Systematic reviews of and integrated report on the quantitative, qualitative and economic evidence base for the management of obesity in men

Quantifying Downstream Healthcare Utilization in Studies of Genomic Testing

OBJECTIVES

The challenges of understanding how interventions influence follow-up medical care are magnified during genomic testing because few patients have received it to date and because the scope of information it provides is complex and often unexpected. We tested a novel strategy for quantifying downstream healthcare utilization after genomic testing to more comprehensively and efficiently identify related services. We also evaluated the effectiveness of different methods for collecting these data.

METHODS

We developed a risk-based approach for a trial of newborn genomic sequencing in which we defined primary conditions based on existing diagnoses and family histories of disease and defined secondary conditions based on unexpected findings. We then created patient-specific lists of services associated with managing primary and secondary conditions. Services were quantified based on medical record reviews, surveys, and telephone check-ins with parents.

RESULTS

By focusing on services that genomic testing would most likely influence in the short-term, we reduced the number of services in our analyses by more than 90% compared with analyses of all observed services. We also identified the same services that were ordered in response to unexpected findings as were identified during expert review and by confirming whether recommendations were completed. Data also showed that quantifying healthcare utilization with surveys and telephone check-ins alone would have missed the majority of attributable services.

CONCLUSIONS

Our risk-based strategy provides an improved approach for assessing the short-term impact of genomic testing and other interventions on healthcare utilization while conforming as much as possible to existing best-practice recommendations.

Éléments structurant les programmes d’activité physique dans la lutte contre le surpoids et l’obésité : état des lieux et suggestions

To date, physical activity (PA) programs for overweight and obese people are built around recommendations established for the general population. However, these people have special characteristics that require adapted coaching. In order to begin this work of recommendations, the objective of this article was to list the criteria usually used to describe and study PA programs for overweight and obese people and its associated postprogram follow-up. A systematic review of both meta-analyses and systematic reviews related to PA programs in the management of overweight and obesity has highlighted that few descriptive elements of programs are systematically reported, and that PA programs are rarely sufficiently detailed to be able to calculate a PA dose or to compare the different programs. These convergences, disparities or gaps in the description of PA programs, led us to initiate a reflection on the interest of these criteria as well as on the interest of their systematization in weight management program design, including PA. We hope that will be a first step towards facilitating the development of recommendations for PA management of overweight and obesity. Novelty Objective: to identify criteria used to describe PA programs in the management of overweight and obesity. Criteria to systematize: data to calculate PA dose; description of program individualization strategy. Criteria to develop: drop-out rate as an indicator of program adaptation; description of fatigue management strategy.

Males with Obesity and Overweight

Global average data suggest that the prevalence of obese and overweight males is much higher than that of females in some regions. The gender gap in obese and overweight individuals has deepened in many countries, and the gap is more prominent in overweight than in obesity. In particular, the prevalence of male obesity has continuously increased in the Republic of Korea over the past two decades, whereas the increase in female obesity has slowed and may even have plateaued. The cutoff point for obesity in Korea is a body mass index of ≥25 kg/m², which is equivalent to the international classification of being overweight. Researching obesity in males is not as prevalent as studying obesity in females. Previous studies have rarely considered obesity type (android vs. gynoid), hormones (testosterone, androgen, etc.), awareness of body shape, or special resources such as exercise interventions to improve male weight issues. Adaptations to exercise interventions show individual variability as well as differences between men and women. Therefore, integrated approaches to research should be adopted, including evaluation of socio-demographic and physiological characteristics, to ensure that such interventions are not simply a symptomatic treatment but are actually treating the root cause of the obesity.

Food assessment: a discursive analysis of diet talk in interviews with older men who are obese

Objective: Obesity rates are increasing faster in men than in women, with particular concerns raised regarding older men. However, men are less likely than women to engage in weight-loss activities such as dieting, typically constructed as a feminine practice. Previous research has argued that men's food consumption is notably different and unhealthier than women's. The novel contribution of this article is an analysis of food assessments in order to explore how older men (mostly) undergoing weight management programmes make sense of changes in their nutritional intake. Design: Semi-structured interviews were conducted with 30 men who were obese, 27 of whom were engaged in weight loss programmes. Discursive psychology was employed to analyse the data. Results: In contrast to other research, participants constructed nutritional advice as enlightening. Participants worked up 'ownership' and pleasure assessments to certain food choices which they contrasted with new, less calorific, eating practices. Moreover, new diets were constructed as acceptable. Conclusion: Our study contributes new insights about how nutritional advice impacts upon preconceived (mis)understandings of healthy eating practices. During the interviews, men positioned themselves as educators - health promoters might usefully develop nutritional advice in collaboration with men who have successfully changed their diets for optimum effect.

Using avatars in weight management settings: A systematic review

BACKGROUND

Obesity interventions rely predominantly on managing dietary intake and/or increasing physical activity but sustained adherence to behavioural regimens is often poor. Avatar technology is well established within the computer gaming industry and evidence suggests that virtual representations of self may impact real-world behaviour, acting as a catalyst for sustained weight loss behaviour modification. However, the effectiveness of avatar technology in promoting weight loss is unclear.

AIMS

We aimed to assess the quantity and quality of empirical support for the use of avatar technologies in adult weight loss interventions.

METHOD

A systematic review of empirical studies was undertaken. The key objectives were to determine if: (i) the inclusion of avatar technology leads to greater weight loss achievement compared to routine intervention; and (ii) whether weight loss achievement is improved by avatar personalisation (avatar visually reflects self).

RESULTS

We identified 6 papers that reported weight loss data. Avatar-based interventions for weight loss management were found to be effective in the short (4-6 weeks) and medium (3-6 months) term and improved weight loss maintenance in the long term (12 months). Only 2 papers included avatar personalisation, but results suggested there may be some added motivational benefit.

CONCLUSIONS

The current evidence supports that avatars may positively impact weight loss achievement and improve motivation. However, with only 6 papers identified the evidence base is limited and therefore findings need to be interpreted with caution.

Game of Stones: feasibility randomised controlled trial of how to engage men with obesity in text message and incentive interventions for weight loss

OBJECTIVES

To examine the acceptability and feasibility of narrative text messages with or without financial incentives to support weight loss for men.

DESIGN

Individually randomised three-arm feasibility trial with 12 months' follow-up.

SETTING

Two sites in Scotland with high levels of disadvantage according to Scottish Index for Multiple Deprivation (SIMD).

PARTICIPANTS

Men with obesity (n=105) recruited through community outreach and general practitioner registers.

INTERVENTIONS

Participants randomised to: (A) narrative text messages plus financial incentive for 12 months (short message service (SMS)+I), (B) narrative text messages for 12 months (SMS only), or (C) waiting list control.

OUTCOMES

Acceptability and feasibility of recruitment, retention, intervention components and trial procedures assessed by analysing quantitative and qualitative data at 3, 6 and 12 months.

RESULTS

105 men were recruited, 60% from more disadvantaged areas (SIMD quintiles 1 or 2). Retention at 12 months was 74%. Fewer SMS+I participants (64%) completed 12-month assessments compared with SMS only (79%) and control (83%). Narrative texts were acceptable to many men, but some reported negative reactions. No evidence emerged that level of disadvantage was related to acceptability of narrative texts. Eleven SMS+I participants (31%) successfully met or partially met weight loss targets. The cost of the incentive per participant was £81.94 (95% CI £34.59 to £129.30). Incentives were acceptable, but improving health was reported as the key motivator for weight loss. All groups lost weight (SMS+I: -2.51 kg (SD=4.94); SMS only: -1.29 kg (SD=5.03); control: -0.86 kg (SD=5.64) at 12 months).

CONCLUSIONS

This three-arm weight management feasibility trial recruited and retained men from across the socioeconomic spectrum, with the majority from areas of disadvantage, was broadly acceptable to most participants and feasible to deliver.

