Randomised controlled trial and economic analysis of an internet-based weight management programme: POWeR+ (Positive Online Weight Reduction)

Paul Little, Beth Stuart, Fd Richard Hobbs, Jo Kelly, Emily R Smith, Katherine J Bradbury, Stephanie Hughes, Peter Wf Smith, Michael V Moore, Mike Ej Lean, Barrie M Margetts, Christopher D Byrne, Simon Griffin, Mina Davoudianfar, Julie Hooper, Guiqing Yao, Shihua Zhu, James Raftery, Lucy Yardley

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Abstract

BACKGROUND: Behavioural counselling with intensive follow-up for obesity is effective, but in resource-constrained primary care settings briefer approaches are needed.

OBJECTIVES: To estimate the clinical effectiveness and cost-effectiveness of an internet-based behavioural intervention with regular face-to-face or remote support in primary care, compared with brief advice.

DESIGN: Individually randomised three-arm parallel trial with health economic evaluation and nested qualitative interviews.

SETTING: Primary care general practices in the UK.

PARTICIPANTS: Patients with a body mass index of ≥ 30 kg/m2 (or ≥ 28 kg/m2 with risk factors) identified from general practice records, recruited by postal invitation.

INTERVENTIONS: Positive Online Weight Reduction (POWeR+) is a 24-session, web-based weight management intervention completed over 6 months. Following online registration, the website randomly allocated participants using computer-generated random numbers to (1) the control intervention (n = 279), which had previously been demonstrated to be clinically effective (brief web-based information that minimised pressure to cut down foods, instead encouraging swaps to healthier choices and increasing fruit and vegetables, plus 6-monthly nurse weighing); (2) POWeR+F (n = 269), POWeR+ supplemented by face-to-face nurse support (up to seven contacts); or (3) POWeR+R (n = 270), POWeR+ supplemented by remote nurse support (up to five e-mails or brief telephone calls).

MAIN OUTCOME MEASURES: The primary outcome was a modelled estimate of average weight reduction over 12 months, assessed blind to group where possible, using multiple imputation for missing data. The secondary outcome was the number of participants maintaining a 5% weight reduction at 12 months.

RESULTS: A total of 818 eligible individuals were randomised using computer-generated random numbers. Weight change, averaged over 12 months, was documented in 666 out of 818 participants (81%; control, n = 227; POWeR+F, n = 221; POWeR+R, n = 218). The control group maintained nearly 3 kg of weight loss per person (mean weight per person: baseline, 104.4 kg; 6 months, 101.9 kg; 12 months, 101.7 kg). Compared with the control group, the estimated additional weight reduction with POWeR+F was 1.5 kg [95% confidence interval (CI) 0.6 to 2.4 kg; p = 0.001] and with POWeR+R was 1.3 kg (95% CI 0.34 to 2.2 kg; p = 0.007). By 12 months the mean weight loss was not statistically significantly different between groups, but 20.8% of control participants, 29.2% of POWeR+F participants (risk ratio 1.56, 95% CI 0.96 to 2.51; p = 0.070) and 32.4% of POWeR+R participants (risk ratio 1.82, 95% CI 1.31 to 2.74; p = 0.004) maintained a clinically significant 5% weight reduction. The POWeR+R group had fewer individuals who reported doing another activity to help lose weight [control, 47.1% (64/136); POWeR+F, 37.2% (51/137); POWeR+R, 26.7% (40/150)]. The incremental cost to the health service per kilogram weight lost, compared with the control group, was £18 (95% CI -£129 to £195) for POWeR+F and -£25 (95% CI -£268 to £157) for POWeR+R. The probability of being cost-effective at a threshold of £100 per kilogram was 88% and 98% for POWeR+F and POWeR+R, respectively. POWeR+R was dominant compared with the control group. No harms were reported and participants using POWeR+ felt more enabled in managing their weight. The qualitative studies documented that POWeR+ was viewed positively by patients and that health-care professionals generally enjoyed supporting patients using POWeR+.

STUDY LIMITATIONS: Maintenance of weight loss after 1 year is unknown.

FUTURE WORK: Identifying strategies for longer-term engagement, impact in community settings and increasing physical activity.

CONCLUSION: Clinically valuable weight loss (> 5%) is maintained in 20% of individuals using novel written materials with brief follow-up. A web-based behavioural programme and brief support results in greater mean weight loss and 10% more participants maintain valuable weight loss; it achieves greater enablement and fewer participants undertaking other weight-loss activities; and it is likely to be cost-effective.

TRIAL REGISTRATION: Current Controlled Trials ISRCTN21244703.

FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 4. See the NIHR Journals Library website for further project information.

Original languageEnglish
Pages (from-to)1-62
Number of pages62
JournalHealth Technology Assessment
Volume21
Issue number4
DOIs
Publication statusPublished - 31 Jan 2017

Research Groups and Themes

  • Physical and Mental Health

Keywords

  • Adult
  • Aged
  • Blood Glucose
  • Blood Pressure
  • Body Mass Index
  • Cost-Benefit Analysis
  • Exercise
  • Female
  • Healthy Diet
  • Humans
  • Internet
  • Lipids/blood
  • Liver Function Tests
  • Male
  • Middle Aged
  • Obesity/therapy
  • Primary Health Care/methods
  • Quality-Adjusted Life Years
  • Single-Blind Method
  • State Medicine/economics
  • United Kingdom
  • Weight Loss
  • Weight Reduction Programs/economics

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