Jacquie Lavin

Weight outcomes audit for 34,271 adults referred to a primary care/commercial weight management partnership scheme

Objective: This project audited rate and extent of weight loss in a primary care/commercial weight management organisation partnership scheme. Methods: 34,271 patients were referred to Slimming World for 12 weekly sessions. Data were analysed using individual weekly weight records. Results: Average (SD) BMI change was –1.5 kg/m2 (1.3), weight change –4.0 kg (3.7), percent weight change –4.0% (3.6), rate of weight change –0.3 kg/week, and number of sessions attended 8.9 (3.6) of 12. For patients attending at least 10 of 12 sessions (n = 19,907 or 58.1%), average (SD) BMI change was –2.0 kg/m2 (1.3), weight change –5.5 kg (3.8), percent weight change –5.5% (3.5), rate of weight change –0.4 kg/week, and average number of sessions attended was 11.5 (0.7) (p < 0.001, compared to all patients). Weight loss was greater in men (n = 3,651) than in women (n = 30,620) (p < 0.001). 35.8% of all patients enrolled and 54.7% in patients attending 10 or more sessions achieved at least 5% weight loss. Weight gain was prevented in 92.1% of all patients referred. Attendance explained 29.6% and percent weight lost in week 1 explained 18.4% of the variance in weight loss. Conclusions: Referral to a commercial organisation is a practical option for National Health Service (NHS) weight management strategies, which achieves clinically safe and effective weight loss.

Attendance and weight outcomes in 4754 adults referred over 6 months to a primary care/commercial weight management partnership scheme.

•  There is growing evidence of the effectiveness of commercial weight management programmes in the community. A recent randomized controlled trial has shown commercial providers to be more effective than NHS providers for weight management solutions in primary care. Some commercial weight management providers have established national slimming on referral schemes for weight management, which result on average in weight losses of 4–5% over a 12‐week referral period. A recent randomized controlled trial of a similar scheme over 12 months yielded similar weight loses. Another RCT comparing commercial providers over 6 months showed average weight losses of ∼6.6% across providers.

Influence of Slimming World’s lifestyle programme on diet, activity behaviour and health of participants and their families

BACKGROUND Understanding the impact of commercial weight management programmes on behaviour change is an area that requires greater evidence. The present study investigated the impact of a commercial weight management organisations diet and activity programmes on the lifestyles of those accessing the services and their families. METHODS This survey was based on self-reports from a group of people involved in their own weight control. A questionnaire consisting of multiple choice and open-ended questions regarding diet, activity patterns and health was distributed in a commercial slimming organisations magazine and was available on the website for a 4 week period. Two thousand eight hundred and twelve respondents were analysed, including the organisations members (53%) and nonmembers (47%). RESULTS Those following the dietary programme reported significant changes towards healthier food choices in line with current guidelines (P < 0.01). Over 80% reported an improvement in their own health and over 26% reported an improvement in their partners or familys health (P < 0.01). Respondents reported increasing physical activity after being made aware of the organisations activity programme (P < 0.001). Members were more likely to have become more active than nonmembers (P = 0.011). The longer respondents had been members, the more likely they were to report an increased participation in physical activity (P = 0.02). Half of those reporting increased activity indicated that their partner or whole family had also increased their activity levels. CONCLUSIONS The commercial slimming organisations programme appeared to be having a beneficial impact on the diet and activity behaviours of those accessing the service. Group members were more likely to make positive behaviour changes and health improvements tended to increase with the duration of membership. The improvements observed with respect to both diet and activity levels also reached the wider family network.

Behavioural and Motivational Factors Associated with Weight Loss and Maintenance in a Commercial Weight Management Programme

This survey examined self-reported behaviour changes associated with weight loss and maintenance in a group of 292 members of a commercial weight management organisation (CWMO). Mean (SD) joining weight was 89.0 (20.0) kg, duration of membership was 29.1 (16.2) months and time taken to reach their current weight was 16.3 (13.5) months. Mean (SD) weight change was -15.6 (11.4) kg and BMI change was -5.7 (4.0) kg/m 2 , (both p<0.001), which had been maintained for 11.7 (12.8) months. Primary factors reported by participants as important in achieving their weight loss included not going hungry by satisfying appetite with low energy density food eaten ad libitum, following a flexible diet, peer-group support and tools to cope with small lapses. Several reported eating/activity behaviours significantly correlated with weight loss maintenance (WLM). However in regression analysis, while most individual changes in eating behaviour and activity behaviour were significant predictors of weight change in this group, no variables explained more than a few percent of the variance, after adjusting for age, gender, height and starting weight. A range of eating and activity behaviours was associated with weight loss maintenance. It is important to offer consumers flexible solutions they can adapt to their individual lifestyle needs.

