Could habits hold the key to weight loss maintenance? A narrative review

Despite the significance placed on lifestyle interventions for obesity management, most weight loss is followed by weight regain. Psychological concepts of habitual behaviour and automaticity have been suggested as plausible explanations for this overwhelming lack of long‐term weight loss success. Interventions that focus on changing an individual's behaviour are not usually successful at changing an individual's habits because they do not incorporate the strategies required to break unhealthy habits and/or form new healthy habits. A narrative review was conducted and describes the theory behind habit formation in relation to weight regain. The review evaluated the effectiveness of using habits as tools to maintain weight loss. Three specific habit‐based weight loss programmes are described: ‘10 Top Tips’, ‘Do Something Different’ and ‘Transforming Your Life’. Participants in these interventions achieved significant weight loss compared to a control group or other conventional interventions. Habit‐based interventions show promising results in sustaining behaviour change. Weight loss maintenance may benefit from incorporating habit‐focused strategies and should be investigated further.     

A comparison of specific strategies for long term maintenance following a behavioural treatment program for obese women

Over a 10-week period, 102 women who had been randomly assigned to conditions received 7 sessions of a standard behavioral treatment, followed by 3 sessions of training in one of the following 5 maintenance strategies: continued self-monitoring, urge control, relapse prevention, a combination of the previous three strategies, or attention-placebo. There were 85 women available for a 1 year follow-up. Results showed that the different maintenance conditions did not differentially affect weight loss beyond that produced by the attention-placebo. Participants lost an average of 5.08 kg during the 10-week program. They began to regain weight by the 4-month follow-up and continued to do so at the 1-year follow-up. However, mean weight at the 1-year follow-up was still significantly below pretreatment weight (mean Joss of 2.18 kg). In total, 21.8% of the sample either maintained postprogram weight or continued to lose weight, whereas 29% either returned to pretreatment weight or regained above pretreatment weight by the 1-year follow-up. Consideration of results clearly suggests that adherence is a major problem with maintenance techniques.     

Weight-loss intention in the well-functioning, community-dwelling elderly: associations with diet quality, physical activity, and weight change

BACKGROUND: Many older adults desire to lose weight, yet the proportion with a health-related weight-loss indication, weight-loss strategies, and success is unknown. OBJECTIVE: We examined the associations of reported intention to lose weight with health-related indications for weight loss, diet quality, physical activity, and weight-loss success in well-functioning older adults. DESIGN: This prospective, community-based cohort included 2708 elderly persons aged 70-79 y at baseline. We determined indication for weight loss by using the modified National Institutes of Health guidelines, diet quality by using the Healthy Eating Index, and weight-loss intention and physical activity by using questionnaires. Measured weight change over 1 y was assessed. RESULTS: Twenty-seven percent of participants reported an intention to lose weight, and 67% of those participants had an indication for weight loss. Participants who reported a weight-loss intention were heavier than those who did not, had more depressive symptoms, and were more likely to be dissatisfied with their weight, regardless of weight-loss indication. Participants with an intention to lose weight reported better eating behaviors and a more active lifestyle than did participants without a weight-loss intention, independent of other health conditions. No significant difference in actual weight loss was found between participants intending and not intending to lose weight, regardless of indication for weight loss. CONCLUSIONS: Despite being associated with healthier behaviors, the intention to lose weight did not predict greater weight loss in this well-functioning elderly cohort. More attention needs to be focused on the necessity and efficacy of specific strategies for weight loss in older adults.     

E‐mail contact as an effective strategy in the maintenance of weight loss in adults

Background: Professional face‐to‐face contact is known to be beneficial in effective weight management, but costly, in supporting weight maintenance. Within the UK, studies have examined using the Internet to achieve weight loss; however, there is a need to evaluate the use of dietetic intervention via e‐mail to support the maintenance of weight loss in a National Health Service (NHS) setting. The present study aimed to assess the effects of dietetic support through e‐mail on weight loss maintenance on individuals who were successful in weight loss. Methods: Fifty‐five patients, who had lost ≥5% body weight, were assigned to either an intervention group (weekly e‐mail messages and monthly personal e‐mail message with reporting of weight, n = 28) or a control group (n = 27). The level of weight maintenance, plus dietary changes and the ability to maintain a level of activity, were recorded after 6 months. Results: At 6 months, the e‐mail group maintained an average weight loss of 10%, which was significantly (P = 0.05) greater than the mean percentage weight loss maintained by the control group (7.3%). The control group regained weight at a statistically significant greater velocity (P = 0.02) than the intervention group. There were correlations between the amount of fruits and vegetables (P = 0.07) eaten and exercise episodes (P = 0.01) against weight change in maintenance. Conclusions: The present study showed that dietetic support using e‐mail can be used effectively in reducing weight gain velocity and assisting in the maintenance of weight loss. It is a system that can be used in the UK NHS to reach many people.     

