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Extended and standard duration weight-loss programme referrals for adults in primary care (WRAP): a randomised controlled trial
Open accessAbstract
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 [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]
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Self-citationWeight management programmes of extended duration
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Self-citationEvaluating a pre-surgical health optimisation programme: a feasibility study
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“While men where under-represented, there was a higher proportion (32%) of men in this trial than typically found in trials of weight-management interventions and there was no evidence that sex moderated the effect of the intervention.(9) Over half of the participating practices were in areas with a high index of multi…”
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“Similarly, a recent evaluation in the UK of a primary care-led behavioural programme 30 looked at a brief advice and self-help materials (primary care-led programme) versus Weight Watchers over 12 weeks and over 52 weeks.”
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InfluentialRecovery from weight regain among long‐term weight loss maintainers in WW
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Self-citationProviding food to patients in primary care to induce weight loss: a systematic literature review
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Self-citationJaiswal, N., Gregg, R., Hawkins, N., Sharif, S., Avenell, A., Ells, L. J., Jayacodi, S., Mackenzie, R. M., Simpson, S. A., Wu, O., et al. (2025) · Health Technology Assessment · doi:10.3310/gjjl0630 · Cited by 2
Team-based “Get-a-Grip” lifestyle management programme in the treatment of obesity
Taurio, J., Järvinen, J., Hautaniemi, E. J., Eräranta, A., Viitala, J. M., Nordhausen, K., Kaukinen, K., Mustonen, J. T., & Pörsti, I. H. (2020) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2020.101119 · Cited by 2
“Referral of overweight adults to an open-group behavioural programme for ≥ 12 weeks was more e ff ective than brief advice and self-help materials (Ahern et al., 2017).”
Tocque, K., & Kennedy, L. (2021) · Maternal and Child Health Journal · doi:10.1007/s10995-021-03204-5 · Cited by 2
Cheng, Y.-C., Liu, H., Hsu, C., & Lee, I. (2022) · Diabetes Metabolic Syndrome and Obesity · doi:10.2147/dmso.s368608 · Cited by 2
“weight losses than 12-week programs based on a randomized controlled trial using life-style modification.(37) Notably, early attrition and drop out, defined as a participant not attending a scheduled visit, were negative predictors of successful weight loss during clinical trials.”
MethodTHE RELATIONSHIP BETWEEN BODY MASS INDEX AND LIFE SATISFACTION AMONG ADULT RUSSIANS
Gromova, D., & Алексеевна, Х. Н. (2023) · Social Aspects of Population Health · doi:10.21045/2071-5021-2023-69-1-5 · Cited by 3
Clina, J. G., Wyatt, H. R., Hill, J. O., Ferguson, C. C., Young, H., & Rimmer, J. H. (2024) · Obesity Science & Practice · doi:10.1002/osp4.750 · Cited by 2
“Typically, weight loss programs range from 12 weeks to 6 months of the active weight loss phase 13–16 and include dietary and exercise components, 17–22 and self ‐ monitoring activities, such as regular self ‐ weighing, 12,18,19 often preventing PWD from fully participating.”
BackgroundMcVay, M. A., Moore, W. S., Deceus, D., Townsend, S. B., Rosenberg, E. I., Muenyi, S., Lou, X., Webb, F. J., Diaz, L. D., Shankar, M. N., et al. (2024) · Contemporary Clinical Trials · doi:10.1016/j.cct.2025.107948 · Cited by 1
MacPhee, M., Howe, J., Habib, H., Piwowarczyk, E., Wong, G., Ahern, A. L., Birdi, G. K., Higgs, S., Oduola, S., Kenny, A., et al. (2025) · Obesity Reviews · doi:10.1111/obr.13962 · Cited by 3
Self-citationImran, R., Kenny, A., Wong, G., & Lee, C. (2025) · BMC Family Practice · doi:10.1186/s12875-025-02929-4 · Cited by 1
“…in 4,305 participants observed that active interventions resulted in more weight loss (mean = −4.37 to + 1 kg at 6 weeks to 18 months follow-up) compared with control groups (−1.64 to + 3.08 kg) [8], which is commensurate with observations in the general population at one-year follow-up [9].”
InfluentialLarsen, S. C., Heitmann, B. L., Wane, S., Wielsøe, S., Lindschou, J., Jakobsen, J. C., Engstrøm, J., Specht, I. O., Christiansen, A.-K. L., Jensen, A. K. G., et al. (2025) · BMJ Open · doi:10.1136/bmjopen-2025-107155 · Cited by 1
Self-citationLong-term management of body weight and physiological mechanisms of weight regain
Hu, T., & Bao, Y. (2026) · Journal of Molecular Cell Biology · doi:10.1093/jmcb/mjaf062 · Cited by 1
“Overall, intensive behavioral interventions can lead to 4%– 9% weight loss at 1 year and 1%–3% at 5–10 years (Ahern et al., 2017 ).”
Hu, R., Yang, Y., Yang, Y., Kong, J., Luo, J., Yang, W., Chen, J., Liu, J., Zeng, H., Zhang, L., et al. (2026) · JMIR Formative Research · doi:10.2196/89077 · Cited by 1
British Nutrition Foundation Annual Lecture 2017 – Diet, obesity and cardiovascular risk
Jebb, S. A., & White, A. (2018) · Nutrition Bulletin · doi:10.1111/nbu.12317 · Cited by 1
“…mean BMI 34.5 kg/m2) from 23 practices around the UK, Professor Jebb has shown that for people seeking support to lose weight, referrals to community based weight loss groups such as WeightWatchers™ leads to significantly greater weight loss than a self-help intervention (Ahern et al. 2017).”
