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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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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., 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

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: 27 Oct 2022 02:05

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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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