Identification of factors contributing to successful self‐directed weight loss: a qualitative study

Background

Despite the number of weight management programmes and their wide promotion, most overweight and obese individuals tend to lose weight on their own. The present study aimed to understand the characteristics and strategies of those who successfully engage in self‐directed weight loss, which could empower other overweight and obese individuals with information and strategies to manage their weight on their own.

Methods

Men and women who had lost at least 5% of their body weight without direct interaction with professionals or weight management programmes were recruited. Demographic data were collected by questionnaire and participants' weight‐loss experiences were explored using semi‐ structured interviews to elicit in‐depth individual experiences and perspectives. Iterative thematic method data analysis was used to generate themes describing contributing factors to the success of self‐directed weight loss identified by participants.

Results

Most characteristics of those who successfully self‐managed their weight loss were in line with those reported by successful weight losers participating in professional‐led projects. However, strategies such as early embedding of new lifestyle behaviours into daily routine, the ability to learn from previous weight‐loss experiences, and not requiring social support were identified as distinctive factors that contributed to the success of self‐directed weight loss by participants of the present study.

Conclusions

Overweight or obese individuals with strong internal motivation, problem‐solving skills and self‐reliance are more likely to be successful at achieving self‐directed weight loss. The patients identified with these characteristics could be encouraged to self‐manage their weight‐loss process, leaving the places available in more resource‐intensive professional‐led programmes to those individuals unlikely to succeed on their own.

     

To Snack or Not to Snack: What should we advise for weight management?

Aims: Although our current weight management guidelines suggest eating regularly, speculation about whether snacking assists with managing weight occurs widely among the media, weight loss clients and health professionals. We aim to examine whether there is adequate scientific evidence available to support the manipulation of eating frequently for improving body weight, diabetes and cardiovascular risk markers, and theories that link eating frequently with weight management. Methods: Relevant papers from nutrition and dietetics journals and other sources were used to assess the association between eating frequency and weight and health. Results: Longer‐term evidence suggests eating frequency does not affect weight, glucose, insulin control, hunger or energy expenditure in intentional weight losers and maintainers. There is consistent short‐term evidence of an inverse association between blood lipid levels and eating frequency during weight maintenance. Many of the common theories that suggest manipulating eating frequency for weight management are not supported by the literature. Sustaining a change to eating frequency also may be challenging over the longer term. Conclusions: Overall current evidence does not suggest that manipulating eating frequency greatly benefits weight and health. Health professionals may not need to manipulate eating frequency for weight management.     

Mobilising a rural community to lose weight: impact evaluation of the WellingTonne Challenge

Objective: To evaluate the impact of the WellingTonne Challenge. Design: Before–after study. Setting: The National Action Agenda for the prevention and control of obesity in Australia identified community action and development as a key theme. The WellingTonne Challenge was a whole‐of‐community project designed to support a small rural community to lose weight and reduce their risk of chronic disease. Participants: Adult residents of the Wellington Local Government Area who were overweight or obese. Results: The project successfully engaged the community with around 10% of the target group formally participating in the Challenge. Participants achieved a weight reduction of around 3 kg each, as well as positive changes in diet and physical activity. A total of 59% of those who signed up for the Challenge achieved an accumulated loss of 687 kg at the end of the 12‐week program – less than the community goal of 1000 kg. Conclusion: The WellingTonne Challenge is a promising intervention. Wider implementation of this approach in other small rural communities might make a significant contribution to the national effort. The opportunity should be taken to undertake a more rigorous evaluation to determine whether this approach benefits communities in the longer term.     

