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Cited by 26Obesity and Health PracticesObesity, Physical Activity, DietEating Disorders and Behaviors

The impact of participant mental health on attendance and engagement in a trial of behavioural weight management programmes: secondary analysis of the WRAP randomised controlled trial

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Jones, Rebecca A., Mueller, Julia, Sharp, Stephen J., Vincent, Ann, Duschinsky, Robbie, Griffin, Simon J., Ahern, Amy L.·2021·International Journal of Behavioral Nutrition and Physical Activity
DOI 10.1186/s12966-021-01216-6PMC PMC8574009
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Abstract

Background: Low attendance and engagement in behavioural weight management trials are common. Mental health may play an important role, however previous research exploring this association is limited with inconsistent findings. We aimed to investigate whether mental health was associated with attendance and engagement in a trial of behavioural weight management programmes. Methods: This is a secondary data analysis of the Weight loss referrals for adults in primary care (WRAP) trial, which randomised 1267 adults with overweight or obesity to brief intervention, WW (formerly Weight Watchers) for 12-weeks, or WW for 52-weeks. We used regression analyses to assess the association of baseline mental health (depression and anxiety (by Hospital Anxiety and Depression Scale), quality of life (by EQ5D), satisfaction with life (by Satisfaction with Life Questionnaire)) with programme attendance and engagement in WW groups, and trial attendance in all randomised groups. Results: Every one unit of baseline depression score was associated with a 1% relative reduction in rate of WW session attendance in the first 12 weeks (Incidence rate ratio [IRR] 0.99; 95% CI 0.98, 0.999). Higher baseline anxiety was associated with 4% lower odds to report high engagement with WW digital tools (Odds ratio [OR] 0.96; 95% CI 0.94, 0.99). Every one unit of global quality of life was associated with 69% lower odds of reporting high engagement with the WW mobile app (OR 0.31; 95% CI 0.15, 0.64). Greater symptoms of depression and anxiety and lower satisfaction with life at baseline were consistently associated with lower odds of attending study visits at 3-, 12-, 24-, and 60-months. Conclusions: Participants were less likely to attend programme sessions, engage with resources, and attend study assessments when reporting poorer baseline mental health. Differences in attendance and engagement were small, however changes may still have a meaningful effect on programme effectiveness and trial completion. Future research should investigate strategies to maximise attendance and engagement in those reporting poorer mental health. Trial registration: The original trial (ISRCTN82857232) and five year follow up (ISRCTN64986150) were prospectively registered with Current Controlled Trials on 15/10/2012 and 01/02/2018.

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Research works printed but not linked: 44

