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Study backs commercial weight-loss services over GPs

GPs should consider commissioning commercial weight loss programmes, researchers have said, after a randomised controlled trial found patients enrolled in year-long schemes lost nearly twice as much weight as patients receiving standard primary care.

The UK-led study, published in The Lancet, is the latest to suggest GPs should turn to commercial solutions to encourage patients to lose weight.

Last April, Pulse reported a study of the costs and outcomes of a primary care-based weight loss programme found it cost £60 per patient to deliver cost-effective savings.

Advisers to NICE have considered recommending the inclusion of indicators for referring patients to local weight management schemes, but rejected the plans due to concerns they were merely a 'tick-box exercise' and a lack of availability of the schemes.

Researchers assigned 377 patients with a mean weight of 86.9kg and a mean body mass index of 31.5kg/m2 to free access to weekly community-based Weight Watchers meetings for 12 months.

Some 395 patients in the standard care group received weight loss advice from a primary care professional at their GP practice. The primary outcome was weight change from baseline to 12 months, with secondary outcomes of changes in fat mass, weight circumference, blood pressure and biomarkers of cardiovascular risk.

At 12 months, 61% of patients completed the final assessment in the commercial programme group, compared with 54% in the standard care group, but this difference was not significant.

At 12 months, in the 772 patients in the UK, Australia and Germany, mean weight loss was over 5.1kg in patients given free membership to a commercial programme run by Weight Watchers, compared with a mean 2.8kg loss in those receiving standard care.

The greater weight loss in participants assigned to the commercial programme, compared with those assigned to standard care, was also accompanied by larger reductions in waist circumference and fat mass, but there were no significant differences in blood pressure.                

Dr Susan Jebb, head of diet and population health at the Human Nutrition Research Unit, said the trial ‘provides important data to inform weight management interventions in primary care.'

Dr Jebb concluded: ‘Referral by a primary health-care professional to a commercial weight loss programme that provides regular weighing, advice about diet and physical activity, motivation, and group support can offer a clinically useful early intervention for weight management in overweight and obese people that can be delivered at large scale.'

Dr Kate Jolly, a GP and senior clinical lecturer in public health at the University of Birmingham, said: ‘The study is the first to show that a commercial provider, for which people normally pay themselves, is more effective than primary care management. If the health system is prepared to pay for a less effective intervention, should it not spend that money with a commercial provider instead?'

‘The data lend support to these policies, but also question whether commissioners should disinvest in provision of weight loss management in primary care. However, this step would be premature in the absence of other evidence.'

The Lancet 2011, published online 8 September