Diet and physical activity behaviors among Americans trying to lose weight: 2000 Behavioral Risk Factor Surveillance System

OBJECTIVE: To examine the prevalence and correlates of trying to lose weight among U.S. adults, describe weight loss strategies, and assess attainment of recommendations for weight control (eating fewer calories and physical activity). RESEARCH METHODS AND PROCEDURES: This study used the Behavioral Risk Factor Surveillance System, a state-based telephone survey of adults > or =18 years of age (N = 184,450) conducted in the 50 states, the District of Columbia, and Puerto Rico in 2000. RESULTS: The prevalence of trying to lose weight was 46% (women) and 33% (men). Women reported trying to lose weight at a lower BMI than did men; 60% of overweight women were trying to lose weight, but men did not reach this level until they were obese. Adults who had a routine physician checkup in the previous year and reported medical advice to lose weight vs. checkup and no medical advice to lose weight had a higher prevalence of trying to lose weight (81% women and 77% men vs. 41% women and 28% men, respectively). The odds of trying to lose weight increased as years of education increased. Among respondents who were trying to lose weight, approximately 19% of women and 22% of men reported using fewer calories and > or =150 min/wk leisure-time physical activity. DISCUSSION: A higher percentage of women than men were trying to lose weight; both sexes used similar weight loss strategies. Education and medical advice to lose weight were strongly associated with trying to lose weight. Most persons trying to lose weight were not using minimum recommended weight loss strategies.     

An evaluation of the long‐term effectiveness of two adult community‐based group weight management interventions

Background: National guidance supports the provision of weight loss group programmes in a community setting using behavioural change methods as the first line intervention for adults (NICE, 2006) and post‐natal women (NICE, 2010). The evidence base for the long‐term effectiveness for such National Health Service‐provided interventions is currently limited (Paul‐Ebhohimhen & Avenell, 2009). The aim of this service evaluation of two types of community‐based, group weight management, 6‐week courses in a multicultural deprived inner city area was to determine whether the weight loss achieved over 6 weeks was sustained over the long term, thus demonstrating that these courses are effective. Methods: All 167 clients, who had attended four or more sessions of a 6‐week long Size Down or Post‐Natal Size Down weight loss course between 6 and 24 months ago, were telephoned with the purpose of completing a telephone questionnaire to determine a recent weight measure. At least two attempts were made to contact each client. In addition, those who had attended the Post‐Natal Size Down course were offered a home visit with electronic scales to obtain a weight measure aiming to lend validity to the reported weights from the telephone questionnaire. The weights obtained were compared with the clients’ weights on completion of the course. Verbal consent was obtained. Results: Seventy‐four clients (72 female and two male) completed the telephone questionnaire. Ninety‐three (56%) clients were noncontactable. Recent weight measures were obtained for 65 clients, 17 of which were obtained by a home visit. Nine clients refused to report their weight. Since completing the course, 31 (42%) clients had continued to lose weight with a mean further weight loss of 5.5% (Size Down, 4.3%; Post‐Natal Size Down, 9%) (range 0.1–21.9%), in addition to the mean weight loss of 1.9% (Size Down, 1.7%; Post‐Natal Size Down, 2.2%) over the 6‐week course. Twenty‐one (28%) clients had maintained their weight and 13 (18%) had gained weight. Overall mean weight change for all clients from the beginning of the course to the telephone questionnaire was ?3.8% (Size Down, ?3.9%; Post‐Natal Size Down, ?3.6%). Further analysis of all the 38 clients that had completed both courses ≥12 months ago (mean 17.5 months; range 12–25 months) demonstrated a mean ?4.1 kg (3.9%) weight change from baseline weight. Discussion: Given that further weight loss or weight maintenance is reportedly unachievable over the long term for the majority of those who attend weight management groups (Wing, 2005), these data suggest a more positive outcome for these two particular interventions, with two‐thirds of clients either continuing to lose more weight or being able to maintain the weight initially lost. The further analysis of the group weight change from baseline values compares favourably with a recent Cochrane review on weight loss interventions (Norris et al., 2009) where, after 1 year, baseline weight was reduced by 2.8 kg (3.3%). The limitations of this evaluation are the accuracy of the telephone interview for obtaining weight data because these weights were self‐reported; the majority of the clients were female; the sample size used was small with a large number of clients noncontactable. Conclusions: This service evaluation of Size Down and Post‐Natal Size Down suggests that the weight loss achieved over 6 weeks was successfully sustained by two‐thirds of the clients over the long term, and that these particular interventions are effective. Further evaluation using actual weight measures and including more male clients is needed. References: NICE (2006) Obesity: Guidance on the Prevention, Identification, Assessment and Management of Overweight and Obesity in Adults and Children. Clinical Guideline 43. London: NICE. NICE (2010) Weight Management Before, During and After Pregnancy. Public Health Guidance 27. London: NICE. Norris, S.L., Zhang, X., Avenall, A., et al. (2009) Long‐term non‐pharmacological weight loss interventions for adults with pre‐diabetes. Cochrane Database Syst. Rev. Issue 1. Paul‐Ebhohimhen, V. & Avenell, A., Gregg, E., Schmid, C.H., Lau, J. (2009) A systematic review of the effectiveness of group versus individual treatments for adult obesity. Obesity Facts 2, 17–24. Wing, R. & Phelan, S. (2005) Long‐term weight loss maintenance. Am. J. Clin. Nutr. 82 (Suppl.), 222–225.     