TRIAL REGISTRATION NUMBER

NCT03040518.

Exploring the influences on men's engagement with weight loss services: a qualitative study

BACKGROUND

Engagement of men with commercial and UK National Health Service (NHS) weight loss services is low, and few studies report on why this may be. However, evidence shows that men who do participate in weight loss programmes tend to lose as much, or more weight than women. The present study aimed to explore men's experiences and expectations of mainstream weight loss services in the UK, following referral from a medical professional, particular in relation to barriers and motivators.

METHODS

Semi-structured interviews were conducted with 18 men with a BMI over 25 kg/m2 including those who had, and had not, attended group-based or one-to-one weight loss services. Interviews were analysed using thematic analysis.

RESULTS

Two themes were identified; 'Fear as a motivation for change' (1) and 'Attitudes towards existing weight loss services' (2). Within theme two, two subthemes were identified; 'Female dominated services' and 'Incompatibility of existing services for men'. The findings suggest that fear, as a result of a medical diagnosis or referral is a mechanism for motivating men to engage with weight loss services. This was often augmented by awareness of other people's experiences of poor health due to their weight. The gender imbalance and attitudes towards existing weight loss services deterred men from engaging with or continuously attending sessions. This imbalance resulted in feelings of self-consciousness, shame and a perceived stigma for men using weight loss services. These experiences highlighted the importance of providing services which align with men's preferences to promote engagement.

CONCLUSIONS

A medical diagnosis or referral serves as a strong motivator for men to engage with weight loss services by invoking fear of negative consequences of not losing weight. Men perceived weight loss services to be feminised spaces, in which they felt self-conscious and out of place. As a result, men were deterred from engaging and considered their options were limited. Implications for service design and commissioning are discussed. Involving men in research, service design and evaluation is key to improving their engagement and weight loss.

Putative functional variants of PI3K/AKT/mTOR pathway are associated with knee osteoarthritis susceptibility

BACKGROUND

Osteoarthritis (OA) is a degenerative musculoskeletal disease which causes joint deformity and pain and finally leads to limb dysfunction. Knee osteoarthritis (KOA) has the highest incidence among all kinds of OA. Strong evidence leads to the understanding that P13K/AKT/mTOR signaling is very important in cartilage degeneration.

METHODS

This research sought to understand the association between genetic variation of PI3K/AKT/mTOR genes and KOA susceptibility among Chinese population. All the genetic variants of PI3K/AKT/mTOR pathway were graded and selected using RegulomeDB database, and then, an association study including 278 osteoarthritis patients and 289 controls was conducted.

RESULTS

Finally, eight SNPs' genotypes' distributions and susceptibility to KOA were presented. AKT1 rs2498789 was associated with KOA susceptibility in dominate genetic model (AA + GA vs GG) after adjusted for BMI, age, and gender: OR = 1.46, 95% CI: 1.03-2.05, P = .03. PIK3CA rs7646409 was also associated with KOA susceptibility (TC vs TT) after adjusted for BMI, age, and gender: OR = 0.58, 95% CI: 0.36-0.93, P = .02. PIK3CA rs7646409 (TC vs TT) with KOA risk was more significant in age < 60 group (P for heterogeneity was .03). Risk score showed significant association with KOA susceptibility after cumulative analysis (OR = 2.45, 95% CI: 1.35-4.45, P = .003).

CONCLUSIONS

This study shows that genetic variation of PI3K/AKT/mTOR is associated with KOA susceptibility in Chinese Han population, indicating that PI3K/AKT/mTOR is very important in KOA pathogenesis.

Fractures in Adults After Weight Loss from Bariatric Surgery and Weight Management Programs for Obesity: Systematic Review and Meta-analysis

BACKGROUND

Weight loss interventions for obesity, such as bariatric surgery, are associated with reductions in bone mineral density and may increase the risk of fractures. We undertook a systematic review and meta-analysis of bariatric surgery and lifestyle weight management programs (WMPs) with fracture outcomes.

METHODS

We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials from 1966 to 2018, and our trial registry of WMP randomized controlled trials (RCTs). We included RCTs, non-randomized trials, and observational studies of bariatric surgery, and RCTs of WMPs. Studies had follow-up ≥ 12 months, mean group body mass index ≥ 30 kg/m². The primary outcome measure was incidence of any type of fracture in participants, and the secondary outcome was weight change. We used random effects meta-analysis for trial data.

RESULTS

Fifteen studies were included. Three small trials provided short-term evidence of the association between bariatric surgery and participants with any fracture (365 participants; RR 0.82; 95% CI 0.29 to 2.35). Four out of six observational studies of bariatric surgery demonstrated significantly increased fracture risk. Six RCTs of WMPs with 6214 participants, the longest follow-up 11.3 years, showed no clear effect on any type of fracture (RR 1.04; 95% CI 0.91 to 1.18), although authors of the largest RCT reported an increased risk of frailty fracture by their definition (RR 1.40; 95% CI 1.04 to 1.90).

CONCLUSION

Bariatric surgery appears to increase the risk of any fracture; however, longer-term trial data are needed. The effect of lifestyle WMPs on the risk of any fracture is currently unclear.

How men receive and utilise partner support when trying to change their diet and physical activity within a men's weight management programme

BACKGROUND

The impacts of interventions designed to change health behaviours are potentially affected by the complex social systems in which they are embedded. This study uses Scottish data to explore how men receive and utilise partner support when attempting to change dietary practices and physical activity within the context of Football Fans in Training (FFIT), a gender-sensitised weight management and healthy living programme for men who are overweight/obese.

METHODS

Separate semi-structured face-to-face interviews were conducted with 20 men and their cohabiting female partners (total n = 40), 3-12 months after the men had completed FFIT. Data were thematically analysed and individual interviews were combined for dyadic analysis.

RESULTS

Men's and women's accounts suggested variations in men's need for, and utilisation of, partner support in order to make changes to dietary practices and physical activity. There were also differences in descriptions of women's involvement in men's behaviour changes. Typologies were developed categorising men as 'resolute', 'reliant'/'receptive' and 'non-responsive' and women as 'very involved', 'partially involved' and 'not involved'. Men were more reliant, and women more involved, in changes to dietary practices compared to physical activity. The role of partner involvement in promoting men's behaviour change seemed contingent on men's resoluteness, or their reliance on the partner support.

CONCLUSIONS

These results highlight how interactions between men's resoluteness/reliance on cohabiting female partners and the partners' involvement impact the extent to which female partners influence men's changes to dietary practices and physical activity following a weight loss intervention. Understanding this interaction could increase the impact of health interventions aimed at one individual's behaviour by considering other family members' roles in facilitating those changes. The typologies developed for this study might contribute towards the development of behaviour change theories within the cohabiting couple context.

A systematic review of UK-based long-term nonsurgical interventions for people with severe obesity (BMI ≥35 kg m-2 )

Introduction

The aim of this project was to systematically review UK evidence on the effectiveness of long‐term (≥12 months) weight management services (WMSs) for weight loss and weight maintenance for adults (≥16 years) with severe obesity (body mass index ≥35 kg m⁻²), who would generally be eligible for Tier 3 services.

Methods

Four data sources were searched from 1999 to October 2018.

Results

Our searches identified 20 studies, mostly noncomparative studies: 10 primary care interventions, nine in secondary care specialist weight management clinics and one commercial setting intervention. A programme including a phase of low energy formula diet (810–833 kcal day⁻¹) showed the largest mean (SD) weight change at 12 months of –12.4 (11.4) kg for complete cases, with 25.3% dropout. Limitations or differences in evaluation and reporting (particularly for denominators), unclear dropout rates, and differences between participant groups in terms of comorbidities and psychological characteristics, made comparisons between WMSs and inferences challenging.

