Commercial weight management; review of evidence 11 October 2011 Commercial weight management; review of evidence Insert name of presentation on Master Slide Presenter: Dr Sarah J Jones

Background Overweight and obesity in Wales at 57% Range 53% to 62% across HBs Need effective interventions Lots of gaps in evidence Moves to develop NHS : commercial partnerships Commercial weight management; review of evidence

Question Is there evidence of effectiveness of commercial weight management that would support closer links between the NHS and these programmes and, if so, how should such links be managed? Commercial weight management; review of evidence

Approach Scoped inclusion / exclusion criteria Structure of each programme NICE guidance Information about processes of involvement and what influences participation Outcomes of participation Clinically important weight loss and maintenance of weight loss Commercial weight management; review of evidence

Programmes reviewed Weight Watchers Jenny Craig Lighter Life Slimming World Cambridge Rosemary Conley Commercial weight management; review of evidence

Realistic target; 5-10% of original weight ? NICE (2006) guidance Sl World J Craig WW C’bridge Lighter Life R Conley Realistic target; 5-10% of original weight ? Max. weekly loss 1kg Long-term change, not short term, quick fix Diet and physical activity Balanced, healthy eating Recommending regular physical activity Includes keeping a diary, and coping with ‘lapses’ and ‘high-risk’ situations On-going support Note: - LighterLife state that for the very obese higher targets are appropriate and they have agreed this with NICE in private discussions. Until NICE makes this public policy, the programme is not regarded as meeting NICE guidance in these areas. Commercial weight management; review of evidence

Commercial weight management; review of evidence S World J Craig WW C’bridge L’ Life R’ Conley Meets NICE good practice guidance? Yes Meets some guidance, could not assess all elements No Research evidence satisfies (CASP) guidance? No evidence to assess Sys review reasonable quality, reasonable quality RCT Moderate quality study Effective? Clinically significant weight loss? No evidence of this Some evidence of clinically sig weight loss at 1 year Some evidence of clinically sig weight loss at 6 months Some evidence of clinically sig weight loss Some evidence of clinically sig weight loss in short term Weight loss sustained? No evidence of this Evidence of weight gain at 2 years No longer term data No follow up data No follow up data Row 1 – structure, row 2 – process, rows 3 / 4 - outcomes Commercial weight management; review of evidence

Commercial weight management; review of evidence Programme Costs Effectiveness Cost effectiveness Other Jenny Craig Individual, with support if needed Current UK fees NK; 1 or 3 yrs paid in advance 1 RCT carried out, funded by Jenny Craig No good quality evidence of cost effectiveness 60,164 people enrolled for 1yr, 73% retained at 4 wks, 42% at 13 wks, 22% at 26 wks, 7% at 52 wks Jenny Craig estimated to cost 5 x Weight Watchers Clinically important weight loss 10% at 1 yr, dropping to 7% by 2 yrs. Programme is diet, physical activity and behaviour change Low quality study, lacking info about group assignment and measurement methods. By 10 wks, 50% of those who had enrolled had dropped out As April 2011, food and consultations £277 per mth, food only £249 and consultation only £148. Excludes membership fees. All costs covered for study participants. Very different to 'real world' and the outcomes greater than in community. Commercial weight management; review of evidence

Commercial weight management; review of evidence Programme Costs Effectiveness Cost effectiveness Other Slimming World Group based, lead by successful member Membership fee of £10, weekly fee £4.95 (as February 2011) There is no good quality evidence to demonstrate the effectiveness No good quality evidence to demonstrate cost effectiveness 12 week study, n=107 GP funded 62 completed 12 weeks (57.9%) Meetings in community venues, last 1 to 1.5 hours 28 completers used free vouchers (26.2%) 12 weeks attendance would cost £69.40 before the cost of food 35 lost ≥5% body weight (32.7%) Programme is diet, physical activity and behaviour change GP endorsement was validation; cost a barrier for some; others preferred to self fund even when free vouchers available Some men only groups. Some evidence men lose weight using Slimming World Commercial weight management; review of evidence

Commercial weight management; review of evidence Programme Costs Effectiveness Cost effectiveness Other Weight Watchers Group, lead by previously successful member Current UK fees (correct as February 2011) ~ £20 per mth; covers joining fee and weekly meetings 3 RCTs, 1 NIH funded, 1 by WW, 1 by BBC Aus. RCT found WW unlikely to be cost effective 95.3% US lifetime members female; mean BMI 27.6 Meetings in community venues, last about 1 hr 1 study; 3kg weight loss at 12 mths. Not clinically important, not true WW At 5 years, only 50% maintained 5% weight loss WW v self help; WW gave fair weight loss at 1 yr, but weight gain by 2 yrs 50% drop out within 6 weeks, 70% within 12 weeks. Programme is diet, physical activity and behaviour change BBC trials; 7.3% loss in WW group at 6 mths. No longer term data . WW highly complex and difficult to follow Commercial weight management; review of evidence

Commercial weight management; review of evidence Programme Costs Effectiveness Cost eff’ness Other C’bridge Individual, with support Current weekly costs £36 to £44 to cover formula No good quality evidence of effectiveness No good quality evidence of cost eff’ness No other info Programme is solely formula diet based L’Life Group based Currently costs £66 per week for the main programme, £49.50 for the Lite version One L’Life funded RCT There is no good quality evidence to demonstrate the cost effectiveness of LighterLife 9 /10 users are female Formula diet based but also includes physical activity and behaviour change Clinically sig weight loss at 9 mths? No longer term data ?? study quality; no data on group assignment and measurement methods Half of users are 36 to 54 years Weekly meetings max.12 single sex participants V obese popn treated at special clinic; high drop out R’Conley Group and individual Membership fee £10, weekly class costs vary One RCT Physical activity and dieting Clinically sig weight loss at 6 mths; no longer term data Commercial weight management; review of evidence

Summary of findings Some individuals lose some weight, sometimes a clinically significant amount, in the short term. Lack of significant, consistent effect in the longer term. Small amount of research evidence. Lack of high quality randomised trials and systematic reviews. Impossible to make definitive statements for specific populations, e.g., people with CVD Little evidence on the cost effectiveness Commercial weight management; review of evidence

For health professionals Based on the information collated and appraised it is not possible to recommend any particular commercial weight loss programme on the basis of effective outcomes or compliance with good practice Two programmes did comply with best practice guidance (NICE), but could not demonstrate longer term effectiveness. When discussing weight loss with patients, health professionals should consider current NICE guidelines and be able to support patients in making an appropriate choice Commercial weight management; review of evidence

For service planning, policy development Insufficient evidence to support formal referral schemes between NHS and commercial weight management organisations Consideration robust evaluation trials. Review current NHS weight loss service to identify innovative practice, good practice and current gaps in services in relation to need. Consider producing and disseminating of information to support patient choice of weight management programmes and to support health professionals in providing advice to their patients on the choice of programmes Commercial weight management; review of evidence

Next steps Turn findings into short information sheets? Put information sheets on Web? Commercial weight management; review of evidence

Acknowledgements Beth Cossins Christian Heathcote – Elliot Copy of report available on Public Health Wales website Commercial weight management; review of evidence