Filling the intervention gap: service evaluation of an intensive nonsurgical weight management programme for severe and complex obesity
Open accessAbstract
Background: Weight management including formula total diet replacement (TDR) is emerging as an effective intervention for severe and complex obesity, particularly with respect to type 2 diabetes (T2 DM). However, no prospective audit and service evaluation of such programmes have been reported. Methods: Following initial feasibility piloting, the Counterweight‐Plus programme was commissioned across a variety of healthcare providers. The programme includes: Screening, TDR (formula low energy diet), food reintroduction and weight loss maintenance, all delivered by staff with 8 h of training, in‐service mentoring, ongoing specialist support and access to medical consultant expertise. Anonymised data are returned centrally for clinical evaluation. Results: Up to December 2016, 288 patients commenced the programme. Mean (SD) baseline characteristics were: age 47.5 (12.7) years, weight 128.0 (32.0) kg, body mass index 45.7 (10.1) kg m−2, n = 76 (26.5%) were male and n = 99 (34.5%) had T2 DM. On an intention‐to‐treat (ITT) basis, a loss of ≥15 kg at 12 months was achieved by 48 patients, representing 22.1% of all who started and 40% of those who maintained engagement. For complete cases, mean (95% confidence interval) weight loss was 13.3 (12.1–14.4) kg at 3 months, 16.0 (14.4–17.6) kg at 6 months and 14.2 (12.1–16.3) kg at 12 months (all P < 0.001), with losses to follow‐up of 10.8%, 29.3% and 44.2%, respectively. Mean loss at 12 months by ITT analyses was: single imputation –10.5 (9.5) kg, last observation carried forward –10.9 (11.6) kg and baseline observation carried forward –7.9 (11.1) kg. The presence of diabetes had no significant impact on weight change outcomes. Conclusions: This nonsurgical approach is effective for many individuals with severe and complex obesity, representing an option before considering surgery. The results are equally effective in terms of weight loss for people with T2 DM.
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The 12-month intervention cost is under half of the average annual UK healthcare cost of a person with type 2 diabetes.
“The 12-month intervention cost is under half of the average annual UK healthcare cost of a person with type 2 diabetes. 23”
From Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial (2019) · cites this paper as [23]
The Discussion (p. 11) mentions potential savings on diabetes medications, and the Results (p. 9) report 12-month weight outcomes. Neither gives a 12-month intervention cost or an average annual UK healthcare cost for a person with type 2 diabetes; searches for those costs and the claimed comparison found no supporting passage. (LLM, conf=0.74)
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- Authors
- McCombie, L., Brosnahan, N., Ross, H., Bell‐Higgs, A., Govan, L., & Lean, M. E. J.
- Affiliations
- University of Glasgow (GB)
- Counterweight Ltd London UK
- Phastar Statistical Consultancy Chiswick, London UK
- Corresponding author
- McCombie, L.
- Venue
- Journal of Human Nutrition and Dietetics
- Publisher
- Wiley
- Published
- 2018-11-22
- Volume
- 32
- Issue
- 3
- Pages
- 329-337
- ISSN
- 0952-3871 (ISSN-L)
- 1365-277X
- OpenAlex
- W2904363567
- Cited by
- 40
- References
- 22
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 3 · 2023: 3 · 2022: 9 · 2021: 5 · 2020: 12 · 2019: 4 · 2018: 1
- FWCI
- 5.72
- Type
- journal article
- Language
- en
- Open access
- green
- eprints.gla.ac.uk
- Licence
- Locations
- Journal of Human Nutrition and Dietetics (publishedVersion)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- morbid obesity, total diet replacement, weight management, type 2 diabetes, weight loss, weight loss maintenance, food reintroduction, non-surgical obesity treatment
- MeSH terms
- Mentoring, Adult, Diabetes Mellitus, Type 2, Female, Humans, Male, Medical Audit, Middle Aged, Obesity, Scotland, Program Evaluation, Weight Loss, Body Mass Index, Treatment Outcome, Caloric Restriction, Weight Reduction Programs
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