Conclusions

There is a persistent and clear need for guidance on long‐term weight data collection and reporting methods to allow comparisons across studies and services for participants with severe obesity. Data could also include quality of life, clinical outcomes, adverse events, costs and economic outcomes. A randomised trial comparison of National Health Service Tier 3 services with commercial WMSs would be of value.

A weight management programme for fathers of children aged 4–11 years: cultural adaptation and the Healthy Dads, Healthy Kids UK feasibility RCT

Background

More men than women in the UK are living with overweight or obesity, but men are less likely to engage with weight loss programmes. Healthy Dads, Healthy Kids is an effective Australian weight management programme that targets fathers, who participate with their primary school-aged children. Behavioural interventions do not always transfer between contexts, so an adaptation of the Healthy Dads, Healthy Kids programme to an ethnically diverse UK setting was trialled.

Objectives

To adapt and test the Australian Healthy Dads, Healthy Kids programme for delivery to men in an ethnically diverse, socioeconomically disadvantaged UK setting.

Design

Phase 1a studied the cultural adaptation of the Healthy Dads, Healthy Kids programme and was informed by qualitative data from fathers and other family members, and a theoretical framework. Phase 1b was an uncontrolled feasibility trial. Phase 2 was a randomised controlled feasibility trial.

Setting

Two ethnically diverse, socioeconomically disadvantaged UK cities.

Participants

In phase 1a, participants were parents and family members from black and minority ethnic groups and/or socioeconomically deprived localities. In phases 1b and 2, participants were fathers with overweight or obesity and their children aged 4–11 years.

Interventions

The adapted Healthy Dads, Healthy Kids intervention comprised nine sessions that targeted diet and physical activity and incorporated joint father–child physical activity. Healthy Dads, Healthy Kids was delivered in two programmes in phase 1b and four programmes in phase 2. Those in the comparator arm in phase 2 received a family voucher to attend a local sports centre.

Main outcome measures

The following outcomes were measured: recruitment to the trial, retention, intervention fidelity, attendance, feasibility of trial processes and collection of outcome data.

Results

Forty-three fathers participated (intervention group, n = 29) in phase 2 (48% of recruitment target), despite multiple recruitment locations. Fathers’ mean body mass index was 30.2 kg/m2 (standard deviation 5.1 kg/m2); 60.2% were from a minority ethnic group, with a high proportion from disadvantaged localities. Twenty-seven (63%) fathers completed follow-up at 3 months. Identifying sites for delivery at a time that was convenient for the families, with appropriately skilled programme facilitators, proved challenging. Four programmes were delivered in leisure centres and community venues. Of the participants who attended the intervention at least once (n = 20), 75% completed the programme (attended five or more sessions). Feedback from participants rated the sessions as ‘good’ or ‘very good’ and participants reported behavioural change. Researcher observations of intervention delivery showed that the sessions were delivered with high fidelity.

Conclusions

The intervention was well delivered and received, but there were significant challenges in recruiting overweight men, and follow-up rates at 3 and 6 months were low. We do not recommend progression to a definitive trial as it was not feasible to deliver the Healthy Dads, Healthy Kids programme to fathers living with overweight and obesity in ethnically diverse, socioeconomically deprived communities in the UK. More work is needed to explore the optimal ways to engage fathers from ethnically diverse socioeconomically deprived populations in research.

Trial registration

Current Controlled Trials ISRCTN16724454.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 2. See the NIHR Journals Library website for further project information.

Twelve-month outcomes of a father-child lifestyle intervention delivered by trained local facilitators in underserved communities: The Healthy Dads Healthy Kids dissemination trial

Healthy Dads Healthy Kids (HDHK) was the first program internationally to specifically target overweight and obese fathers to improve their children's health. In previous randomized controlled trials, HDHK generated meaningful short-term improvements in the adiposity, physical activity, and eating behaviors of both fathers and children. The aim of this dissemination trial was to evaluate the 12-month impact of HDHK when delivered by trained facilitators across four low socioeconomic and regional communities in the Hunter Region, Australia. The study was a nonrandomized, prospective trial with minimal eligibility criteria (i.e., father body mass index [BMI] ≥ 25 kg/m2 and children aged 4-12 years). HDHK included eight weekly practical and theoretical sessions. Assessments were baseline, 3 months (post-intervention), 6-months, and 12-months. The primary outcome was fathers' weight. Secondary outcomes included child BMI z-score and validated lifestyle behavior measures (e.g., physical activity, diet). Overall, 189 fathers (mean age: 40.2 years, BMI: 32.6 kg/m2) and 306 children (mean age: 8.1 years) participated in one of 10 HDHK programs in four areas. Intention-to-treat linear mixed models revealed a significant mean reduction in fathers' weight at post-intervention (-3.6 kg, 95% confidence interval: -4.3, -2.9), which was maintained at 12 months (71% retention). Corresponding improvements were also detected in children's BMI z-score and a range of lifestyle behaviors for both fathers and children. Attendance and satisfaction levels were high. Positive intervention effects observed in previous randomized controlled trials were largely replicated and sustained for 12 months when HDHK was delivered by trained local facilitators in underserved communities. Further investigation into the key systems, processes, and contextual factors required to deliver HDHK at scale appears warranted.

Healthy Dads, Healthy Kids UK, a weight management programme for fathers: feasibility RCT

OBJECTIVE

To assess (1) the feasibility of delivering a culturally adapted weight management programme, Healthy Dads, Healthy Kids United Kingdom (HDHK-UK), for fathers with overweight or obesity and their primary school-aged children, and (2) the feasibility of conducting a definitive randomised controlled trial (RCT).

DESIGN

A two-arm, randomised feasibility trial with a mixed-methods process evaluation.

SETTING

Socioeconomically disadvantaged, ethnically diverse localities in West Midlands, UK.

PARTICIPANTS

Fathers with overweight or obesity and their children aged 4-11 years.

INTERVENTION

Participants were randomised in a 1:2 ratio to control (family voucher for a leisure centre) or intervention comprising 9 weekly healthy lifestyle group sessions.

OUTCOMES

Feasibility of the intervention and RCT was assessed according to prespecified progression criteria: study recruitment, consent and follow-up, ability to deliver intervention, intervention fidelity, adherence and acceptability, weight loss, using questionnaires and measurements at baseline, 3 and 6 months, and through qualitative interviews.

RESULTS

The study recruited 43 men, 48% of the target sample size; the mean body mass index was 30.2 kg/m2 (SD 5.1); 61% were from a minority ethnic group; and 54% were from communities in the most disadvantaged quintile for socioeconomic deprivation. Recruitment was challenging. Retention at follow-up of 3 and 6 months was 63%. Identifying delivery sites and appropriately skilled and trained programme facilitators proved difficult. Four programmes were delivered in leisure centres and community venues. Of the 29 intervention participants, 20 (69%) attended the intervention at least once, of whom 75% attended ≥5 sessions. Sessions were delivered with high fidelity. Participants rated sessions as 'good/very good' and reported lifestyle behavioural change. Weight loss at 6 months in the intervention group (n=17) was 2.9 kg (95% CI -5.1 to -0.6).

CONCLUSIONS

The intervention was well received, but there were significant challenges in recruitment, programme delivery and follow-up. The HDHK-UK study was not considered feasible for progression to a full RCT based on prespecified stop-go criteria.

TRIAL REGISTRATION NUMBER

ISRCTN16724454.

Intermittent fasting interventions for treatment of overweight and obesity in adults: a systematic review and meta-analysis

OBJECTIVE

To examine the effectiveness of intermittent energy restriction in the treatment for overweight and obesity in adults, when compared to usual care treatment or no treatment.

INTRODUCTION

Intermittent energy restriction encompasses dietary approaches including intermittent fasting, alternate day fasting, and fasting for two days per week. Despite the recent popularity of intermittent energy restriction and associated weight loss claims, the supporting evidence base is limited.

