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Effectiveness and cost-effectiveness of referral to a commercial open group behavioural weight management programme in adults with overweight and obesity: 5-year follow-up of the WRAP randomised controlled trial

Effectiveness and cost-effectiveness of referral to a commercial open group behavioural weight management programme in adults with overweight and obesity: 5-year follow-up of the WRAP randomised controlled trial
Effectiveness and cost-effectiveness of referral to a commercial open group behavioural weight management programme in adults with overweight and obesity: 5-year follow-up of the WRAP randomised controlled trial
Background: there is evidence that commercially available behavioural weight management programmes can lead to short-term weight loss and reductions in glycaemia. Here, we aimed to provide the 5-year impact and cost-effectiveness of these interventions compared with a brief intervention.

Methods: WRAP was a non-blinded, parallel-group randomised controlled trial (RCT). We recruited from primary care practices in England and randomly assigned participants to one of three interventions (brief intervention, 12-week open-group behavioural programme [WW, formerly Weight Watchers], or a 52-week open-group WW behavioural programme) in an uneven (2:5:5) allocation. Participants were followed up 5 years after randomisation using data from measurement visits at primary care practices or a research centre, review of primary care electronic medical notes, and self-report questionnaires. The primary outcome was change in weight at 5 years follow-up, assessed using analysis of covariance. We also estimated cost-effectiveness of the intervention. This study is registered at Current Controlled Trials, ISRCTN64986150.

Findings: between Oct 18, 2012, and Feb 10, 2014, we recruited 1269 eligible participants (two participants were randomly assigned but not eligible and therefore excluded) and 1040 (82%) consented to be approached about additional follow-up and to have their medical notes reviewed at 5 years. The primary outcome (weight) was ascertained for 871 (69%) of 1267 eligible participants. Mean duration of follow-up was 5·1 (SD 0·3) years. Mean weight change from baseline to 5 years was −0·46 (SD 8·31) kg in the brief intervention group, −1·95 (9·55) kg in the 12-week programme group, and −2·67 (9·81) kg in the 52-week programme. The adjusted difference in weight change was –1·76 (95% CI –3·68 to 0·17) kg between the 52-week programme and the brief intervention; –0·80 (–2·13 to 0·54) kg between the 52-week and the 12-week programme; and –0·96 (–2·90 to 0·97) kg between the 12-week programme and the brief intervention. During the trial, the 12-week programme incurred the lowest cost and produced the highest quality-adjusted life-years (QALY). Simulations beyond 5 years suggested that the 52-week programme would deliver the highest QALYs at the lowest cost and would be the most cost-effective. No participants reported adverse events related to the intervention.

Interpretation: although the difference in weight change between groups was not statistically significant, some weight loss was maintained at 5 years after an open-group behavioural weight management programme. Health economic modelling suggests that this could have important implications to reduce the incidence of weight-related disease and these interventions might be cost-saving.

Funding: the UK National Institute for Health and Care Research Programme Grants for Applied Research and the Medical Research Council.
2468-2667
e866-e875
Ahern, Amy L.
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Breeze, Penny
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Fusco, Francesco
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Sharp, Stephen J
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Islam, Nazrul
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Wheeler, Graham M.
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Hill, Andrew J.
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Hughes, Carly A.
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Duschinsky, Robbie
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Thomas, Chloe
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Bates, Sarah
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Woolston, Jenny
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Stubbings, Marie
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Whittle, Fiona
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Boothby, Clare
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Bostock, Jennifer
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Jebb, Susan
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Aveyard, Paul
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Boyland, Emma
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Halford, Jason C.G.
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Morris, Stephen
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Brennan, Alan
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Griffin, Simon J.
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Ahern, Amy L.
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Breeze, Penny
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Fusco, Francesco
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Sharp, Stephen J
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Islam, Nazrul
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Wheeler, Graham M.
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Hill, Andrew J.
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Thomas, Chloe
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Bates, Sarah
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Woolston, Jenny
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Aveyard, Paul
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Boyland, Emma
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Halford, Jason C.G.
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Morris, Stephen
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Brennan, Alan
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Griffin, Simon J.
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Ahern, Amy L., Breeze, Penny, Fusco, Francesco, Sharp, Stephen J, Islam, Nazrul, Wheeler, Graham M., Hill, Andrew J., Hughes, Carly A., Duschinsky, Robbie, Thomas, Chloe, Bates, Sarah, Woolston, Jenny, Stubbings, Marie, Whittle, Fiona, Boothby, Clare, Bostock, Jennifer, Jebb, Susan, Aveyard, Paul, Boyland, Emma, Halford, Jason C.G., Morris, Stephen, Brennan, Alan and Griffin, Simon J. (2022) Effectiveness and cost-effectiveness of referral to a commercial open group behavioural weight management programme in adults with overweight and obesity: 5-year follow-up of the WRAP randomised controlled trial. The Lancet Public Health, 7 (10), e866-e875. (doi:10.1016/S2468-2667(22)00226-2).

