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Cited by 219Obesity, Physical Activity, DietObesity and Health PracticesPharmacology and Obesity Treatment

Extended and standard duration weight-loss programme referrals for adults in primary care (WRAP): a randomised controlled trial

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Ahern, Amy L, Wheeler, Graham M, Aveyard, Paul, Boyland, Emma J, Halford, Jason C G, Mander, Adrian P, Woolston, Jennifer, Thomson, Ann M +12 more·2017·The Lancet
DOI 10.1016/s0140-6736(17)30647-5PMC PMC5459752
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Abstract

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: 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; p<0·0001). The 52-week programme was more effective than the 12-week programme (-2·14 kg, -3·05 to -1·22; p<0·0001). Differences between groups were still significant at 2 years. No adverse events related to the intervention were reported. Over 2 years, the incremental cost-effectiveness ratio (ICER; compared with brief intervention) was £159 per kg lost for the 52-week programme and £91 per kg for the 12-week programme. Modelled over 25 years after baseline, the ICER for the 12-week programme was dominant compared with the brief intervention. The ICER for the 52-week programme was cost-effective compared with the brief intervention (£2394 per quality-adjusted life-year [QALY]) and the 12-week programme (£3804 per QALY). INTERPRETATION: 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).

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  • Adverse mental burden may lead to emotional eating and decreased physical activity and thus to increases in bodyweight.

    “Adverse mental burden may lead to emotional eating and decreased physical activity [9, 10, 11, 12, 13, 14] and thus to increases in bodyweight [15].”

    From Supporting Weight Management during COVID-19: A Randomized Controlled Trial of a Web-Based, ACT-Based, Guided Self-Help Intervention (2022) · cites this paper as [11]

    Citation [15] is attached to the claim that the preceding changes lead to increased bodyweight. The Results report weight changes after referrals to weight-loss programmes, but do not address whether adverse mental burden, emotional eating, or reduced physical activity cause weight gain; searches for those terms found no relevant passage. No page number was provided in our copy. (LLM, conf=0.76)

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Authors
Ahern, A. L., Wheeler, G. M., Aveyard, P., Boyland, E. J., Halford, J. C. G., Mander, A. P., Woolston, J., Thomson, A. M., Tsiountsioura, M., Cole, D., Mead, B. R., Irvine, L., Turner, D., Suhrcke, M., Pimpin, L., Retat, L., Jaccard, A., Webber, L., Cohn, S. R., & Jebb, S. A.
Affiliations
  • MRC Elsie Widdowson Laboratory (GB)
  • University of Cambridge (GB)
  • University of Oxford (GB)
  • University of Liverpool (GB)
  • University of East Anglia (GB)
  • UK Health Forum (GB)
  • London School of Hygiene & Tropical Medicine (GB)
Corresponding author
Ahern, Amy L
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
2017-06
Volume
389
Issue
10085
Pages
2214-2225
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(17)30647-5
PMC
PMC5459752
OpenAlex
W2610544411
Cited by
218
References
31
Citations by year
2026: 9 · 2025: 21 · 2024: 22 · 2023: 13 · 2022: 35 · 2021: 21 · 2020: 32 · 2019: 37 · 2018: 19 · 2017: 9
FWCI
25.17
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
  • UEA Digital Repository (University of East Anglia) (acceptedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • UCL Discovery (University College London) (submittedVersion)
  • Spiral (Imperial College London) (submittedVersion, cc-by)
  • Apollo (University of Cambridge) (submittedVersion, cc-by)
  • Apollo (cc-by)
Funders
National Prevention Research Initiative through research (grant MR/J000493/1)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
  • Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
Keywords
obesity, weight loss, weight management interventions, intervention duration, primary care referral, behavioural weight management, Weight Watchers, self-help materials, cost-effectiveness, long-term weight maintenance, health-related quality of life, cardiovascular risk, cost-effectiveness analysis, microsimulation
MeSH terms
Adult, Aged, Behavior Therapy, Body Weight, Cost-Benefit Analysis, England, Female, Follow-Up Studies, Humans, Male, Middle Aged, Obesity, Primary Health Care, Quality of Life, Referral and Consultation, Socioeconomic Factors, State Medicine, Time Factors, Weight Loss, Health Care Costs, Weight Reduction Programs

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