INCLUSION CRITERIA

This review included overweight or obese (BMI ≥25 kg/m) adults (≥18 years). Intermittent energy restriction was defined as consumption of ≤800 kcal on at least one day, but no more than six days per week. Intermittent energy restriction interventions were compared to no treatment (ad libitum diet) or usual care (continuous energy restriction ∼25% of recommended energy intake). Included interventions had a minimum duration of 12 weeks from baseline to post outcome measurements. The types of studies included were randomized and pseudo-randomized controlled trials. The primary outcome of this review was change in body weight. Secondary outcomes included: i) anthropometric outcomes (change in BMI, waist circumference, fat mass, fat free mass); ii) cardio-metabolic outcomes (change in blood glucose and insulin, lipoprotein profiles and blood pressure); and iii) lifestyle outcomes: diet, physical activity, quality of life and adverse events.

METHODS

A systematic search was conducted from database inception to November 2015. The following electronic databases were searched: MEDLINE, Embase, CINAHL, Cochrane Library, ClinicalTrials.gov, ISRCTN registry, and anzctr.org.au for English language published studies, protocols and trials. Two independent reviewers evaluated the methodological quality of included studies using the standardized critical appraisal instruments from the Joanna Briggs Institute. Data were extracted from papers included in the review by two independent reviewers using the standardized data extraction tool from the Joanna Briggs Institute. Effect sizes were expressed as weighted mean differences and their 95% confidence intervals were calculated for meta-analyses.

RESULTS

Six studies were included in this review. The intermittent energy restriction regimens varied across studies and included alternate day fasting, fasting for two days, and up to four days per week. The duration of studies ranged from three to 12 months. Four studies included continuous energy restriction as a comparator intervention and two studies included a no treatment control intervention. Meta-analyses showed that intermittent energy restriction was more effective than no treatment for weight loss (-4.14 kg; 95% CI -6.30 kg to -1.99 kg; p ≤ 0.001). Although both treatment interventions achieved similar changes in body weight (approximately 7 kg), the pooled estimate for studies that investigated the effect of intermittent energy restriction in comparison to continuous energy restriction revealed no significant difference in weight loss (-1.03 kg; 95% CI -2.46 kg to 0.40 kg; p = 0.156).

CONCLUSIONS

Intermittent energy restriction may be an effective strategy for the treatment of overweight and obesity. Intermittent energy restriction was comparable to continuous energy restriction for short term weight loss in overweight and obese adults. Intermittent energy restriction was shown to be more effective than no treatment, however, this should be interpreted cautiously due to the small number of studies and future research is warranted to confirm the findings of this review.

Acceptability and feasibility of weight management programmes for adults with severe obesity: a qualitative systematic review

OBJECTIVES

To improve our understanding of the acceptability of behavioural weight management programmes (WMPs) for adults with severe obesity.

DESIGN

A systematic review of qualitative evidence.

DATA SOURCES

Medline, Embase, PsycINFO, CINAHL, SCI, SSCI and CAB abstracts were searched from 1964 to May 2017.

ELIGIBILITY CRITERIA

Papers that contained qualitative data from adults with body mass index (BMI) ≥35 kg/m² (and/or the views of providers involved in their care) and considered issues about weight management.

DATA EXTRACTION AND SYNTHESIS

Two reviewers read and systematically extracted data from the included papers which were compared, and contrasted according to emerging issues and themes. Papers were appraised for methodological rigour and theoretical relevance using Toye's proposed criteria for quality in relation to meta-ethnography.

RESULTS

33 papers met our inclusion criteria from seven countries published 2007-2017. Findings were presented from a total of 644 participants and 153 programme providers. Participants described being attracted to programmes that were perceived to be novel or exciting, as well as being endorsed by their healthcare provider. The sense of belonging to a group who shared similar issues, and who had similar physiques and personalities, was particularly important and seemed to foster a strong group identity and related accountability. Group-based activities were enjoyed by many and participants preferred WMPs with more intensive support. However, some described struggling with physical activities (due to a range of physical comorbidities) and not everyone enjoyed group interaction with others (sometimes due to various mental health comorbidities). Although the mean BMI reported across the papers ranged from 36.8 to 44.7 kg/m², no quotes from participants in any of the included papers were linked to specific detail regarding BMI status.

CONCLUSIONS

Although group-based interventions were favoured, people with severe obesity might be especially vulnerable to physical and mental comorbidities which could inhibit engagement with certain intervention components.

Men's Sheds: A conceptual exploration of the causal pathways for health and well-being

Although men have a lower life expectancy than women, and are more susceptible to illness, they have been found to be less likely to engage in health-seeking behaviour. Men's Sheds, as a gendered intervention, has been identified as an effective way to engage men in meaningful activity and gain social support from others. However, links between sheds and health and well-being are not well-documented, and evidence is lacking of the potential causal pathways to health generation. This study aims to develop a plausible empirically based causal theory of how Men's Sheds influence the health and well-being of their participants and to set out future research directions to test this theory. Drawing on a scoping review of academic, peer-reviewed journal articles published between 1990 and 2018, potential causal linkages between shed activity and health and well-being outcomes are synthesised into a logic model framework. Sixteen relevant peer-reviewed journal were identified from the academic literature. The data from the articles are predominantly self-reported, and characterised by small sample sizes and/ or low response rates. Further, information is lacking on the demographics of Men's Shed participants and the contexts in which they exist. Most notably, while there is some evidence on the potential mental health and social well-being impacts of shed activities, physical health is less documented. The study shows that there is a lack of reliable and systematic evidence of the potential causal pathways between Men's Shed activities and health and well-being outcomes. In order to address research gaps, further research is required to test and develop the proposed theory and logic model.

Clustering of the Deadliest Diseases among Iranian Men from 1990 to 2016: A Growth Mixture Model Approach

BACKGROUND

Paying attention to men's health seems quite important for a variety of reasons. We evaluated the change of mortality rates due to various causes in Iranian men over the past decades.

STUDY DESIGN

A cross-sectional study.

METHODS

The mortality rates for deadliest causes of diseases among Iranian men during 1990-2016 were extracted from the Global Burden of Disease (GBD) study. Latent Growth Mixture Models (LGMM) were applied to determine subgroups' cause of death. In this way, the causes within each group showed similar trends of mortality rates over time.

RESULTS

The LGMM clustered causes into 4 classes. Diabetes mellitus, hypertensive heart disease and neurological disorders have had increasing trend. Causes in class 2, including diarrhea, lower respiratory and other common infectious diseases, ischemic heart disease, ischemic stroke, neonatal disorders, and other non-communicable diseases manifested a slow decreasing trend. Most causes were allocated to 3rd class with a slow increase in mortality rates over time. Finally, within the last class, transport injuries and unintentional injuries revealed a decreasing trend.

CONCLUSION

Most factors have rising trend, despite the fact that some have shown a very slight downward trend. Consequently, according to the four distinguished clusters resulting from LGMM, it is essential to provide programs to attain the goal of access to prevention, treatment, and support for high-risk mortality factors.

Assessment of Blood Donation and Transfusion in Eastern Uganda: A Mixed-Methods Study

BACKGROUND

Blood and blood products are essential in the management of injuries, medical illnesses, and childbirth. Chronic shortages in the blood supply perpetuates the high levels of morbidity and mortality from injury and treatable diseases. Patients in low- and middle-income countries are frequently unable to access blood units necessary for transfusion in a timely manner.

OBJECTIVES

This study aimed to gain insight into the community and hospital factors that contribute to the observed insufficient supply of blood units available for transfusion at a regional referral hospital in rural Eastern Uganda.

METHODS

A mixed-methods approach was utilized; community members were surveyed on knowledge, attitudes, and practices of blood donation and health professionals were queried on hospital factors affecting blood transfusions. Transfusion records were prospectively collected and analyzed, and the pathway of a single blood unit was observed and recorded.