  1. [1]Semlitsch T Stigler FL Jeitler K Horvath K Siebenhofer A Management of overweight and obesity in primary care—a systematic overview of international evidence-based guidelines Obes Rev 2019 20 9 1218 1230 31286668 PMC6852048
  2. [4]Ahmad Zamri L, Appannah G, Zahari Sham SY, Mansor F, Ambak R, Mohd Nor NS, et al. Weight change and its association with cardiometabolic risk markers in overweight and obese women. J Obes. 2020; Available from: https://www.hindawi.com/journals/jobe/2020/3198326/?utm_source=researcher_app&utm_medium=referral&utm_campaign=RESR_MRKT_Researcher_inbound. PMC7211250 32399286
  3. [6]Jones RA, Lawlor ER, Birch JM, Patel MI, Werneck AO, Hoare E, et al. The impact of adult behavioural weight management interventions on mental health: a systematic review and meta-analysis. Obes Rev. 2020:1–18. PMC7116866 33103340
  4. [8]Pirotta S, Joham A, Hochberg L, Moran L, Lim S, Hindle A, et al. Strategies to reduce attrition in weight loss interventions: a systematic review and meta-analysis. Obes Rev. 2019;20(10). 31347759
  5. [9]Johnston CA Moreno JP Hernandez DC Link BA Chen TA Wojtanowski AC Levels of adherence needed to achieve significant weight loss Int J Obes 2019 43 1 125 131 10.1038/s41366-018-0226-7 30301963 · DOI · Paper page
  6. [10]Stubbs RJ Morris L Pallister C Horgan G Lavin JH Weight outcomes audit in 1.3 million adults during their first 3 months’ attendance in a commercial weight management programme BMC Public Health 2015 15 1 1 13 10.1186/s12889-015-2225-0 26359180 PMC4566482 · DOI
  7. [11]Stubbs RJ Brogelli DJ Pallister CJ Whybrow S Avery AJ Lavin JH Attendance and weight outcomes in 4754 adults referred over 6 months to a primary care/commercial weight management partnership scheme Clin Obes. 2012 2 1–2 6 14 25586042
  8. [12]Blane DN McLoone P Morrison D MacDonald S O’Donnell CA Patient and practice characteristics predicting attendance and completion at a specialist weight management service in the UK: a cross-sectional study BMJ Open 2017 7 11 1 9 PMC5719278 29162575
  9. [13]Leung AWY, Chan RSM, Sea MMM, Woo J. An overview of factors associated with adherence to lifestyle modification programs for weight management in adults. Int J Environ Res Public Health. 2017;14(8). PMC5580624 28813030
  10. [14]Elfhag K Rössner S Initial weight loss is the best predictor for success in obesity treatment and sociodemographic liabilities increase risk for drop-out Patient Educ Couns 2010 79 3 361 366 10.1016/j.pec.2010.02.006 20223613 · DOI
  11. [15]Geiker NRW Astrup A Hjorth MF Sjödin A Pijls L Markus CR Does stress influence sleep patterns, food intake, weight gain, abdominal obesity and weight loss interventions and vice versa? Obes Rev 2018 19 1 81 97 28849612
  12. [17]Fruh SM Obesity: risk factors, complications, and strategies for sustainable long-term weight management J Am Assoc Nurse Pract 2017 29 S3 14 29024553 PMC6088226
  13. [18]Fabricatore A Wadden T Higginbotham A Faulconbridge L Nguyen A Heymsfield S Intentional weight loss and changes in symptoms of depression: a systematic review and meta-analysis Int J Obes 2011 35 11 1363 1376 PMC3139753 21343903
  14. [19]McKibbin CL Kitchen KA Wykes TL Lee AA Barriers and facilitators of a healthy lifestyle among persons with serious and persistent mental illness: perspectives of community mental health providers Community Ment Health J 2014 50 5 566 576 24129587 PMC3989460
  15. [24]Avila C Holloway AC Hahn MK Morrison KM Restivo M Anglin R An overview of links between obesity and mental health Curr Obes Rep 2015 4 3 303 310 26627487
  16. [25]Erickson ZD Kwan CL Gelberg HA Arnold IY Chamberlin V Rosen JA A randomized, controlled multisite study of behavioral interventions for veterans with mental illness and antipsychotic medication-associated obesity J Gen Intern Med 2017 32 S1 32 39 28271424 PMC5359155
  17. [26]Rouse PC Ntoumanis N Duda JL Jolly K Williams GC In the beginning: role of autonomy support on the motivation, mental health and intentions of participants entering an exercise referral scheme Psychol Health 2011 26 6 729 749 21827332
  18. [27]Santini ZI Jose PE York Cornwell E Koyanagi A Nielsen L Hinrichsen C Social disconnectedness, perceived isolation, and symptoms of depression and anxiety among older Americans (NSHAP): a longitudinal mediation analysis Lancet Public Heal [Internet] 2020 5 1 E62 E70 31910981
  19. [28]Stafford M Von Wagner C Perman S Taylor J Kuh D Sheringham J Social connectedness and engagement in preventive health services: an analysis of data from a prospective cohort study Lancet Public Heal 2018 3 9 E438 E446 PMC6123501 30143472
  20. [29]Nuyen J Tuithof M de Graaf R van Dorsselaer S Kleinjan M Have M t The bidirectional relationship between loneliness and common mental disorders in adults: findings from a longitudinal population-based cohort study Soc Psychiatry Psychiatr Epidemiol 2020 55 10 1297 1310 10.1007/s00127-019-01778-8 31538206 · DOI
  21. [30]Seow LSE Chua BY Xie H Wang J Ong HL Abdin E Correct recognition and continuum belief of mental disorders in a nursing student population BMC Psychiatry 2017 17 1 1 8 28784095 PMC5547490
