura, Abbygail Jaccard, Jennifer Woolston, Darren Cole, Lisa Irvine, Adrian Mander, Marc Suhrcke, Lise Retat, Bethan R. Mead, Susan A. Jebb, Jason C.G. Halford, David A. Turner, Ann M Thomson, Graham M. Wheeler, Paul Aveyard, Simon Cohn |
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| Přispěvatelé: | Ahern, Amy [0000-0001-5069-4758], Mander, Adrian [0000-0002-0742-9040], Apollo - University of Cambridge Repository, Medical Research Council |
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Referral Cost effectiveness Cost-Benefit Analysis 030209 endocrinology & metabolism State Medicine law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Quality of life law Weight loss Behavior Therapy General & Internal Medicine Weight Loss Medicine Humans 030212 general & internal medicine Intervention Duration Obesity Referral and Consultation 11 Medical and Health Sciences Aged Primary Health Care business.industry Body Weight General Medicine Health Care Costs Middle Aged 3. Good health Clinical trial Weight Reduction Programs England Socioeconomic Factors Physical therapy Quality of Life Female Brief intervention medicine.symptom business Follow-Up Studies |
| Zdroj: | Lancet |
| ISSN: | 0140-6736 |
| Popis: | 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. 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. 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; pINTERPRETATION: 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. FUNDING: National Prevention Research Initiative, Weight Watchers International (as part of an UK Medical Research Council Industrial Collaboration Award). |
| Databáze: | OpenAIRE |
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