FINDINGS

Among the 82 community members that were surveyed, knowledge was poor (&lt;50% correct) regarding age, weight, and volume of blood to be able to donate, but participants were overall knowledgeable on general characteristics that would exclude individuals from donating blood. Major themes elicited during qualitative interviews included a positive attitude towards and lack of information regarding blood donation. Health professionals expressed frustration in delayed testing of transfusion transmissible infections. The majority of blood transfusions were allocated to female patients (55.8%) and children under five years of age (33.2%).

CONCLUSIONS

Broadened inclusion and education of the general population in blood donation and increased outreach programs may be promising interventions to increase the blood supply at the Soroti Regional Referral Hospital. To reduce the current bottleneck seen in TTI testing, the feasibility and cost-effectiveness of local TTI testing technology should be investigated further.

Rugby Fans in Training New Zealand (RUFIT-NZ): a pilot randomized controlled trial of a healthy lifestyle program for overweight men delivered through professional rugby clubs in New Zealand

Background

Healthy lifestyle programs that are designed specifically to appeal to and support men to improve lifestyle behaviors and lose weight are needed. The Rugby Fans in Training-New Zealand (RUFIT-NZ) program is delivered by professional rugby clubs and inspired by the successful Football Fans In Training program (FFIT), a gender sensitized weight loss program for obese middle-aged men delivered by professional football clubs in Scotland. RUFIT-NZ required development and evaluation for feasibility.

Methods

To develop the intervention we reviewed content from the FFIT program and evidence-based physical activity, dietary and weight management guidelines, and undertook a series of focus groups and key informant interviews. We then evaluated the feasibility of the intervention in a two-arm, parallel, pilot randomized controlled trial in New Zealand. Ninety-six participants were randomized to either the 12-week RUFIT-NZ intervention (N = 49) or a control group (N = 47). The intervention was delivered through professional rugby clubs and involved physical activity training and classroom sessions on healthy lifestyle behaviors. Pilot trial outcomes included body weight, heart rate, blood pressure, cardiorespiratory fitness, and lifestyle behaviors. Feasibility was assessed by recruitment and retention rates, and acceptability of the intervention.

Results

At 12 weeks the mean difference in body weight was 2.5 kg (95% CI -0.4 to 5.4), which favored the intervention. Statistically significant differences in favor of the intervention group were also observed for waist circumference, resting heart rate, diastolic blood pressure, cardiorespiratory fitness, and the proportion of participants that were adherent to 3 or more healthy lifestyle behaviors. The intervention was considered feasible to test in a full trial given the good recruitment and retention rates, and positive feedback from participants.

Conclusions

A pilot study of a healthy lifestyle intervention delivered via professional rugby clubs in New Zealand demonstrated positive effects on weight and physiological outcomes, as well as adherence to lifestyle behaviors. Feasibility issues in terms of recruitment, retention, and participant acceptability were assessed and findings will be used to inform the design of a definitive trial.

Trial registration

The trial was prospectively registered with the Australian New Zealand Clinical Trials Registry ACTRN12616000137493, 05/12/2016.

The effect of a programme to improve men's sedentary time and physical activity: The European Fans in Training (EuroFIT) randomised controlled trial

BACKGROUND

Reducing sitting time as well as increasing physical activity in inactive people is beneficial for their health. This paper investigates the effectiveness of the European Fans in Training (EuroFIT) programme to improve physical activity and sedentary time in male football fans, delivered through the professional football setting.

METHODS AND FINDINGS

A total of 1,113 men aged 30-65 with self-reported body mass index (BMI) ≥27 kg/m2 took part in a randomised controlled trial in 15 professional football clubs in England, the Netherlands, Norway, and Portugal. Recruitment was between September 19, 2015, and February 2, 2016. Participants consented to study procedures and provided usable activity monitor baseline data. They were randomised, stratified by club, to either the EuroFIT intervention or a 12-month waiting list comparison group. Follow-up measurement was post-programme and 12 months after baseline. EuroFIT is a 12-week, group-based programme delivered by coaches in football club stadia in 12 weekly 90-minute sessions. Weekly sessions aimed to improve physical activity, sedentary time, and diet and maintain changes long term. A pocket-worn device (SitFIT) allowed self-monitoring of sedentary time and daily steps, and a game-based app (MatchFIT) encouraged between-session social support. Primary outcome (objectively measured sedentary time and physical activity) measurements were obtained for 83% and 85% of intervention and comparison participants. Intention-to-treat analyses showed a baseline-adjusted mean difference in sedentary time at 12 months of -1.6 minutes/day (97.5% confidence interval [CI], -14.3-11.0; p = 0.77) and in step counts of 678 steps/day (97.5% CI, 309-1.048; p < 0.001) in favor of the intervention. There were significant improvements in diet, weight, well-being, self-esteem, vitality, and biomarkers of cardiometabolic health in favor of the intervention group, but not in quality of life. There was a 0.95 probability of EuroFIT being cost-effective compared with the comparison group if society is willing to pay £1.50 per extra step/day, a maximum probability of 0.61 if society is willing to pay £1,800 per minute less sedentary time/day, and 0.13 probability if society is willing to pay £30,000 per quality-adjusted life-year (QALY). It was not possible to blind participants to group allocation. Men attracted to the programme already had quite high levels of physical activity at baseline (8,372 steps/day), which may have limited room for improvement. Although participants came from across the socioeconomic spectrum, a majority were well educated and in paid work. There was an increase in recent injuries and in upper and lower joint pain scores post-programme. In addition, although the five-level EuroQoL questionnaire (EQ-5D-5L) is now the preferred measure for cost-effectiveness analyses across Europe, baseline scores were high (0.93), suggesting a ceiling effect for QALYs.

CONCLUSION

Participation in EuroFIT led to improvements in physical activity, diet, body weight, and biomarkers of cardiometabolic health, but not in sedentary time at 12 months. Within-trial analysis suggests it is not cost-effective in the short term for QALYs due to a ceiling effect in quality of life. Nevertheless, decision-makers may consider the incremental cost for increase in steps worth the investment.

TRIAL REGISTRATION

International Standard Randomised Controlled Trials, ISRCTN-81935608.

A lifestyle management programme focused on exercise, diet and physiotherapy support for patients with hip or knee osteoarthritis and a body mass index over 35: A qualitative study

The Lifestyle Management Programme (LMP) is an exercise and weight management programme with physiotherapy support for people with hip or knee osteoarthritis (OA) and a body mass index (BMI) over 35. This qualitative study explored views and experiences of the LMP among patients and professionals, and offers insight for future programmes. Five referring clinicians and six delivering professionals participated in focus groups. Three referring GPs and nine patients who attended the LMP took part in semi-structured interviews. Topics included: referral, reasons for taking up and continuing the programme or not, and experiences and outcomes. Framework method was used to analyse the qualitative data. Overall, patients and professionals valued the multidisciplinary nature of the LMP. However, professionals explained feeling guilty about delaying patients on the orthopaedic waiting list and believed that the programme should be redirected to those with less severe OA and a lower BMI. Referring clinicians differed in their interpretation of the referral criteria and expressed varying levels of autonomy when making referrals. Patients referred after a consultation with their general practitioner appeared to be more satisfied with the referral process. Patients were also encouraged by the opportunity to improve health, their likelihood of surgery and social benefits. However, patients were discouraged by inconvenience, cost, lack of readiness to change and embarrassment. In conclusion, shared decision-making about lifestyle management without delaying orthopaedic opinion is preferable, and more psychological support may increase participation. Importantly, the programme may be better focused on rehabilitation for patients with a lower BMI and less severe symptoms.