  22. [31]Angermeyer MC Millier A Rémuzat C Refaï T Schomerus G Toumi M Continuum beliefs and attitudes towards people with mental illness: results from a national survey in France Int J Soc Psychiatry 2015 61 3 297 303 25061023
  23. [32]Schomerus G Angermeyer MC Baumeister SE Stolzenburg S Link BG Phelan JC An online intervention using information on the mental health-mental illness continuum to reduce stigma Eur Psychiatry [Internet] 2016 32 21 27 10.1016/j.eurpsy.2015.11.006 26802980 · DOI
  24. [33]McLean R Morrison D Shearer R Boyle S Logue J Attrition and weight loss outcomes for patients with complex obesity, anxiety and depression attending a weight management programme with targeted psychological treatment Clin Obes. 2016 6 2 133 142 26842226
  25. [34]Somerset SM Graham L Markwell K Depression scores predict adherence in a dietary weight loss intervention trial Clin Nutr 2011 30 5 593 598 10.1016/j.clnu.2011.04.004 21575998 · DOI
  26. [35]Funderburk JS Arigo D Kenneson A Initial engagement and attrition in a national weight management program: demographic and health predictors Transl Behav Med 2016 6 3 358 368 10.1007/s13142-015-0335-y 27528525 PMC4987595 · DOI
  27. [36]Ahern AL Aveyard PN Halford JC Mander A Cresswell L Cohn SR Weight loss referrals for adults in primary care (WRAP): protocol for a multi-Centre randomised controlled trial comparing the clinical and cost-effectiveness of primary care referral to a commercial weight loss provider for 12 weeks, referral for 52 week BMC Public Health 2014 14 1 620 24943673 PMC4230033
  28. [38]Brooks R EuroQol: the current state of play Health Policy (New York) 1996 37 1 53 72 10158943
  29. [39]Diener E, Emmons RA, Larsen RJ, Griffin S. The satisfaction with life scale. J Pers Assess [Internet]. 1985;49(1):71–75. Available from: 10.1207/s15327752jpa4901_13. 16367493 · DOI · Paper page
  30. [40]Zigmond AS Snaith RP The hospital anxiety and depression scale Acta Psychiatr Scand 1983 67 6 361 370 10.1111/j.1600-0447.1983.tb09716.x 6880820 · DOI · Paper page
  31. [42]Pavot W Diener E Review of the satisfaction with life scale Psychol Assess 1993 5 2 164 172
  32. [44]Bjelland I Dahl AA Haug TT Neckelmann D The validity of the hospital anxiety and depression scale J Psychosom Res 2002 52 2 69 77 11832252
  33. [45]Jagielski AC, Brown A, Hosseini-Araghi M, Thomas GN, Taheri S. The association between adiposity, mental well-being, and quality of life in extreme obesity. PLoS One. 2014;9(3). PMC3966835 24671197
  34. [46]Mackenzie RM Ells LJ Simpson SA Logue J Core outcome set for behavioural weight management interventions for adults with overweight and obesity: standardised reporting of lifestyle weight management interventions to aid evaluation (STAR-LITE) Obes Rev 2020 21 2 1 25 PMC7050499 31756274
  35. [50]Zwickert K Rieger E A qualitative investigation of obese women’s experiences of effective and ineffective social support for weight management Clin Obes 2014 4 5 277 286 25825860
  36. [51]Roberts Haf S Bailey Elisabeth J Roberts SH Bailey JE Incentives and barriers to lifestyle interventions for people with severe mental illness: a narrative synthesis of quantitative, qualitative and mixed methods studies J Adv Nurs 2011 67 4 690 708 21323972
  37. [52]Rand K, Vallis M, Aston M, Price S, Piccinini-Vallis H, Rehman L, et al. “It is not the diet; it is the mental part we need help with.” A multilevel analysis of psychological, emotional, and social well-being in obesity. Int J Qual Stud Health Well Being. 2017;12(1) Available from:. 10.1080/17482631.2017.1306421. PMC5421368 28418818 · DOI · Paper page
  38. [53]Kirk SFL Price SL Penney TL Rehman L Lyons RF Piccinini-Vallis H Blame, shame, and lack of support: a multilevel study on obesity management Qual Health Res 2014 24 6 790 800 24728109
  39. [54]Garip G Yardley L A synthesis of qualitative research on overweight and obese people’s views and experiences of weight management Clin Obes. 2011 1 2–3 110 126 25585576
  40. [55]Mold F Forbes A Patients’ and professionals’ experiences and perspectives of obesity in health-care settings: a synthesis of current research Health Expect 2013 16 2 119 142 21645186 PMC5060648
  41. [56]Ma J Rosas LG Lv N Xiao L Snowden MB Venditti EM Effect of integrated behavioral weight loss treatment and problem-solving therapy on body mass index and depressive symptoms among patients with obesity and depression: the RAINBOW randomized clinical trial JAMA 2019 321 9 869 879 30835308 PMC6439596
  42. [57]Grossi E Dalle Grave R Mannucci E Molinari E Compare A Cuzzolaro M Complexity of attrition in the treatment of obesity: clues from a structured telephone interview Int J Obes 2006 30 7 1132 1137 16432536
  43. [58]Colombo O Ferretti VV Ferraris C Trentani C Vinai P Villani S Is drop-out from obesity treatment a predictable and preventable event? Nutr J 2014 13 1 9 11 24490952 PMC3914843
  44. [59]Miller BML Brennan L Measuring and reporting attrition from obesity treatment programs: a call to action! Obes Res Clin Pract 2015 9 3 187 202 10.1016/j.orcp.2014.08.007 25293585 · DOI

