Title: The effectiveness and cost effectiveness of a brief behavioural intervention to promote regular self weighing to prevent weight regain after weight loss: randomised controlled trial
Funder: Department of Health (England)

Abstract: In the UK the rates of obesity have more than doubled in the last 25 years. The costs of obesity place a significant burden on the NHS. There is a need therefore to investigate the effectiveness of pragmatic interventions that can be delivered in the community and reach the high number of people needing to lose weight and sustain this. Although evidence suggests many behavioural weight loss treatments are effective in the short term long term weight maintenance remains a critical challenge. On average people will regain one third to one half of lost weight within the first year following treatment and will return to baseline weight within 3-5 years. Only a few studies have focused on weight maintenance and reviews have concluded evidence remains equivocal. A review of RCTs of weight maintenance interventions after weight loss identified 34 studies none of which had been conducted in the UK. Most studies had evaluated interventions such as food supplements meal replacements or medication. The review identified the greatest need for research was lifestyle interventions that supported people to manage their weight in the longer term. One promising strategy for weight maintenance is regular self weighing which is a simple instruction for a health professional to give or public health communication to advocate and it is the kind of behaviour that could become habitual in the way that cleaning one’s teeth becomes automatic and self-sustaining. Systematic reviews suggest that self-weighing can prevent weight regain but this was part of an intensive multi-component intervention. Only two RCTs have focussed on self weighing alone as a maintenance strategy; both were small and had methodological shortcomings but showed evidence that self weighing prevents weight regain. We have also completed a pilot quasi randomised RCT of regular self weighing where we showed such an intervention delivered by non-specialist telephonists prevented weight regain at 12 months. Following our pilot the aim here is to evaluate the longer term effectiveness and cost effectiveness of a 12 week weight maintenance intervention focussed on encouraging daily self weighing in adults who have recently lost weight. 560 adults will be randomised to usual care or a theoretically informed weight maintenance intervention following completion of standard widely available commercial (e.g. Weight Watchers) and NHS weight loss programmes. People who have lost at least 5% of their weight after completing a weight loss programme will be invited to take part. The focus of the intervention is brief regular support telephone calls (5 min) that encourage daily self weighing. Calls will focus on habit formation and implementation intentions getting people to plan where when and how they will weigh themselves and then how they will record it. Few people (1:10) are able to recover from even small (1-2kg) lapses in weight regain. Regular weighing could be used as an early warning of the lapse and allow people to implement the strategies they learnt previously when attending their weight loss programme. Participants will receive text messages to remind them to weigh themselves. The intervention will be delivered by non-specialist telephonists from Gateway a community interest company. The primary outcome will be change in weight (objective) between the groups from baseline to 12 months. The West Midlands is the most overweight region in the EU with a diverse multi ethnic population.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: STROKE;CANCER AND NEOPLASMS;METABOLIC AND ENDOCRINE;CARDIOVASCULAR;ORAL AND GASTROINTESTINAL