Behavioural weight management programmes can help people lose weight and reduce their risk of chronic diseases, but programmes led by specialists in clinical settings can be too costly for the NHS to deliver at the necessary scale. There is good evidence that primary care referral to commercially available open-group behavioural weight management programmes (like Weight Watchers or Slimming World) is a cost-effective option and 12-week referrals to these programmes are often used in the NHS. However, there is debate about whether a 12 week programme is sufficient to have a long term impact. In the WRAP trial we evaluated whether an extended referral (52 weeks) is more effective and cost-effective over 2 years.
We recruited 1267 adults with overweight and obesity and randomly allocated them to one of three weight loss programmes: brief intervention (a self-help booklet), an open-group behavioural weight management programme (Weight Watchers) for 12 weeks, or the same programme for 52-weeks. Participants were followed up for 2 years, and we collected clinical measurements and self-reported data on psychosocial variables and health resource use at baseline, 3 months, 1 year and 2 years.
At 1 year, both behavioural programmes led to greater weight loss than the brief intervention, but the 52 week programme led to greater weight loss and greater reductions in risk markers for diabetes than the 12 week programme and the brief intervention. Participants in the 52 week programme still had lower weight that the other groups at 2 year follow up.
We modelled the impact of the three programmes over the next 25 years, assuming that everyone regained any weight they had lost by year 5. Over the 25 years, the 12 week programme was predicted to be cost-saving because the initial costs of the programme were outweighed by reductions in diseases incidence and associated healthcare cost. The 52 week programme was more expensive initially, but had greater health benefits than both other groups and was very cost-effective by the usual clinical standards.
Estimates of the long term cost-effectiveness of these programmes is based on assumptions about weight regain in the medium-term. We are currently running a 5-year follow up study – WRAP UP – to test these assumptions. WRAP UP will provide the first objective data on 5-year weight trajectories and health outcomes following this type of scalable weight management programme. We will use this data to refine our estimates of the long-term impact on disease incidence and health-care resource use.
- AL Ahern,GM Wheeler, PN Aveyard, EJ Boyland, JCG Halford, AP Mander, et al. Extended and standard duration weight-loss programme referrals for adults in primary care (WRAP): a randomised controlled trial. Lancet 2017, 389 (10085), 2214-2225
- AL Ahern, P Aveyard, EJ Boyland, JCG Halford, SA Jebb. Inequalities in the uptake of weight management interventions in a pragmatic trial: an observational study in primary care.Br J Gen Pract 2016, 66 (645), e258-e263
- JT Allen, SR Cohn, &AL Ahern. Experiences of a commercial weight-loss programme after primary care referral: a qualitative study. Br J Gen Pract 2016, 65 (633), e248-e255
- A L Ahern PN Aveyard, JCG Halford, A Mander, L Cresswell, SR Cohn, M Suhrcke, T Marsh, AM Thomson SA Jebb Weight loss referrals for adults in primary care (WRAP): protocol for a multi-centre randomised controlled trial comparing the clinical and cost-effectiveness of primary care referral to a commercial weight loss provider for 12 weeks, referral for 52 weeks and a brief self-help intervention BMC Public Health 2014, 10.1186/1471-2458-14-620
Status Two year follow up of WRAP participants was completed in 2016. The main findings have been published. Secondary analysis and publication of data is ongoing.
Unit Role From 31st October 2016, responsibility for the WRAP study transferred from MRC Human Nutrition Research to the MRC Epidemiology Unit, University of Cambridge. University of Cambridge are the sponsor and data controller for this trial. For more information about this please read our letter to participants
Funding This study is funded by the National Prevention Research Initiative through research grant MR/J000493/1. The Funding Partners relevant to this award are (in alphabetical order): Alzheimer’s Research Trust; Alzheimer’s Society; Biotechnology and Biological Sciences Research Council; British Heart Foundation; Cancer Research UK; Chief Scientist Office, Scottish Government Health Directorate; Department of Health; Diabetes UK; Economic and Social Research Council; Health and Social Care Research and Development Division of the Public Health Agency (HSC R&D Division); Medical Research Council; The Stroke Association; Wellcome Trust; Welsh Assembly Government; and World Cancer Research Fund. The cost of the Weight Watchers programme and the costs of blood sampling and analysis are funded by Weight Watchers International as part of an MRC Industrial Collaboration Award.