Assessment of Reliability Worth

Abstract

Introduction: Obesity is a rising threat to health that is now also contributing to health inequalities. Weight management programmes are needed that are effective and reach underprivileged groups. We examined whether a task-based weight management group programme structured to cater for underprivileged clients (Weight Action Programme; WAP) has better long-term effects than a 'best practice' intervention provided in primary care by practice nurses (PN). Methods: 330 adults from areas of high social deprivation with a body mass index (BMI) >= 30 kg/m2 or BMI >= 28 kg/m2 with co-morbidities were randomised (2:1) to the WAP or PN arms. WAP comprised eight weekly group sessions providing verifable tasks concerning diet, physical activity and self-monitoring, followed by ten monthly sessions. PN provided advice on diet and physical activity based on NHS 'Change4Life' materials in four sessions over eight weeks. The analysis of weight change at 12 months used a mixed-effects linear regression model adjusted for baseline variables. Results: Less than half of the participants were in paid employment. 88% of participants in each study arm provided at least one recorded outcome and were included in the primary analysis. Weight loss at 12 months was greater in the WAP arm (-4.2kg vs. -2.3kg; diference = -1.9kg, 95% CI: -3.7 to -0.1; p = 0.04). Participants in the WAP arm were also more likely to lose at least 5% of their baseline body weight (41% vs. 27%, OR = 14.61 95% CI: 2.32 to 91.96, p = 0.004). Conclusion: A task-based programme was more effective than a 'best practice' intervention within primary care. WAP can provide a public-domain template for an economical programme that can reach clients from diverse ethnic and socio-economic backgrounds.