Record type: Article

Abstract

Background: there is evidence that commercially available behavioural weight management programmes can lead to short-term weight loss and reductions in glycaemia. Here, we aimed to provide the 5-year impact and cost-effectiveness of these interventions compared with a brief intervention.

Methods: WRAP was a non-blinded, parallel-group randomised controlled trial (RCT). We recruited from primary care practices in England and randomly assigned participants to one of three interventions (brief intervention, 12-week open-group behavioural programme [WW, formerly Weight Watchers], or a 52-week open-group WW behavioural programme) in an uneven (2:5:5) allocation. Participants were followed up 5 years after randomisation using data from measurement visits at primary care practices or a research centre, review of primary care electronic medical notes, and self-report questionnaires. The primary outcome was change in weight at 5 years follow-up, assessed using analysis of covariance. We also estimated cost-effectiveness of the intervention. This study is registered at Current Controlled Trials, ISRCTN64986150.

Findings: between Oct 18, 2012, and Feb 10, 2014, we recruited 1269 eligible participants (two participants were randomly assigned but not eligible and therefore excluded) and 1040 (82%) consented to be approached about additional follow-up and to have their medical notes reviewed at 5 years. The primary outcome (weight) was ascertained for 871 (69%) of 1267 eligible participants. Mean duration of follow-up was 5·1 (SD 0·3) years. Mean weight change from baseline to 5 years was −0·46 (SD 8·31) kg in the brief intervention group, −1·95 (9·55) kg in the 12-week programme group, and −2·67 (9·81) kg in the 52-week programme. The adjusted difference in weight change was –1·76 (95% CI –3·68 to 0·17) kg between the 52-week programme and the brief intervention; –0·80 (–2·13 to 0·54) kg between the 52-week and the 12-week programme; and –0·96 (–2·90 to 0·97) kg between the 12-week programme and the brief intervention. During the trial, the 12-week programme incurred the lowest cost and produced the highest quality-adjusted life-years (QALY). Simulations beyond 5 years suggested that the 52-week programme would deliver the highest QALYs at the lowest cost and would be the most cost-effective. No participants reported adverse events related to the intervention.

Interpretation: although the difference in weight change between groups was not statistically significant, some weight loss was maintained at 5 years after an open-group behavioural weight management programme. Health economic modelling suggests that this could have important implications to reduce the incidence of weight-related disease and these interventions might be cost-saving.

Funding: the UK National Institute for Health and Care Research Programme Grants for Applied Research and the Medical Research Council.

