Developing and evaluating an online intervention for weight loss: POWeR+ Dr Katherine Bradbury Health Technology Assessment (HTA) programme at the University of Southampton

Aim: Discuss the development and evaluation of an online weight management tool: POWeR+ - The development of POWeR+ -The evaluation of POWeR+ (effectiveness, cost-effectiveness) -Dissemination of POWeR+

Need to develop cost-effective intervention for weight loss Aim is to support people to adopt a sustainable and positive approach to weight management Build habits Become own personal health trainer

The development of POWeR Theory: Self-determination theory Evidence base: Literature review of effective components, BCTs, Habit formation Person-based approach: 1- Interviews with 25 adults about previous weight loss experiences Development of a prototype 2- Interviews with 16 obese adults who gave feedback on POWeR modifications further interviews we took a theory, evidence and person based approach Continued until we knew it was acceptable, persuasive, feasible, engaging, etc. After this POWeR went into a feasibility trial?

What does POWeR+ include? Choice of low calorie or low carb eating plan Choice of walking plan of ‘any other’ physical activity 25 sessions: Behaviour change/CBT techniques (packaged as ‘POWeR tools’) designed to form habits Weekly weight and goal review Facility for nurse to see patients progress

Evaluating POWeR Feasibility RCT (N=179) POWeR + brief nurse support: Mean weight loss at 12 months= 4.5kg (control group=1.7kg) Feasibility trial showed best way to provide POWeR was with brief nurse support In collaboration with public health teams (NHS Tees, NHS Durham and Darlington)

Evaluating POWeR Feasibility RCT (N=179) POWeR + brief nurse support: Mean weight loss at 12 months= 4.5kg (control group 1.7kg) Public Health trial (N=246): Mean weight loss at 8 weeks=web only group lost 2kg, control group lost 0.25kg Further development to extend content of POWeR from 6 months to 12 months…POWeR+ Feasibility trial showed best way to provide POWeR was with In collaboration with public health teams (NHS Tees, NHS Durham and Darlington)

POWeR+ RCT- Main trial 836 obese adults recruited from primary care. Randomised Active control ‘usual care’ Leaflet & monitoring POWeR+ Face-to-face support POWeR+ Remote Support

Nurse support Mean N of Face-to-Face Support 2.3 Face to face appointments 2.1 Emails 1.8 phone calls Total 4.5 contacts Mean N of Remote Support 3.1 Emails 1.6 Phone calls 18 patients=1.56 face-to-face Total contacts= 4.25 Out of 270 pts in remote group 18 sought f2f care.

Percentage of patients maintaining at least 5% weight loss between 6 and 12 months Mean: 3kg 4.3 kg 4.5kg Note control group v active, but also found that almost half were taking part in other weight loss programmes by 12 months. Put this in context, best face-to-face weight loss interventions including commerical sector are around 4.5kg weight loss at 12 months, including web interventions too. Even if you add detailed CBT from psychologists for a year meta analysis only indicates the effects go up to 4.9kg in a year, which again is much more costly in terms of resources

Cost effectiveness of POWeR+ NICE: 1kg per head weight loss is cost-effective if less than £100 Very cost effective in terms of NHS costs Likely to be very, very cost-effective from a societal perspective Previous modelling by NICE showed that at least a 1 kg per head weight loss among overweight or obese adults is likely to be cost- eff ective, provided that the cost per person of intervening is less than ￡100 and the weight difference is maintained for life. The present results suggests that irrespective of whether intervention costs or overall costs are used, both POWeR+ interventions achieve weight losses at a cost per kg that is less that required by NICE.4

Qualitative interviews with patients “It’s quite easy to use and I'm not that computer savvy and I found it quite easy …so it was quite good, (Male, aged 60) “What I like about it is it gives you a list of green and amber and red…That is quite a good way of you know, I mean believe me I have tried every diet you can think of, and the problem is that eventually you put the weight back on, and I think this is a more sensible way of doing it, because you can eat normally” (Female, aged 66) “It makes me think what I am doing” (Female, age 59)

Interviews with patients… “Being able to do it online and having the support, rather than having to leave your own home to get weighed in front of other people” (Female, aged 49) “It’s not as intrusive as going to a class or whatever.” (Female, aged 55) “I could have been paying, what, me fiver a week or whatever at the (slimming) club and who’s to say the results would have been any better?” (Male, aged 65)

In conclusion POWeR+ is effective, cost-effective and valued by patients!

Dissemination of POWeR+ We want to disseminate POWeR+ across the UK: -Public Health, NHS, 3rd sector, anyone else who wants it! Some initial success: 6 PH trusts signed up to use POWeR+ Used in a diabetes intervention MOD