335. Weight Management Within Primary Care

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335. Weight Management Within Primary Care

CATEGORY: Fitness, Workout & Exercise 500 Courses

COURSE NUMBER: 01

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Syllabus

Abstract…………………………………………………………………………………………………………………….. II
Acknowledgements ……………………………………………………………………………………………………. II
List of Abbreviations………………………………………………………………………………………………….III
List of Tables…………………………………………………………………………………………………………….XI
List of Figures……………………………………………………………………………………………………………..1
CHAPTER 1……………………………………………………………………………………………………………….1
1.0 Introduction……………………………………………………………………………………………………1
CHAPTER 2……………………………………………………………………………………………………………….3
2.0 Literature review…………………………………………………………………………………………….3
2.1 What is obesity? ……………………………………………………………………………………………..3
2.2 Obesity prevalence: International and England……………………………………………………4
2.3 Consequences of obesity ………………………………………………………………………………….6
2.3.1 Public health consequences…………………………………………………………………………………… 6
2.3.2 Economic consequences……………………………………………………………………………………… 10
2.4 Epidemiology of obesity…………………………………………………………………………………10
2.4.1 Ethnicity …………………………………………………………………………………………………………… 10
2.4.2 Gender and age………………………………………………………………………………………………….. 11
2.4.3 Socioeconomic status…………………………………………………………………………………………. 12
2.4.3.1 Income…………………………………………………………………………………………………………… 12
2.4.3.2 Education……………………………………………………………………………………………………….. 12
2.5 Causes and influences of obesity……………………………………………………………………..13
2.5.1 Energy expenditure ……………………………………………………………………………………………. 14
2.5.2 Energy intake…………………………………………………………………………………………………….. 16

2.5.3 Environmental causes…………………………………………………………………………………………. 17
2.5.4 Physical activity environment ……………………………………………………………………………… 17
2.5.5 Food environment ……………………………………………………………………………………………… 18
2.5.6 Biological causes of obesity………………………………………………………………………………… 20
2.5.7 Psychosocial influences………………………………………………………………………………………. 20
2.5.8 Summary of causes of obesity……………………………………………………………………………… 21
2.6 Treatment of obesity………………………………………………………………………………………22
2.6.1 Weight loss and weight maintenance for clinical benefits……………………………………….. 22
2.6.2 Current weight management guidelines in the UK …………………………………………………. 25
2.6.3 Behavioural weight management interventions in primary care……………………………….. 27
2.6.4 Summary ………………………………………………………………………………………………………….. 30
2.6.5 Weight loss maintenance…………………………………………………………………………………….. 31
2.6.6 Behaviour change techniques………………………………………………………………………………. 33
2.7 Self-monitoring of behaviour ………………………………………………………………………….35
2.7.1 Self-regulation theory…………………………………………………………………………………………. 35
2.7.2 Self-monitoring of diet and physical activity …………………………………………………………. 35
2.7.3 Self-weighing ……………………………………………………………………………………………………. 36
2.7.3.1 Evidence for self-weighing ………………………………………………………………………………. 36
2.7.3.2 Self-weighing isolated and as part of a multi-component intervention……………………. 38
2.7.3.3 Adverse effects of self-weighing……………………………………………………………………….. 38
2.8 Summary of the evidence ……………………………………………………………………………….40
2.8.1 Objectives…………………………………………………………………………………………………………. 41
CHAPTER 3……………………………………………………………………………………………………………..42
3.0 Which weight loss programmes are as effective as Weight Watchers: A prospective
cohort noninferiority analysis…………………………………………………………………………………..42
3.1 Introduction ………………………………………………………………………………………………….42
3.2 Participants and methods………………………………………………………………………………..45
3.2.1 Study design ……………………………………………………………………………………………………… 45
3.2.2 Setting and recruitment of participants …………………………………………………………………. 45