Service evaluation of weight outcomes as a function of initial BMI in 34,271 adults referred to a primary care/commercial weight management partnership scheme

BackgroundIt is not clear if behaviour change programmes are more or less effective for weight management in people with high BMIs than for those who are moderately overweight. An earlier service evaluation reported on the rate and extent of weight loss in a primary care/commercial weight management organisation partnership scheme, in 34,271 patients were referred by their health care professionals to a UK commercial weight management organisation, Slimming World for 12 weekly sessions. This project updated that service evaluation by examining weight loss outcomes as a function of initial BMI in the same 34,271 patients.FindingsPatients referred to the scheme (n = 34,271) were categorised by BMI groups <30 kg/m2, 30-34.9 kg/m2, 35-39.9 kg/m2 and to ≥ 40 kg/m2. Mean weight losses after 12 weekly sessions were 2.9, 3.6, 4.1, and 4.8 kg for each BMI category respectively. Regression analysis showed that after adjusting for age and gender, relative to the <30 kg/m2 group, absolute weight losses were 0.8, 1.4 and 2.4 kg more for the 30-34.9 kg/m2, 35-39.9 kg/m2 and to ≥ 40 kg/m2 groups, respectively (all p<0.001). Percent weight loss was similar in each BMI category: 3.7%, 4.0%, 4.0% and 3.9%, respectively (p<0.001).ConclusionsThis service evaluation demonstrates that 12 week referral to a commercial organisation is as effective for people with high BMIs as for those who are moderately overweight.

An initial evaluation of a family-based approach to weight management in adolescents attending a community weight management group

Background Family-based approaches are recommended for the prevention and management of childhood obesity. Given the large numbers of obese children, scalable practical solutions are required. The present study evaluated a family-based national programme that aimed to empower adolescents to adopt healthier lifestyles. Methods Group facilitators supporting more than six young members (11–15 years) participated in the study. A questionnaire was designed to determine the characteristics of the adult attending with the adolescent, any health professional recommendations given and the young member’s integration within traditional adult weight management groups. Data on measured height and weight [and calculated body mass index (BMI)], sex and attendance were collated from member’s records. Results Questionnaires were completed by 22 facilitators (15% response rate), representing data for 128 young members with complete weight data available for 106. All members had a joining BMI > 91st centile, with 68% >98th centile. The mean (SD) number of weeks attended was 12.5 (8.1), with 19% (20) having attended for more than 20 weeks with 62% still attending. A mean (SD) BMI Z-score change of 2.49 (0.72) to 2.27 (0.74) was achieved (P < 0.001). The relationship of the adult supporter to the young member was varied, with 62% either already members or joining alongside their daughter/son. Limited guidance was provided by health professionals before or during attendance. Facilitators were comfortable about the age mix within groups. Conclusions The community weight management organisation studied takes a family-based approach and successfully supports young members to manage their weight.

Weight, body mass index and behaviour change in a commercially run lifestyle programme for young people.

BACKGROUND   There are few practical, scalable, community-based solutions that provide ongoing support to combat the recent rapid rise in obesity in young people. A commercial weight management organisation (CWMO) has developed a tailored version of its programme for young people. The present study assessed the programmes impact on self-reported body weight, body mass index (BMI; kg m(-2) ) and health-related behaviour changes in participating young people. METHODS   Seventy-nine current young members completed a web-based questionnaire on age, height, weight and self-reported eating and activity behaviours for when they joined the programme and at the time of survey. Inclusion criteria were age 11-15 years old and membership for at least 1 month. Subjects completed the questionnaire online via the CWMO website. This was a retrospective observational study without a control group. All data were self-reported. RESULTS   Mean (SD) age was 13.4 (1.4) years and start weight was 78.5 (16.7) kg; 67% were >99th centile for BMI. Mean (SD) attendance was 23 (19) weeks; weight change was -5.0 (4.5) kg; BMI change was -2.5 (2.0) kg m(-2) ; and BMI Z-score change was -0.5 (0.4) (all P < 0.001). Height increased by 0.01 (0.03) m (P < 0.01); however, height Z-score remained unchanged. Regression analysis showed that BMI Z-score change was related to increased fruit and vegetable intake (P = 0.012), as well as a decrease in avoidance of moderate and intense activity (both P < 0.003). CONCLUSIONS   This programme for overweight and obese young people helped implement behaviour and lifestyle changes that were associated with significant reductions in self-reported weight and BMI Z-score, without compromising growth in height.