Cited by

Sorted by citations

Authors
Jones, R. A., Mueller, J., Sharp, S. J., Vincent, A., Duschinsky, R., Griffin, S. J., & Ahern, A. L.
Affiliations
  • University of Cambridge (GB)
  • University College London (GB)
Corresponding author
Jones, Rebecca A.
ORCID
Venue
International Journal of Behavioral Nutrition and Physical Activity
Publisher
Springer Science and Business Media LLC
Published
2021-11-07
Volume
18
Issue
1
Pages
146-146
ISSN
1479-5868 (ISSN-L)
DOI
10.1186/s12966-021-01216-6
PMC
PMC8574009
OpenAlex
W3213029313
Cited by
26
References
11
Citations by year
2026: 5 · 2025: 2 · 2024: 7 · 2023: 4 · 2022: 8
FWCI
7.41
Type
journal article
Language
en
Open access
Licence
Locations
  • International Journal of Behavioral Nutrition and Physical Activity (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Apollo (University of Cambridge) (submittedVersion, cc-by)
  • Apollo
  • Apollo (cc-by)
Funders
  • Medical Research Council (Grant MC_UU_00006/6)
  • National Institute for Health Research (RP-PG-0216-20010)
  • National Prevention Research Initiative (MR/J000493)
Topics
  • Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
Keywords
depression, anxiety, weight management interventions, program attendance, participant engagement, trial retention, quality of life, life satisfaction, Weight Watchers, obesity, overweight, trial completion, digital health interventions, brief intervention, participant retention
MeSH terms
Adult, Cost-Benefit Analysis, Humans, Mental Health, Quality of Life, Surveys and Questionnaires, Weight Loss, Weight Reduction Programs

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