3.2.3 Allocation…………………………………………………………………………………………………………. 46
3.2.4 Measurements……………………………………………………………………………………………………. 46
3.2.5 Demographic and baseline information ………………………………………………………………… 46
3.2.6 Weight loss interventions……………………………………………………………………………………. 46
3.2.7 Data analyses…………………………………………………………………………………………………….. 47
3.2.8 Noninferiority analyses………………………………………………………………………………………. 48
3.3 Results …………………………………………………………………………………………………………50
3.3.1 Baseline characteristics………………………………………………………………………………………. 50
3.3.2 Noninferiority analyses………………………………………………………………………………………. 52
3.4 Discussion…………………………………………………………………………………………………….55
3.4.1 Findings in relation to other research……………………………………………………………………. 56
3.4.2 Strengths and limitations…………………………………………………………………………………….. 57
3.5 Conclusion……………………………………………………………………………………………………58
CHAPTER 4……………………………………………………………………………………………………………..59
4.0 A randomised controlled trial of the effectiveness of self-weighing as an isolated
weight loss intervention (SCALE DOWN)………………………………………………………………..59
4.1 Introduction ………………………………………………………………………………………………….59
4.2 Patients and methods……………………………………………………………………………………..61
4.2.1 Design ……………………………………………………………………………………………………………… 61
4.2.2 Participants……………………………………………………………………………………………………….. 61
4.2.3 Inclusion criteria………………………………………………………………………………………………… 61
4.2.4 Exclusion criteria……………………………………………………………………………………………….. 62
4.2.5 Settings…………………………………………………………………………………………………………….. 62
4.2.6 Components across both groups…………………………………………………………………………… 62
4.2.7 Intervention group……………………………………………………………………………………………… 63
4.2.8 Control group ……………………………………………………………………………………………………. 66
4.2.9 Outcomes………………………………………………………………………………………………………….. 66
4.2.10 Sample size……………………………………………………………………………………………………… 67
4.2.11 Allocation and randomisation ……………………………………………………………………………. 67

4.2.12 Blinding………………………………………………………………………………………………………….. 68
4.2.13 Data analysis …………………………………………………………………………………………………… 68
4.3 Results …………………………………………………………………………………………………………70
4.3.1 Primary outcome ……………………………………………………………………………………………….. 72
4.3.2 Adherence to self-weighing ………………………………………………………………………………… 73
4.3.3 Implementation of self-weighing …………………………………………………………………………. 76
4.3.4 Weight management strategies…………………………………………………………………………….. 76
4.3.5 Physical activity ………………………………………………………………………………………………… 78
4.3.6 Adverse Events………………………………………………………………………………………………….. 78
4.3.7 Feedback from participants…………………………………………………………………………………. 79
4.4 Discussion…………………………………………………………………………………………………….80
4.4.1 Strengths and limitations…………………………………………………………………………………….. 81
4.4.2 Results in the context of other studies…………………………………………………………………… 82
4.5 Conclusions ………………………………………………………………………………………………….84
CHAPTER 5……………………………………………………………………………………………………………..85
5.0 Regular self-weighing to promote weight maintenance after intentional weight loss:
a quasi-randomised controlled trial …………………………………………………………………………..85
5.1 Introduction ………………………………………………………………………………………………….85
5.1.1 Lighten Up………………………………………………………………………………………………………… 86
5.2 Methods and procedures…………………………………………………………………………………88
5.2.1 Setting and recruitment of participants …………………………………………………………………. 88
5.2.2 Allocation…………………………………………………………………………………………………………. 89
5.2.3 Primary outcome and assessments……………………………………………………………………….. 90
5.2.4 Demographic information …………………………………………………………………………………… 90
5.2.5 Weight loss maintenance intervention ………………………………………………………………….. 90
5.2.6 Data analysis …………………………………………………………………………………………………….. 91
5.2.6.1 Imputation of missing weight data …………………………………………………………………….. 91
5.2.6.2 Analyses………………………………………………………………………………………………………… 93
5.3 Results …………………………………………………………………………………………………………94