Quality of life in longer-term members of a commercial weight loss organisation

Introduction: It is generally accepted that weight loss has significant physiological benefits, such as reduced risk of diabetes, lowered blood pressure and blood lipid levels. However, few behavioural and dietary interventions have investigated psychological benefit as the primary outcome. Method: Systematic review methodology was adopted to evaluate the psychological outcomes of weight loss following participation in a behavioural and/or dietary weight loss intervention in overweight/obese populations. 35 studies were selected for inclusion and were reviewed. Results: Changes in self-esteem, depressive symptoms, body image and health related quality of life (HRQoL) were evaluated and discussed.The results demonstrated consistent improvements in psychological outcomes concurrent with and sometimes without weight loss. Improvements in body image and HRQoL (especially vitality) were closely related to changes in weight. Conclusion: Although the quality of the studies reviewed was generally acceptable, only 8 out of 35 studies included a suitable control/comparison group and the content, duration of intervention and measures used to assess psychological outcomes varied considerably. Further research is required to improve the quality of studies assessing the benefits of weight loss to fully elucidate the relationship between weight loss and psychological outcomes.Introduction: The role of the workplace as an opportunity for improving health has been highlighted in recent reports. The East Midlands Platform for Health and Wellbeing is a network of private, public and voluntary sector organisations working to improve health and reduce obesity. Member organisations commit to undertake actions to improve health and wellbeing of employees, individuals and/or communities. As part of Slimming World’s commitment, this pilot assessed the merits of providing weight management support via the workplace at two large regional employers. Methods: 278 British Gas and Nottingham University Hospitals NHS Trust employees were offered 12 weeks’ support at either a bespoke workplace group or established community-based Slimming World group. Weight change was recorded weekly. Dietary and physical activity behaviours, along with aspects of psychological health were assessed by questionnaire pre and post-programme. Results: 121 employees (meeting inclusion criteria) joined a workplace-based group and 114 a community-based group. Weight and attendance: Mean joining BMI was 32.4kg/m2. 138 (59%) participants completed the programme (attended within final 4 weeks).Behaviour changes: Participants who completed both questionnaires (n=87), reported positive changes in dietary and physical activity behaviours (all p<.001) (figure 1), and psychological health (mental wellbeing, self-worth and self-esteem, all p<0.05). There were no significant differences between worksite and community intervention groups for any outcomes. Conclusion: Providing weight management support via the workplace significantly reduced weight of participants (-3.9%). Completer analysis also revealed positive changes in healthy eating habits and activity levels, and also importantly psychological health, which may impact on working life. The Slimming World programme works effectively within both the work setting and via community-based provision when employees are recruited via the workplace.

Changes in Self-esteem in Participants Associated with Weightloss and Maintenance of Commercial Weight Management Programme

Introduction and methods: This study examined associations between weight loss, its maintenance and self-esteem in 292 members of a commercial weight management organisation, Slimming World. Self-esteem was measured with the Rosenberg self-esteem questionnaire adapted to 5-point Likert scales. Associations between dimensions of self-esteem and weight change were examined by correlation and regression using the GENSTAT 5 statistical program. Results: Mean (SD) weight on joining the CWMO was 89.0 (20.0) kg; time taken to reach current weight was 16.3 (13.5) months. Mean (SD) weight change was -15.6 (11.4) kg and BMI change was -5.7 (4.0) (both p < 0.001), maintained for 11.7 (12.8) months. Percent variance in weight change associated with each component of self-esteem is given in parentheses. All weight changes were negative. Participants reported a decrease in sense of failure (3.9%) and an increase in self-respect (3.0%) and self-pride (2.4%). Self-satisfaction (12.8%), feelings of self-achievement (10.6%), positive attitudes towards themselves (9.9%), sense of self-worth (10.6%) and self-efficacy (7.3%) all significantly increased in association with reaching and maintaining their current weight (all p < 0.001). Multiple regression analysis showed that age, gender, height and start weight accounted for 35.4% of the variance in weight change. Self-esteem components of the model accounted for 50.4% of the variance in weight change. Conclusion: Successful weight loss and maintenance was associated with significant reported improvements in self-esteem in members of a Commercial Weight Management Organisation.

Providing weight management via the workplace

Purpose – The purpose of this paper is to assess the feasibility and benefits of providing weight management support via the workplace. Design/methodology/approach – Quasi-experimental design using non-random assignment to a 12-week Slimming World (SW) weight management programme, either within the workplace or at a regular community group. Weight was recorded weekly and a 39-item questionnaire focused on mental and emotional health, self-esteem, dietary habits and physical activity habits administered at baseline, 12 weeks, six and 12 months. Findings – In total, 243 participants enroled (workplace n=129, community n=114) with 138 completers (defined as those weighing-in at baseline and attending at least once within the last four weeks; workplace n=76, community n=62). Completers reported a mean weight change of −4.9 kg±3.4 or −5.7 per cent±3.8. Mental and emotional health scores increased (p < 0.05) from baseline to 12 weeks. Self-worth scores increased (p < 0.05) from baseline to 12 weeks, six and 12 ...