Behavioural weight management programmes can help prevent type 2 diabetes and can help people who have type 2 diabetes to reduce their need for medication and their risk of related complications such as heart disease. However, programmes delivered by specialist health professionals in clinical settings are too expensive to provide to everyone who needs them. Furthermore, many people regain weight when these programmes end.

We need behavioural weight management programmes that help people achieve and maintain a healthy weight and that can be delivered to large numbers of people. In this research programme we will examine the cost-effectiveness of using non-specialists (health trainers, community members) and technology (internet, phones) to deliver behavioural weight management programmes to two groups of people:

1. people at high risk of developing type 2 diabetes
2. people with a recent diagnosis of type 2 diabetes

Work package 1 will focus on evaluating existing behavioural programmes for weight loss. Work package 2 will focus on developing and piloting a new behavioural programme for weight loss maintenance.

Work Package 1 – Evaluating Existing Weight Loss Programmes

We will evaluate existing commercial group-based weight loss programmes that use non-specialists and technology.

Weight Loss Referrals for Adults in Primary Care (WRAP) 5yr follow-up

For people with overweight or obesity, who are at high risk of developing diabetes, we will follow up participants from the WRAP trial – an existing trial of a group-based programme (Weight Watchers). We will:

• collect 5-year outcomes for weight, blood glucose, and diabetes status
• compare outcomes for 3 treatment groups (brief advice, 12 weeks programme, 52 week programme)

Glucose Lowering through Weight Management

For people with recently diagnosed type 2 diabetes, we will conduct a new trial. We will:

• combine the same commercial group-based behavioural programme with diabetes education and dietician support via telephone.
• recruit patients diagnosed with type 2 diabetes in the previous 3 years
• randomly allocate participants to this new programme (Live Well With Diabetes) or to standard diabetes education.
• compare glucose control and body weight in the two groups after 6 and 12 months.

Patient and Practitioner Experience

In both studies, we will interview participants and practitioners to assess the acceptability of the programmes and gauge views about what helps (or hinders) weight loss maintenance. We will use what we learn from these interviews to inform the design of a new weight loss maintenance programme.

Modelling Long Term Outcomes

For each programme, we will use modelling and statistics to estimate the longer term impacts on risk of diabetes and its complications (such as heart disease) and their value for money.

Work Package 2 – Development of a weight loss maintenance programme

We will develop a new weight loss maintenance programme. We aim to develop a programme that uses new behavioural techniques and can be delivered in groups by trained non-specialists using technology. We will evaluate its feasibility and acceptability and estimate potential effects by performing a small pilot trial in people with recent experience of group-based weight loss programmes.

Potential Impact

We will include patients, the public, practitioners, commissioners, and other stakeholders in the design of the weight loss maintenance programme, the design and management of our studies, and the analysis, interpretation and dissemination of our findings. Our findings will provide policy-makers and commissioners with evidence regarding the value for money of scalable behavioural weight management programmes for the prevention and treatment of type 2 diabetes. We will also have a new weight loss maintenance programme that (if shown to be cost-effective in further evaluation) could be delivered at scale in the UK.

Joint Principal Investigators

Dr Amy Ahern
Professor Simon Griffin

Status

The programme started on 1 October 2017.

Unit role

The Unit is the lead collaborator on this programme

Host NHS Trust

Cambridgeshire and Peterborough Clinical Commissioning Group.

Collaborators

University of Sheffield, University of Leeds, University of Oxford, Fakenham Medical Practice, NHS North Norfolk and Cambridgeshire and Peterborough Clinical Commissioning Groups.

Funding

This is independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research programme (Reference Number RP-PG-0216-20010).

The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the PGfAR programme, the NIHR, the NHS or the Department of Health. The NIHR advised on the study design as part of the grant application process, but had no role in the writing of the protocol and will not be involved in the decision to publish findings.

Weight Watchers International will provide the Live Well With Diabetes intervention for the purposes of the trial at no cost. They had no role in the design of the study and will play no role in the study conduct, the analysis or interpretation of data, or the decision to publish findings.

Linked Projects

Five year follow up of the WRAP trial 

The Glucose Lowering through Weight management (GLoW) trial

The development and evaluation of the Supporting Weight Management (SWiM) programme