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e-pub ahead of print date: 29 September 2022
Published date: October 2022
Additional Information: Funding Information: We thank the research and Clinical Research Network staff who supported data collection and thank all staff from the MRC Epidemiology Unit Functional Group Teams. We are grateful to the UK National Institute for Health and Care Research (NIHR) Cambridge Biomedical Research Centre Core Biochemical Assay Laboratory at Addenbrookes Hospital for analysing the blood samples. We also thank the WRAP study participants, and the ongoing support of our Patient Public Involvement Panel. The 5-year follow-up of the WRAP trial was funded by the UK NIHR under its Programme Grants for Applied Research Programme (RP-PG-0216–20010). The views expressed are those of the authors and not necessarily those of the NIHR or the UK Department of Health and Social Care. The WRAP trial was funded by the National Prevention Research Initiative through the UK Medical Research Council (MRC; MR/J000493). WW (formerly Weight Watchers) provided the intervention at no cost via an MRC Industrial Collaboration Award. ALA, SJG, and SJS are supported by the MRC (MC_UU_00006/6). The University of Cambridge has received salary support in respect of SJG from the National Health Service in the East of England through the Clinical Academic Reserve. PA and SAJ were funded by the NIHR Oxford Biomedical Research Centre and NIHR Oxford and Thames Valley Applied Research Collaboration. PA is an NIHR senior investigator. Funding Information: We thank the research and Clinical Research Network staff who supported data collection and thank all staff from the MRC Epidemiology Unit Functional Group Teams. We are grateful to the UK National Institute for Health and Care Research (NIHR) Cambridge Biomedical Research Centre Core Biochemical Assay Laboratory at Addenbrookes Hospital for analysing the blood samples. We also thank the WRAP study participants, and the ongoing support of our Patient Public Involvement Panel. The 5-year follow-up of the WRAP trial was funded by the UK NIHR under its Programme Grants for Applied Research Programme (RP-PG-0216–20010). The views expressed are those of the authors and not necessarily those of the NIHR or the UK Department of Health and Social Care. The WRAP trial was funded by the National Prevention Research Initiative through the UK Medical Research Council (MRC; MR/J000493). WW (formerly Weight Watchers) provided the intervention at no cost via an MRC Industrial Collaboration Award. ALA, SJG, and SJS are supported by the MRC (MC_UU_00006/6). The University of Cambridge has received salary support in respect of SJG from the National Health Service in the East of England through the Clinical Academic Reserve. PA and SAJ were funded by the NIHR Oxford Biomedical Research Centre and NIHR Oxford and Thames Valley Applied Research Collaboration. PA is an NIHR senior investigator. Funding Information: ALA reports research grants from the UK National Institute for Health and Care Research (NIHR), UK Medical Research Council (MRC) and the European Association for the Study of Obesity and membership of the Scientific Advisory Board for WW (all payments to her institution). PB reports research grants to her institution from NIHR and consultancy fees from Genomics. NI reports grants from the UK Office for National Statistics, Canadian Institutes of Health Research, Health Data Research UK, and NIHR; is an advisory board member of the WHO-UN Technical Advisory Board, The BMJ Research Forum and BMJ Medicine; and has received consultancy fees and payments from The BMJ. GMW reports grants from MRC and Innovate UK; has received payment from AstraZeneca and support for meeting attendance from Eli Lilly; and is a committee member of the NIHR Statistics Group Early Stage Trials Section, UK National Cancer Research Institute Teenage and Young Adult and Germ Cell Therapies subgroup, and the MRC Experimental Medicine Funding Panel. AJH reports grants to his institution from NIHR and payment for advice from Slimming World. CAH reports consultancy fees from Novo Nordisk; payments or honoraria for presentations; manuscript writing or educational events from Novo Nordisk, Ethicon, Alva Health and International Medical Press; and is an Advisory Board Member for Novo Nordisk. RD reports research grants from NIHR and the Wellcome Trust. SB reports research grants from the Wellcome Trust and NIHR; consultancy fees from the UK Office for Health Improvement and Disparities and Dark Peak Analytics; and is on the Editorial Board of the Journal of Medical Decision Making. SJ has received grants from NIHR and is Chair of the UK Food Standards Agency. PA reports research grants to his institution from NIHR, British Heart Foundation and Nestle Life Sciences, and materials or services from Nestle Life Sciences. EB reports grants to her institution from NIHR, Public Health England, and WHO, and consultancy fees from WHO. JCGH has received grants from Novo Nordisk and the American Beverage Association; consulting fees from Novo Nordisk, Dupont, Boheim Inhelheim, and Mars; support for meeting attendance from Novo Nordisk; and is an Advisory Board Member for Dupont (all payments to his institution). SM and AB report grant funding to their institution from NIHR. SJG reports grants to his institution from NIHR and MRC; consultancy fees to his institution from Genomics; payments for educational events from AstraZeneca; and unpaid membership of the Board of Trustees for the Novo Nordisk UK Research Foundation. FF, SJS CC, CT, JW, MS, FW, and CB report no competing interests beyond funding to their institutions for the current project. Publisher Copyright: © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

Identifiers

Local EPrints ID: 471104
URI: http://eprints.soton.ac.uk/id/eprint/471104
ISSN: 2468-2667
PURE UUID: a8a41982-e9ba-4e93-af44-aff56a3d0244
ORCID for Nazrul Islam: ORCID iD orcid.org/0000-0003-3982-4325

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Date deposited: 26 Oct 2022 16:45
Last modified: 17 Mar 2024 04:15

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Contributors

Author: Amy L. Ahern
Author: Penny Breeze
Author: Francesco Fusco
Author: Stephen J Sharp
Author: Nazrul Islam ORCID iD
Author: Graham M. Wheeler
Author: Andrew J. Hill
Author: Carly A. Hughes
Author: Robbie Duschinsky
Author: Chloe Thomas
Author: Sarah Bates
Author: Jenny Woolston
Author: Marie Stubbings
Author: Fiona Whittle
Author: Clare Boothby
Author: Jennifer Bostock
Author: Susan Jebb
Author: Paul Aveyard
Author: Emma Boyland
Author: Jason C.G. Halford
Author: Stephen Morris
Author: Alan Brennan
Author: Simon J. Griffin

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