BackgroundInfluentialSelf-citationWeight loss interventions for overweight and obese patients in primary care: A literature review
Woadden, J., & James, J. (2018) · Practice Nursing · doi:10.12968/pnur.2018.29.10.493 · Cited by 1
Sauchelli, S., Bradley, J., Cox, J. S., England, C. Y., & Perry, R. E. (2020) · Systematic Reviews · doi:10.1186/s13643-020-01467-7 · Cited by 1
Tong, J., Duan, R., Li, R., Luo, C., Moore, J. H., Zhu, J., Foster, G. D., Volpp, K. G. M., Yancy, W. S., Shaw, P. A., et al. (2023) · Scientific Reports · doi:10.1038/s41598-023-41853-4 · Cited by 1
“The participants were recruited from WeightWatchers (WW), which is a global weight management program with over 4 million members and is empirically validated (ClinicalTrials.gov Identifier: NCT00702455) 33–35 .”
BackgroundBates, S. E., Breeze, P. R., Thomas, C., Jackson, C., Church, O., & Brennan, A. (2024) · BMC Public Health · doi:10.1186/s12889-024-18134-4 · Cited by 1
“Behavioural weight management programmes have been shown to result in weight loss and reductions in glycaemia [1–3].”
BackgroundJoyce, J. B., Hajizadeh, A., Begh, R. A., Jolly, K. B., Jebb, S. A., & Aveyard, P. N. (2025) · Clinical Obesity · doi:10.1111/cob.70020 · Cited by 1
“…for people with obesity are acceptable and evidence that simple inexpensive weight management programmes are effective and cost-saving for the NHS. 16,17 In 2021, a Nation-ally Enhanced Service (NES) incentive scheme was rolled out in England, in which, weight management services were made…”
Self-citationErfolgreiche Teilnahme an einem interdisziplinären Interventionsprogramm für übergewichtige Kinder
Roschatt, I. S., Kapitzke, K., Sadeghian, E., Ziegler, C., Bokelmann, A., Galuschka, L., Guntermann, K., Danne, T., & Kordonouri, O. (2017) · Kinder- und Jugendmedizin · doi:10.1055/s-0038-1636557 · Cited by 1
Erfolgreiche Teilnahme an einem interdisziplinären Interventionsprogramm für übergewichtige Kinder
Roschatt, I. S., Kapitzke, K., Sadeghian, E., Ziegler, C., Bokelmann, A., Galuschka, L., Guntermann, K., Danne, T., & Kordonouri, O. (2018) · Adipositas - Ursachen Folgeerkrankungen Therapie · doi:10.1055/s-0038-1636969 · Cited by 1
Fogelholm, M. (2019) · Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature · doi:10.3410/f.734229568.793555246 · Cited by 1
Ewe, M. B., Hildingh, C. I., Månsson, J., & Lydell, M. (2020) · doi:10.21203/rs.3.rs-48057/v1 · Cited by 1
“At one PHCC, they had tried to collaborate with Weight Watchers, but the relationship was discontinued because many of the staff felt it was unethical to favour an external actor; this was in contrast to a study in England where they collaborated and found better weight loss results with Weight Watchers than with the…”
ResultPsychological well-being of young people engaged in a group- based weight management programme
Khurram-Aziz, N. (2017) · White Rose eTheses Online (University of Leeds, The University of Sheffield, University of York)
Abspeck-Programm sollte lang dauern
Holzapfel, C. (2017) · MMW - Fortschritte der Medizin · doi:10.1007/s15006-017-0001-z
Bourke, S., Morton, J. M., & Williams, P. T. (2020) · Journal of Obesity · doi:10.1155/2020/8026016
“Aherns et al. defined completers as completing 12 visits or the last observation until a 5-week hiatus in attendance [11].”
BackgroundInfluentialGysling, E. (2017) · pharma-kritik · doi:10.37667/pk.2017.1022
Obesity Management in Primary Health Care: Front-Line Providers’ Experiences and Views
Saâdi, H., Malallah, H., Al-Saadi, J., ALsheala, N., Balushi, A. A., Al-Abri, S., & Al-Saadi, T. D. (2020) · European Journal of Medical and Health Sciences · doi:10.24018/ejmed.2020.2.6.549
The development and initial evaluation of a weight specific quality of life instrument
Jefferson, R. (2020) · CLOK (University of Central Lancashire)
Effectiveness of a Single Physician-led Weight loss Program in Primary Care SettingPreprint
Niranjan, V., Śliwińska, A., Chen, F., Ramanan, S., Maheshwari, N., & Wu, H. (2021) · doi:10.22541/au.161976509.98973914/v1
Development of protocols to identify high hunger and low satiety phenotypes
Elfarssi, H. M. (2019) · Sheffield Hallam University · doi:10.7190/shu-thesis-00370
A Practical Approach to Contemporary Obesity Management
Caterson, I. D., Sweeting, A., & Kopelman, P. G. (2022) · Wiley eBooks · doi:10.1002/9781119695257.ch17
Extended weight-loss programme more cost effective
(2017) · PharmacoEconomics & Outcomes News · doi:10.1007/s40274-017-3994-8
Woolston, J., & Ahern, A. L. (2018) · http://isrctn.com/ · doi:10.1186/isrctn64986150
Self-citation
Metadata
- 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
- 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
- hybrid
- doi.org
- 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 › Medicine › Public Health, Environmental and Occupational Health › Obesity and Health Practices
- Health Sciences › Medicine › Pharmacology (medical) › 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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