5.3.1 Characteristics at the start of weight loss maintenance intervention………………………….. 94
5.3.2 Baseline characteristics of those with missing and recorded weight data…………………… 97
5.3.3 Primary analysis………………………………………………………………………………………………… 98
5.3.4 Per protocol analysis ………………………………………………………………………………………….. 99
5.3.5 Effect modification by type of weight loss treatment received and amount of initial
weight loss………………………………………………………………………………………………………………. 100
5.4 Discussion…………………………………………………………………………………………………..101
5.4.1 Main findings of the study ………………………………………………………………………………… 101
5.4.2 What is already known on this topic …………………………………………………………………… 101
5.4.3 What this study adds ………………………………………………………………………………………… 102
5.4.4 Limitations of this study……………………………………………………………………………………. 103
5.5 Conclusion………………………………………………………………………………………………….104
CHAPTER 6……………………………………………………………………………………………………………105
6.0 Is self-weighing an effective weight management tool: A systematic literature review
and meta-analysis …………………………………………………………………………………………………105
6.1 Introduction ………………………………………………………………………………………………..105
6.2 Methods……………………………………………………………………………………………………..107
6.2.1 Trial eligibility criteria ……………………………………………………………………………………… 107
6.2.2 Search strategy ………………………………………………………………………………………………… 108
6.2.3 Study selection ………………………………………………………………………………………………… 109
6.2.4 Data collection process……………………………………………………………………………………… 110
6.2.5 Data items……………………………………………………………………………………………………….. 110
6.2.6 Risk of bias in individual trials…………………………………………………………………………… 110
6.2.7 Summary measures ………………………………………………………………………………………….. 111
6.2.8 Synthesis of results…………………………………………………………………………………………… 112
6.2.9 Analysis strategy ……………………………………………………………………………………………… 112
6.3 Results ……………………………………………………………………………………………………….113
6.3.1 Study selection ………………………………………………………………………………………………… 113
6.3.2 Study characteristics…………………………………………………………………………………………. 114

6.3.3 Risk of bias……………………………………………………………………………………………………… 123
6.3.4 Synthesis of results…………………………………………………………………………………………… 128
6.3.5 Weight loss……………………………………………………………………………………………………… 128
6.3.6 Weight maintenance…………………………………………………………………………………………. 134
6.3.7 Weight loss maintenance…………………………………………………………………………………… 134
6.3.8 Adverse events………………………………………………………………………………………………… 135
6.4 Discussion…………………………………………………………………………………………………..135
6.4.1 Strengths and limitations…………………………………………………………………………………… 139
6.4.2 Future research ………………………………………………………………………………………………… 140
6.5 Conclusions and implications………………………………………………………………………..140
CHAPTER 7……………………………………………………………………………………………………………141
7.0 Discussion, implications and conclusions ………………………………………………………141
7.1 Summary of findings……………………………………………………………………………………141
7.2 Strengths and weaknesses……………………………………………………………………………..143
7.3 Research in relation to other findings……………………………………………………………..146
7.4 Future research ……………………………………………………………………………………………148
7.5 Implications and conclusions ………………………………………………………………………..149
7.5.1 For commissioners…………………………………………………………………………………………… 149
7.5.2 For patients……………………………………………………………………………………………………… 150
7.5.3 For healthcare professionals………………………………………………………………………………. 150
7.6 Conclusions ………………………………………………………………………………………………..150
References ………………………………………………………………………………………………………………152
Appendix 1 ……………………………………………………………………………………………………………..162
Appendix 2 ……………………………………………………………………………………………………………..164
Appendix 3 ……………………………………………………………………………………………………………..168

Appendix 4 ……………………………………………………………………………………………………………..169
Appendix 5 ……………………………………………………………………………………………………………..170
Appendix 6 ……………………………………………………………………………………………………………..173
Appendix 7 ……………………………………………………………………………………………………………..175
Appendix 8 ……………………………………………………………………………………………………………..177
Appendix 9 ……………………………………………………………………………………………………………..178

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