1. Masterclass on lifestyle change How to help patients lose weight?
Masterclass on lifestyle change
How to help patients lose weight?
Prof. Paul Aveyard
Oxford, United Kingdom

2. The risks from obesity

3. Ischaemic heart disease and stroke mortality
by BMI
Figure 1
Prospective Studies Collaboration (2009) Lancet 373: 1083–96
Prospective Studies Collaboration (2009) Lancet 373: 1083–96

4. BMI and blood pressure (males) BMI and blood lipids (males)
Cholesterol concentration (mmol/L)
Figure 2 (males only)
Prospective Studies Collaboration (2009) Lancet 373: 1083–96

5. BMI and risk of diabetes
Colditz et al. (1995) Ann Intern Med 122(7): 481-6
Age-adjusted relative risk of diabetes
Figure 3
Colditz et al. (1995) Ann Intern Med 122(7): 481-6
(original article)
Anderson et al. (2003) J Am Coll Nutr. 22(5):
(systematic review)
AL: not sure what the ‘Reference (1)’ is in the graph for?
AC:The risks are relative to the group – this is therefore the reference (i.e. assigned a risk of 1)
BMI category (kg/m2)

6. Remaining average lifetime risk of diabetes by age and BMI
Diabetes Care 30(6):
Probability of developing diabetes (%)
Figure 4
(males only)
Narayan et al. (2007) Diabetes Care 30(6):
BMI

7. Life expectancy in obesity
Lancet 2009; 373: 1083–96

8. Interventions in primary care
Dept of Primary Care Health Sciences
April 4, 2019

9. The UK Primary Care Challenge
Typical GP list will have >1000 patients who may benefit from weight loss
QOF requires GPs to record BMI, but does not require them to offer treatment.
There is perceived to be a lack of effective treatment options.
Primary Care
Severe obesity and/or
multiple comorbidities
specialist referral
Overweigh and/or
low health risks
self help

10. What is needed in primary care?
Time
Training
Tools
Treatments

11. Lighten Up Trial
RCT involving 6 interventions vs. comparator for 3 months
Weight Watchers (n=100)
Slimming World (n=100)
Rosemary Conley (n=100)
Size Down NHS (n=100)
Pharmacy (n=70)
GP provision (n=70)
Choice (n = 100)
Control group that had no intervention (n=100)

12. Standard care vs. commercial programmes
Weight loss at 12 months
Mean weight loss (kg)
Jolly et al. (2011) BMJ 343: d6500

13. Australia, Germany & UK Jebb et al. (2011) Lancet 378(9801): 1485-92
p<0.0001
Figures 11a and 11b
11a - Lighten Up
Jolly et al. (2011) BMJ 343: d6500
11b - UK, Germany, Australia
Jebb et al. (2011) Lancet 378(9801):
12 mth intervention – weight loss at 12mth
Data presented here are from results where the baseline observation was carried forward - for comparability with BWeL
Jebb et al. (2011) Lancet 378(9801):

15. What effective weight loss interventions mean

16. Weight loss in the Lighten Up trial (Jolly et al)

17. Weight regain after programme end

18. Evidence that length of time you are obese matters for health
Years obese
Up to 5 HR 1.51,
HR 1.94
HR 2.25
>25 HR 2.52
All adjusted for degree of obesity
International Journal of Epidemiology 2011;40:985–996
Similar study JAMA. 2013;310(3):
Rats compared
Overfed
Healthy diet
Intermittent dieting
International Journal of Obesity (2013) 37, 1088–1094

19. Diabetes Prevention Program
Long-term follow-up
Change in weight
(kg) -6
Follow-up (yrs) 10
Control
Lifestyle intervention
Metformin
Cumulative diabetes
incidence (%) 60
Follow-up (yrs) 10
Figures 7a and 7b
Diabetes Prevention Program Research Group (2009) Lancet 374:

20. Conclusions Modest benefits from group-based commercial programmes
No benefits from programmes delivered by GPs and nurses
Modest average benefits conceal large variation between people
Modest temporary weight loss can lead to health benefits- weight loss does not need to be permanent

21. Thank you for listening
For questions or a copy of the slides