Changes in Psychosocial Factors and Physical Activity Among Finnish Working-Age Men in the Adventures of Joe Finn Campaign

This study evaluated changes in psychosocial factors and self-reported physical activity (PA) among the sample of Finnish men who underwent the fitness tests during the national health campaign. Another aim was to examine whether the fitness test feedback was a meaningful experience for PA change. Baseline data were collected in 2011 by fitness test and questionnaire. Men who had low/moderate fitness along with overweight ( n = 361) were recruited to the postcampaign study in 2014. Data were analyzed with nonparametric tests, logistic regression analysis, and content analysis. The postcampaign survey was completed by 102 men. Positive PA change was associated with high goals, planning skills, and self-efficacy for PA. One fourth of men recalled that they had surprisingly poor fitness at baseline. This experience was not related to positive PA change. A fitness test may awake motivation, but promotion of self-efficacy and self-regulatory skills is needed to support concrete behavior change.

Bariatric surgery, lifestyle interventions and orlistat for severe obesity: the REBALANCE mixed-methods systematic review and economic evaluation

BACKGROUND

Adults with severe obesity [body mass index (BMI) of ≥ 35 kg/m2] have an increased risk of comorbidities and psychological, social and economic consequences.

OBJECTIVES

Systematically review bariatric surgery, weight-management programmes (WMPs) and orlistat pharmacotherapy for adults with severe obesity, and evaluate the feasibility, acceptability, clinical effectiveness and cost-effectiveness of treatment.

DATA SOURCES

Electronic databases including MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials and the NHS Economic Evaluation Database were searched (last searched in May 2017).

REVIEW METHODS

Four systematic reviews evaluated clinical effectiveness, cost-effectiveness and qualitative evidence for adults with a BMI of ≥ 35 kg/m2. Data from meta-analyses populated a microsimulation model predicting costs, outcomes and cost-effectiveness of Roux-en-Y gastric bypass (RYGB) surgery and the most effective lifestyle WMPs over a 30-year time horizon from a NHS perspective, compared with current UK population obesity trends. Interventions were cost-effective if the additional cost of achieving a quality-adjusted life-year is < £20,000-30,000.

RESULTS

A total of 131 randomised controlled trials (RCTs), 26 UK studies, 33 qualitative studies and 46 cost-effectiveness studies were included. From RCTs, RYGB produced the greatest long-term weight change [-20.23 kg, 95% confidence interval (CI) -23.75 to -16.71 kg, at 60 months]. WMPs with very low-calorie diets (VLCDs) produced the greatest weight loss at 12 months compared with no WMPs. Adding a VLCD to a WMP gave an additional mean weight change of -4.41 kg (95% CI -5.93 to -2.88 kg) at 12 months. The intensive Look AHEAD WMP produced mean long-term weight loss of 6% in people with type 2 diabetes mellitus (at a median of 9.6 years). The microsimulation model found that WMPs were generally cost-effective compared with population obesity trends. Long-term WMP weight regain was very uncertain, apart from Look AHEAD. The addition of a VLCD to a WMP was not cost-effective compared with a WMP alone. RYGB was cost-effective compared with no surgery and WMPs, but the model did not replicate long-term cost savings found in previous studies. Qualitative data suggested that participants could be attracted to take part in WMPs through endorsement by their health-care provider or through perceiving innovative activities, with WMPs being delivered to groups. Features improving long-term weight loss included having group support, additional behavioural support, a physical activity programme to attend, a prescribed calorie diet or a calorie deficit.

LIMITATIONS

Reviewed studies often lacked generalisability to UK settings in terms of participants and resources for implementation, and usually lacked long-term follow-up (particularly for complications for surgery), leading to unrealistic weight regain assumptions. The views of potential and actual users of services were rarely reported to contribute to service design. This study may have failed to identify unpublished UK evaluations. Dual, blinded numerical data extraction was not undertaken.

CONCLUSIONS

Roux-en-Y gastric bypass was costly to deliver, but it was the most cost-effective intervention. Adding a VLCD to a WMP was not cost-effective compared with a WMP alone. Most WMPs were cost-effective compared with current population obesity trends.

FUTURE WORK

Improved reporting of WMPs is needed to allow replication, translation and further research. Qualitative research is needed with adults who are potential users of, or who fail to engage with or drop out from, WMPs. RCTs and economic evaluations in UK settings (e.g. Tier 3, commercial programmes or primary care) should evaluate VLCDs with long-term follow-up (≥ 5 years). Decision models should incorporate relevant costs, disease states and evidence-based weight regain assumptions.

STUDY REGISTRATION

This study is registered as PROSPERO CRD42016040190.

FUNDING

The National Institute for Health Research Health Technology Assessment programme. The Health Services Research Unit and Health Economics Research Unit are core funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorate.

Protocol for a gender-sensitised weight loss and healthy living programme for overweight and obese men delivered in Australian football league settings (Aussie-FIT): A feasibility and pilot randomised controlled trial

INTRODUCTION

Overweight and obesity are highly prevalent among Australian men. Professional sports settings can act as a powerful 'hook' to engage men in weight loss programmes; the Football Fans in Training programme delivered in professional UK soccer clubs was successful and cost-effective in helping men lose weight. The Australian Football League (AFL) is a potentially attractive setting to engage men in a weight loss programme. We aim to develop, pilot and evaluate the feasibility of a weight loss intervention for overweight/obese middle-aged men, delivered in AFL settings, to promote weight loss and healthier lifestyles and determine its suitability for a future randomised control trial.

METHODS AND ANALYSIS

120 overweight/obese male fans will complete baseline physical and psychological health measures and objective measures of physical activity (PA), weight, waist size and blood pressure prior to randomisation into the intervention or waitlist comparison group. The intervention group will receive 12 weekly 90 min workshops incorporating PA, nutrition education, behaviour change techniques and principles of effective motivation. Four community coaches will be trained to deliver Aussie-FIT at two AFL clubs in Western Australia. Measurements will be repeated in both groups at 3 months (post-intervention) and 6 months (follow-up). Outcomes will include programme uptake, attendance, changes in lifestyle and weight variables to inform power calculations for a future definitive trial, fidelity of programme delivery, acceptability, satisfaction with the programme and perceptions of effectiveness. We will also determine trial feasibility and potential to gather cost-effectiveness data.

ETHICS AND DISSEMINATION

Ethics approval was granted by Curtin University's Human Research Ethics Committee (HREC2017-0458). Results will be disseminated via peer-reviewed publications, conference presentations and reports. A multicomponent dissemination strategy will include targeted translation and stakeholder engagement events to establish strategies for sustainability and policy change.

TRIAL REGISTRATION NUMBER

ACTRN12617000515392; Pre-results.

A review and critique of published real-world weight management program studies

BACKGROUND

Beyond the essential but somewhat artificial conditions that typify formal clinical studies, real-world evidence (RWE) of weight loss program effectiveness is paramount for an accurate assessment of such programs and refinement of best practices.

OBJECTIVES

To evaluate the current state of RWE studies and publications on weight loss, identify the range of weight loss components being used in RWE programs, and to provide a general overview of the consistency or lack of consistency with regard to measuring and reporting outcomes.

METHODS

A structured search of PubMed was performed to identify relevant English-language publications from 2006 to December 2017 that reported real-world studies of weight loss among adults. Duplicates, non-relevant publications, articles on weight loss surgery, pediatric studies, randomized controlled trials, studies with self-reported weight loss, no objective weight measures, or that failed to include weight loss results were excluded.

RESULTS

This review included 62 RWE publications. Forty-nine studies included dietary intervention, 37 included exercise, 29 included motivational counseling, and 5 contained some patients who had pharmacologic treatment as part of their weight loss regimen. The numbers of participants per study ranged from 10 to more than 3 million. The interventions reported in the publications included diet, exercise, counseling to promote diet and/or exercise, motivational counseling, and pharmacotherapy, and various combinations of these.