Very low‐energy diets for weight loss in adults: A review

Aim: Very low‐energy diets are a weight loss strategy that utilises severe and controlled energy restriction to induce rapid weight loss. This review aimed to evaluate their use in terms of efficacy and safety, and to identify for whom they may be effective for weight loss. Methods: English‐language papers examining the use of very low‐energy diets for weight loss in adults with a body mass index ≥30 kg/m² and published between March 2003 and March 2010 were retrieved from health and medical databases. Results: Eight randomised control trials, two cohort and six pre‐post studies were eligible for inclusion and were assessed for methodological quality and had data extracted. The greatest initial weight loss was ?22 kg, after 16 weeks of a very low energy diet. Greatest weight loss after follow up was ?13.1 ± 8.0 kg and 9.1 ± 9.7 kg (7.7 ± 8.1%) after 1 and 2 years, respectively. Studies comparing the effects in males versus females yielded conflicting results. Very low‐energy diets are effective for producing short‐term weight loss. However not all initial weight loss is maintained long term. Conclusion: Future studies using very low‐energy diets should conduct more rigorous analyses of dietary adherence and physical activity and should be required to document side effects experienced in order to identify how and for whom they are effective in facilitating long‐term weight loss in adults.     

The Experience of Group Weight Loss Efforts Among Lesbians

Objective: To describe experiences of group weight loss efforts among lesbians participating in a predominantly lesbian weight loss group. Methods: A qualitative study (N = 14 self-identified overweight lesbians) was conducted, incorporating phenomenology and grounded theory in methodology. Focus groups were analyzed using a Template Analysis style. Results: Several themes were identified that contributed to the weight loss experience of the participants. These themes contributed to the development of a model depicting history, components, and relationships among concepts leading to positive weight loss experiences for lesbians. Conclusions: Participants had long histories of shame and fear surrounding weight loss attempts. Weight loss group participants needed cultural connectivity and a sense of safety and acceptance to address issues contributing to weight gain and in order to lose weight and maintain weight loss. Although more research is needed before implementation of a sexual minority women-specific weight loss program, these data are the basis for further exploration into the development of such a program.     

Examining Patient Perspectives on Weight Management Support in the Primary Care Setting

Obesity affects more than one-third of Americans and is a leading cause of preventable death. Integrating patient perspectives into obesity treatment can help primary care providers (PCPs) intervene more effectively. In this study, we describe patients’ experiences with PCPs concerning the diagnosis and treatment of obesity and offer suggestions for patient-centered care in weight management. We conducted four focus groups with patients of a university medical system-associated family practice who had a BMI?≥?30. Interview questions addressed general weight management perceptions and preferences for weight management support in a primary care setting. Patients completed a brief demographic survey at the conclusion of the group. Four authors independently coded focus group notes to identify themes and determine saturation using qualitative thematic analysis. We resolved discrepancies by team discussion. Thirty primary care patients participated, of whom 23 were female and whose average age was 50. Twenty-four had attempted to lose weight in the past 12 months and had discussed management with their providers. Analyses identified four themes regarding weight management in a primary care setting: motivation and weight management, the provider–patient relationship, desire for concrete weight loss plans, and limitations of the primary care setting. Motivation was named as a weight management obstacle. Participants felt that PCPs need to be partners in weight management efforts and also recognized limitations of PCP time and expertise. They endorsed an integrated behavioral approach that includes physical activity and nutrition support. Improving PCP delivery of evidence-based treatment for obesity will lead to increased patient attempts to lose weight. Incorporating patients’ desires for concrete plans, ongoing support, and referral to integrated service (e.g., nutritionists, care managers, behavioral health providers) programs can increase patient engagement and success. The chronic disease care and Patient Centered Medical Home models offer guidance for ensuring sustainability of weight management services.     

