A pragmatic randomised controlled trial in primary care of the Camden Weight Loss (CAMWEL) programme

London School of Hygiene & Tropical Medicine, London, UK.
BMJ Open (Impact Factor: 2.27). 05/2012; 2(3). DOI: 10.1136/bmjopen-2011-000793
Source: PubMed


To evaluate effectiveness of a structured one-to-one behaviour change programme on weight loss in obese and overweight individuals.
Randomised controlled trial.
23 general practices in Camden, London.
381 adults with body mass index ≥25 kg/m(2) randomly assigned to intervention (n=191) or control (n=190) group.
A structured one-to-one programme, delivered over 14 visits during 12 months by trained advisors in three primary care centres compared with usual care in general practice.
Changes in weight, per cent body fat, waist circumference, blood pressure and heart rate between baseline and 12 months.
217/381 (57.0%) participants were assessed at 12 months: missing values were imputed. The difference in mean weight change between the intervention and control groups was not statistically significant (0.70 kg (0.67 to 2.17, p=0.35)), although a higher proportion of the intervention group (32.7%) than the control group (20.4%) lost 5% or more of their baseline weight (OR: 1.80 (1.02 to 3.18, p=0.04)). The intervention group achieved a lower mean heart rate (mean difference 3.68 beats per minute (0.31 to 7.04, p=0.03)) than the control group. Participants in the intervention group reported higher satisfaction and more positive experiences of their care compared with the control group.
Although there is no significant difference in mean weight loss between the intervention and control groups, trained non-specialist advisors can deliver a structured programme and achieve clinically beneficial weight loss in some patients in primary care. The intervention group also reported a higher level of satisfaction with the support received. Primary care interventions are unlikely to be sufficient to tackle the obesity epidemic and effective population-wide measures are also necessary.
Trial NCT00891943.

Download full-text


Available from: Kiran Nanchahal, Oct 06, 2015
1 Follower
35 Reads
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Overweight and obesity are common and important causes of chronic disease. This should mean that primary care physicians feel tackling obesity is important, but it is uncommon for them to do so. Physicians perceive that this is not their job; they fear offending their patients and are unclear what may be effective. In this review we found two systematic reviews showing that motivational interviewing can lead to effective weight loss but it may not be practicable in this setting. Two trials show referral to specially trained nurses in primary care appears ineffective. Several randomized trials show referral to commercial weight management companies is effective. Observational data but no trials suggest that screening for and opportunistic brief interventions may motivate attempts to lose weight and lead to some weight loss. We conclude there is insufficient evidence to promote treatment opportunistically but sufficient evidence to refer patients wanting to lose weight to commercial weight management services.
    12/2013; 2(4). DOI:10.1007/s13679-013-0073-8
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Government and societal efforts to combat obesity are aimed at prevention, although there is a generation for whom excess weight is the rule rather than the exception. Although measures to prevent a worsening of the current epidemic are important, management of obesity must also be prioritised. Obesity management is beset with problems ranging from attitudinal to clinical and pharmacological, and the individualisation of therapy.
    BMC Medicine 08/2014; 12(1):149. DOI:10.1186/1741-7015-12-149 · 7.25 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: There is limited evidence on the effectiveness of weight management programmes provided within routine healthcare and inconsistent use of outcome measures. Our aim was to evaluate a large National Health Service (NHS) weight management service and report absolute and proportional weight losses over 12 months. Prospective observational study. Glasgow and Clyde Weight Management Service (GCWMS), which provides care for residents of NHS Greater Glasgow and Clyde area (population 1.2 million). All patients who began GCWMS between 1 October 2008 and 30 September 2009. Structured educational lifestyle programme employing cognitive behavioural therapy, 600 kcal deficit diet, physical activity advice, lower calorie diet and pharmacotherapy. Baseline observation carried forward (BOCF), last observation carried forward (LOCF) and changes in programme completers reported using outcomes of absolute 5 kg and 5% weight losses and mean weight changes at a variety of time points. 6505 referrals were made to GCWMS, 5637 were eligible, 3460 opted in and 1916 (34%) attended a first session. 78 patients were excluded from our analysis on 1838 patients. 72.9% of patients were women, mean age of all patients at baseline was 49.1 years, 43.3% lived in highly socioeconomically deprived areas and mean weights and body mass indices at baseline were 118.1 kg and 43.3 kg/m(2), respectively. 26% lost ≥5 kg by the end of phase 1, 30% by the end of phase 2 and 28% by the end of phase 3 (all LOCF). Weight loss was more successful among men, particularly those ≤29 years old. Routine NHS weight management services may achieve moderate weight losses through a comprehensive evidence-based dietary, activity and behavioural approach including psychological care. Weight losses should be reported using a range of outcome measures so that the effectiveness of different services can be compared.
    BMJ Open 01/2014; 4(1):e003747. DOI:10.1136/bmjopen-2013-003747 · 2.27 Impact Factor
Show more