CONCLUSIONS

Despite general acceptance that weight loss programs are capable of facilitating successful outcomes, this review revealed substantial inconsistency in the design and reporting of such programs, making it very difficult to draw conclusions about the comparative merits of different real-world weight loss strategies/components. In addition, there was a marked lack of congruence with current weight loss management guidelines, and notably few studies incorporating anti-obesity medications. There clearly is a need for greater rigor and standardization among designing and reporting RWE weight-loss studies.

A mixed-methods evaluation of a community pharmacy signposting service to a commercial weight-loss provider

OBJECTIVE

Community pharmacies could provide access for clients to commercial weight management organizations. We evaluated recruitment, referral and outcomes of adults provided with free vouchers by community pharmacies to attend Scottish Slimmers classes.

DESIGN

Prospective cohort design with qualitative interviews with clients and pharmacy personnel. Scottish Slimmers collected weight and attendance data.

SETTING

Pharmacies in Aberdeen City, Scotland.

SUBJECTS

Clients aged ≥18 years with BMI≥30 kg/m2.

RESULTS

Ten of twenty-three pharmacies were recruited; eight successfully recruited clients. Of 129 clients recruited, ninety-seven (75 %) attended at least one class and fifty-one (40 %) attended all twelve classes. At baseline, clients' mean weight was 99·4 (sd 17·5) kg, mean BMI was 37·8 (sd 6·0) kg/m2. After 12 weeks, mean weight change was -3·7 % (last observation carried forward) or -2·8 % (baseline observation carried forward) for all ninety-seven clients. Client interviews indicated that many individuals would have not addressed their weight problems if this referral service had not been available. They had positive attitudes towards the pharmacy signposting service, attributed to the use of consultation rooms for privacy, receiving professional service from personnel and ongoing support and encouragement. The free provision of 12-week access facilitated participation. Service providers had positive attitudes and indicated their willingness to provide this service in future.

CONCLUSIONS

Community pharmacies could be used to increase access to weight management services, with pharmacy personnel providing additional support to clients. Future provision of pharmacy referral schemes should be evaluated on a larger scale with an economic evaluation.

Long-term weight loss following a randomised controlled trial of a weight management programme for men delivered through professional football clubs: the Football Fans in Training follow-up study

Background

Rising levels of obesity require interventions that support people in long-term weight loss. The Football Fans in Training (FFIT) programme uses loyalty to football teams to engage men in weight loss. In 2011/12, a randomised controlled trial (RCT) found that the FFIT programme was effective in helping men lose weight up to 12 months.

Objectives

To investigate the long-term weight, and other physical, behavioural and psychological outcomes up to 3.5 years after the start of the RCT; the predictors, mediators and men’s qualitative experiences of long-term weight loss; cost-effectiveness; and the potential for long-term follow-up via men’s medical records.

Design

A mixed-methods, longitudinal cohort study.

Setting

Thirteen professional Scottish football clubs from the RCT and 16 additional Scottish football clubs that delivered the FFIT programme in 2015/16.

Participants

A total of 665 men who were aged 35–65 years at the RCT baseline measures and who consented to follow-up after the RCT (intervention group, n = 316; comparison group, n = 349), and 511 men who took part in the 2015/16 deliveries of the FFIT programme.

Interventions

None as part of this study.

Main outcome measures

Objectively measured weight change from the RCT baseline to 3.5 years.

Results

In total, 488 out of 665 men (73.4%) attended 3.5-year measurements. Participants in the FFIT follow-up intervention group sustained a mean weight loss from baseline of 2.90 kg [95% confidence interval (CI) 1.78 to 4.02 kg; p < 0.001], and 32.2% (75/233) weighed ≥ 5% less than at baseline. Participants in the FFIT follow-up comparison group (who participated in routine deliveries of the FFIT programme after the RCT) lost a mean of 2.71 kg (95% CI 1.65 to 3.77 kg; p < 0.001), and 31.8% (81/255) achieved ≥ 5% weight loss. Both groups showed long-term improvements in body mass index, waist circumference, percentage body fat, blood pressure, self-reported physical activity (PA) (including walking), the consumption of fatty and sugary foods, fruit and vegetables and alcohol, portion sizes, self-esteem, positive and negative affect, and physical and mental health-related quality of life (HRQoL). Mediators included self-reported PA (including walking) and sitting time, the consumption of fatty and sugary foods and fruit and vegetables, portion sizes, self-esteem, positive affect, physical HRQoL, self-monitoring of weight, autonomous regulation, internal locus of control, perceived competence, and relatedness to other FFIT programme participants and family members. In qualitative interviews, men described continuing to self-monitor weight and PA. Many felt that PA was important for weight control, and walking remained popular; most were still aware of portion sizes and tried to eat fewer snacks. The FFIT programme was associated with an incremental cost-effectiveness of £10,700–15,300 per quality-adjusted life-year (QALY) gained at 3.5 years, and around £2000 per QALY gained in the lifetime analysis. Medical record linkage provided rich information about the clinical health outcomes of the FFIT RCT participants, and 90% of men (459/511) who took part in the 2015/16 FFIT programme gave permission for future linkage.

Conclusions

Participation in the FFIT programme under both research (during the FFIT RCT) and routine (after the FFIT RCT) delivery conditions led to significant long-term weight loss. Further research should investigate (1) how to design programmes to improve long-term weight loss maintenance, (2) longer-term follow-up of FFIT RCT participants and (3) very long-term follow-up via medical record linkage.

Trial registration

Current Controlled Trials ISRCTN32677491.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 6, No. 9. See the NIHR Journals Library website for further project information. The Scottish Executive Health Department Chief Scientist Office (CSO) funded the feasibility pilot that preceded the FFIT RCT (CZG/2/504). The Medical Research Council (MRC) funded Kate Hunt and additional developmental research through the MRC/CSO Social and Public Health Sciences Unit Gender and Health programme (5TK50/25605200-68094).

Investigation of the long-term sustainability of changes in appetite after weight loss

Background/Objective

Diet-induced weight loss (WL) leads to a compensatory increase in appetite and changes in the plasma concentration of appetite-regulating hormones are likely to play a role. Whether these changes are transient or sustained remains unclear. This study aimed to assess if changes in subjective and objective appetite markers observed with WL are sustained after 1 year (1Y).

Subjects/Methods

In total 100 (45 males) individuals with obesity (BMI: 37 ± 4 kg/m², age: 43 ± 10 years) underwent 8 weeks (wks) of a very-low energy diet (VLED), followed by 4 wks refeeding, and a 1Y maintenance program. Fasting/postprandial subjective ratings of hunger, fullness, desire to eat, and prospective food consumption (PFC) were assessed, and plasma concentration of active ghrelin (AG), total peptide YY (PYY), active glucagon-like peptide 1, cholecystokinin (CCK), and insulin measured, at baseline, week 13 (Wk13) and 1Y.

Results

At Wk13, 16% WL (−18 ± 1 kg, P < 0.001) was associated with a significant increase in fasting and postprandial hunger ratings (P < 0.01 and P < 0.05, respectively), and postprandial fullness (P < 0.01) combined with a reduction in PFC (P < 0.001). These were accompanied by a significant rise in basal and postprandial AG concentrations (P < 0.001, for both), a reduction in postprandial CCK (P < 0.01) and in basal and postprandial insulin (P < 0.001). At 1Y follow-up, with sustained WL (15%; −16 ± 1 kg, P < 0.001), fasting hunger and postprandial fullness ratings remained increased (P < 0.05 for both), and postprandial PFC reduced (P < 0.001). Basal and postprandial AG remained elevated and insulin reduced (P < 0.001, for all), while postprandial CCK was increased (P < 0.01) and PYY decreased (P < 0.001).

Conclusion

With a 15% sustained WL at 1Y, the drive to eat in the fasting state is increased, but this may be balanced out by raised postprandial feelings of fullness. To assist with WL maintenance, new strategies are required to manage increased hunger and drive to eat.