Ensuring a healthy approach to long‐term weight management: Review of the Slimming World programme

Weight management programmes have been shown to be effective interventions that encourage clinically relevant weight loss. The aim of a weight management programme is not only to achieve weight loss, but also to support long‐term weight maintenance and for that reason their suitability in helping people to meet the key dietary recommendations for health must be considered. The British Nutrition Foundation was asked to investigate whether the Slimming World weight management programme is consistent with current nutrient and food‐based recommendations, and whether Slimming World members following the programme are typically eating diets meeting these recommendations in the ‘real world’. This was to help inform any potential refinements to their dietary approach. A three‐stage approach included a review of Slimming World's dietary approach resources, nutritional analysis of Slimming World's example menu plans and dietary analysis of 40 7‐day weighed food diaries completed by adult female Slimming World members. The Slimming World dietary approach reflects many of the main messages in the UK's Eatwell Guide and generally accepted healthy eating advice. Several observations were made with indications for potential changes in relation to key food groups. Nutritional analysis of the 7‐day menu plans suggests that a Slimming World member following a provided example menu plan could meet many of the UK dietary recommendations that were analysed in this review. Food diary analysis suggests the Slimming World study sample on average met dietary recommendations for total fat, saturated fat, calcium, salt and 5 A DAY. In comparison, national dietary surveys report that the average UK adult female population meets the total fat and calcium recommendations, but is not meeting the recommendations for saturated fat, salt and 5 A DAY. The study sample did not meet the recommendations for intakes of fibre and free sugars and oil‐rich fish, but these were still closer to recommendations than the average UK adult female population. High intakes of red and processed meat and alcohol were observed amongst some of the study sample. Overall, the findings suggest that despite a reduction in energy intake, adult females following this weight management programme may be consuming a diet that more closely meets UK dietary guidelines when compared with the average UK adult female population.     

The Long-Term Dietitian and Psychological Support of Obese Patients Who Have Reduced Their Weight Allows Them to Maintain the Effects

The role of post-therapeutic support after weight loss in obesity treatment is not fully understood. Therefore, weight maintenance after a successful weight loss intervention is not very common, especially in obese individuals. This randomized controlled study was conducted to explore the efficacy of following dietary and psychological support in a group of 36 obese individuals. Participants (22 women, 14 men aged 35.58 ± 9.85 years, BMI 35.04 ± 3.80 kg/m²) who completed a 12-month weight loss phase (balanced energy-restricted diet) were randomly allocated to receive 18-month support (SG) or no additional care (CG). The support phase included some elements of Ten Top Tips (TTT), cognitive behavioral therapy (CBT), motivational interviewing (MI) in combination with nutritional education and assessment of the level of physical activity. The primary outcome was the maintenance of anthropometric parameters at an 18-month follow-up. The secondary outcomes included evaluation of biochemical parameters and single nucleotide polymorphisms (SNPs) in genes connected with obesity. A comparison of SG vs. CG after a 30-month period of the study revealed significant differences in weight changes (−3.83 ± 6.09 vs. 2.48 ± 6.24 kg), Body Mass Index (−1.27 ± 2.02 vs. 0.72 ± 2.12 kg/m²), visceral adipose tissue (−0.58 ± 0.63 vs. 0.45 ± 0.74 L), and waist circumference (−4.83 ± 4.05 vs. 1.83 ± 5.97 cm). Analysis of SNPs (rs9939609 FTO, rs987237 TFAP2B, and rs894160 PLIN1) provided further insight into the potential modulating effect of certain genotypes on weight loss and maintenance and extended the knowledge of the potential benefits of personalized medicine. Post-therapeutical support in current clinical practice may increase the chances of long-term weight loss maintenance in obesity treatment even in patients with a genetic predisposition to excessive weight.     

Body mass index and weight change attempts among adult women. The Norwegian Women and Cancer Study.

BACKGROUND: Based on concern about the widespread increase in being overweight and obesity along with a substantial demand for leanness, we wanted to estimate body mass index (BMI) and the prevalence of weight change attempts in a population-based sample of Norwegian women. Furthermore, we wanted to examine how weight loss attempts are related to BMI and to age, socioeconomic status, reproductive factors, lifestyle and diet. METHODS: A nationwide, cross-sectional study applying a mailed questionnaire was used. Out of a random sample of 20,000 women aged 45-69 years 10,249 women participated. RESULTS: Based on self-reported data, the mean BMI was 24.6 kg m-2 and 40% of the women had a BMI of > or = 25 kg m-2. More than 50% of the women were trying to lose weight and weight loss attempts were very strongly associated with BMI. Age, education, income, smoking status and perception of diet's importance to health were also significant predictors of weight loss attempts. The effect of age, education and income on weight loss attempts was modified by the level of BMI. Women trying to lose weight reported a different diet than those not trying to lose weight, irrespective of BMI. CONCLUSION: A large proportion of middle-aged women are trying to lose weight. BMI is predominant in explaining weight loss attempts. After adjusting for BMI, age, lifestyle and socioeconomic status also contribute to explaining weight loss attempts.     

Formula food‐reducing diets: A new evidence‐based addition to the weight management tool box

The changing pattern of obesity‐related disease has created a need for a greater range of weight management options for the increasing number of people for whom weight loss and maintenance cannot be addressed by conventional dietary methods. Formula diet weight loss programmes [very low‐calorie diets (VLCDs) (400–800 kcal/day) and low‐calorie diets (LCDs) (800–1200 kcal/day)] can deliver weight loss at rates of 1–2 kg/week. This rate of weight loss can result in 10–20 kg weight loss in 8–12 weeks. Many health benefits associated with weight reduction seem to require between 10 and 20 kg weight loss. Formula diet programmes can result in weight loss, reduction of liver volume and reduction of visceral fat before bariatric surgery; weight loss before knee joint replacement surgery has also been shown. The benefit of pre‐operative weight loss is still under investigation and such practices before bariatric surgery are variable in surgical units across the UK. Weight loss with formula diet in obesity‐associated conditions where inflammation is an important component, such as osteoarthritis and psoriasis, has been demonstrated. Maintenance of about 10% of initial bodyweight loss, with symptom improvement in elderly obese people with knee osteoarthritis, has been shown over a period of 4 years. In obese people with psoriasis, weight loss with skin improvement has been maintained for 1 year. Clinical trials are currently underway to examine the merits of an initial weight loss with formula diet in pre‐diabetes, in early type 2 diabetes and in insulin‐treated type 2 diabetes. Rapid initial weight loss can result in rapid symptom improvement, such as reduced joint pain in osteoarthritis, improved sleep quality in obstructive sleep apnoea, reduced shortness of breath on exertion, reduced peripheral oedema and rapid improvement in metabolic control in diabetes, all changes that are highly motivating and conducive towards compliance. There is also some evidence for improved vitamin D status and maintained bone health in elderly obese people with osteoarthritis but more research is needed. Rapid initial weight loss was feared to be followed by rapid weight regain. However, provided initial weight loss is delivered in parallel with an intense education programme about nutrition, cooking, shopping and lifestyle for long‐term maintenance; and where long‐term support is provided, subsequent weight maintenance after VLCDs and LCDs has been shown to be possible. A recent literature review identified high‐protein diets, obesity drugs and partial use of formula meal replacements as methods which can result in statistically significantly greater weight maintenance after initial weight loss with VLCDs or LCDs. Anxiety about serious adverse side effects seems to be unfounded although users need to be aware of both minor and more serious, though very infrequent, adverse events, such as gallstones and gallbladder disease.     

Participants’ Explanatory Model of Being Overweight and Their Experiences of 2 Weight Loss Interventions

PURPOSE

We explored participants’ accounts of weight loss interventions to illuminate the reasons behind the greater weight loss observed among those attending a commercial program compared with those receiving standard care in a recent large-scale trial. We further wanted to examine how participants’ general explanatory model of being overweight related to the 2 different interventions.

METHODS

Our study was based on thematic analysis of semistructured telephone interviews with a purposeful sample of 16 female participants from the UK center of a randomized controlled trial of weight loss in primary care.

RESULTS

The commercial provider delivered weight management in a nonmedical context, which mirrors how participants regard being overweight. Participants felt they needed support and motivation rather than education, and valued the ease of access and frequent contact the commercial provider offered. Some participants preferred individual level support with their primary care clinician, and all were positive about the opportunity to access support through the primary care setting.

CONCLUSIONS

Primary care referral to a commercial weight loss program for people who do not require specific clinical care appears to be in accord with their general explanatory model about being overweight, offering motivation and support to lose weight outside a strictly medical context. This approach may not be effective or acceptable for everyone, however, and there are likely to be considerable variations in the explanatory models held. Findings support the argument that a range of evidence-based options for weight management should be available in primary care.