A mixed method evaluation of adult tier 2 lifestyle weight management service provision across a county in Northern England

Adult obesity in the UK remains a public health priority. Current guidance recommends local areas provide multicomponent interventions to treat adults with overweight and obesity; however, there is currently a dearth of published evidence on the evaluation of these programmes. This study reports on a mixed method evaluation of seven tier 2 weight management programmes funded by a local authority in the North of England through their public health grant (a lifestyle multicomponent weight management programme for the treatment of adults with overweight and obesity, but not severe obesity, or obesity with severe co-morbidities). Data collected from over 2000 participants demonstrated that the proportion of participants achieving 5% initial body weight loss was comparable to that reported in recent UK weight management trials. Two services exceeded national criteria of 30% of participants achieving 5% initial body weight loss at 12 weeks, although long term data was limited. Greater weight loss was also observed in participants aged 35-44 and those without co-morbidities. This study provides important learning points for improvements in real world weight management services, these include: standardised data collection and management tools; staff training and communication requirements; the importance of programmes that are joined up to wider support services; and the importance of providing ongoing peer and provider support, continuous monitoring and feedback, and physical activities tailored to user needs.

Coping Strategies, Psychological Impact, and Support Preferences of Men With Rheumatoid Arthritis: A Multicenter Survey

Objective

To investigate the existence and distribution of 2 typologies (termed “factors”) of men with rheumatoid arthritis (RA) identified through our previous Q‐methodology study (n = 30) in a larger sample of men with RA, and whether differences in psychosocial impact or support preferences exist between the 2 factors, and between men and women with RA.

Methods

A postal survey was sent to 620 men with RA from 6 rheumatology units across England, and the support preferences section of the survey was given to 232 women with RA.

Results

A total of 295 male patients (47.6%) and 103 female patients (44.4%) responded; 15 male participants had missing data, and thus 280 were included in the analysis. Of these, 61 (22%) were assigned to factor A (“accept and adapt”), 120 (35%) were assigned to factor B (“struggling to match up”), and 99 (35%) were unassigned. The two factors differed significantly, with factor B reporting more severe disease, less effective coping strategies, and poorer psychological status. For support, men favored a question and answer session with a consultant (54%) or specialist nurse (50%), a website for information (69%), a talk by researchers (54%), or a symptom management session (54%). Overall, women reported more interest in support sessions than men, with ≥50% of women reporting interest in nearly every option provided.

Conclusion

Some men accept and adapt to their RA, but others (43%) report severe disease, less effective coping, and poor psychological status. Men's preferences for support are practical, with a focus on expanding their knowledge.

The importance of service-users' perspectives: A systematic review of qualitative evidence reveals overlooked critical features of weight management programmes

Background

Extensive research effort shows that weight management programmes (WMPs) targeting both diet and exercise are broadly effective. However, the critical features of WMPs remain unclear.

Objective

To develop a deeper understanding of WMPs critical features, we undertook a systematic review of qualitative evidence. We sought to understand from a service‐user perspective how programmes are experienced, and may be effective, on the ground.

Search strategy

We identified qualitative studies from existing reviews and updated the searches of one review.

Inclusion criteria

We included UK studies capturing the views of adult WMP users.

Data extraction and synthesis

Thematic analysis was used inductively to code and synthesize the evidence.

Main results

Service users were emphatic that supportive relationships, with service providers or WMP peers, are the most critical aspect of WMPs. Supportive relationships were described as providing an extrinsic motivator or “hook” which helped to overcome barriers such as scepticism about dietary advice or a lack confidence to engage in physical activity.

Discussion and conclusions

The evidence revealed that service‐users’ understandings of the critical features of WMPs differ from the focus of health promotion guidance or descriptions of evaluated programmes which largely emphasize educational or goal setting aspects of WMPs. Existing programme guidance may not therefore fully address the needs of service users. The study illustrates that the perspectives of service users can reveal unanticipated intervention mechanisms or underemphasized critical features and underscores the value of a holistic understanding about “what happens” in complex psychosocial interventions such as WMPs.

Hockey Fans in Training: A Pilot Pragmatic Randomized Controlled Trial

Introduction

Hockey Fans in Training (Hockey FIT) is a gender-sensitized weight loss and healthy lifestyle program. We investigated 1) feasibility of recruiting and retaining overweight and obese men into a pilot pragmatic randomized controlled trial and 2) potential for Hockey FIT to lead to weight loss and improvements in other outcomes at 12 wk and 12 months.

Methods

Male fans of two ice hockey teams (35–65 yr; body mass index ≥28 kg·m⁻²) located in Ontario (Canada) were randomized to intervention (Hockey FIT) or comparator (wait-list control). Hockey FIT includes a 12-wk active phase (weekly, coach-led group meetings including provision of dietary information, practice of behavior change techniques, and safe exercise sessions plus incremental pedometer walking) and a 40-wk minimally supported phase (smartphone app for sustaining physical activity, private online social network, standardized e-mails, booster session/reunion). Measurement at baseline and 12 wk (both groups) and 12 months (intervention group only) included clinical outcomes (e.g., weight) and self-reported physical activity, diet, and self-rated health.

Results

Eighty men were recruited in 4 wk; trial retention was >80% at 12 wk and >75% at 12 months. At 12 wk, the intervention group lost 3.6 kg (95% confidence interval, −5.26 to −1.90 kg) more than the comparator group (P < 0.001) and maintained this weight loss to 12 months. The intervention group also demonstrated greater improvements in other clinical measures, physical activity, diet, and self-rated health at 12 wk; most sustained to 12 months.

Conclusions

Results suggest feasible recruitment/retention of overweight and obese men in the Hockey FIT program. Results provide evidence for the potential effectiveness of Hockey FIT for weight loss and improved health in at-risk men and, thus, evidence to proceed with a definitive trial.

Men's reactions to receiving objective feedback on their weight, BMI and other health risk indicators

BACKGROUND

Receiving information about one's weight, Body Mass Index (BMI) and other indicators of health risk may prompt behaviour change. This study investigated men's reactions to receiving information on indicators of health risk prior to taking part in a men-only weight management programme, Football Fans in Training (FFIT). It also investigated the extent to which the information was reported as influencing lifestyle change and having adverse consequences.

METHODS

We undertook a qualitative, semi-structured, telephone interview study with 28 men who took part in FFIT. We sought to interview approximately equal numbers of men who had and had not lost 5% or more of their pre-programme body weight by the end of the 12-week programme. Data were analysed thematically utilising principles of framework analysis.

RESULTS

Some men were apprehensive about receiving information which confirmed their overweight/obese status, particularly those less familiar with having similar information fed back to them. The professional football setting and the people present (including other men on the programme whom they perceived to be 'like them' and the fieldwork staff) were important factors in making the men feel comfortable in an otherwise potentially threatening situation. Men who achieved greater weight loss were more likely to report being motivated by this pre-programme feedback and to perceive themselves as responsible for their current weight and health status. However, for others the information only reaffirmed what they suspected about their relatively poor health status and was insufficient to prompt behaviour change.

CONCLUSION

Undertaking measurements and receiving information on health risk indicators, such as weight or BMI, within the context of behaviour change programmes can enhance motivation for behaviour change when communicated in an empathic and non-stigmatising way, and therefore should be considered as an integral part of interventions. However, providing feedback on health risk may be insufficient to prompt behaviour change in some people and may be detrimental to those with poor body image and/or lacking personal agency to adopt lifestyle changes. It is therefore imperative that adequate support and opportunities are made available when information on weight and disease risk are fed back within research or other settings.

Integrating prevention and health promotion in a London prison

Many people enter prison with poor health from a background of deprivation and with unhealthy lifestyle habits, yet spending time in prisons is often actively detrimental to health. There is therefore a clear value in providing high-quality health promotion services in prisons that are effective at reaching those who need support to improve their lifestyle. The health promotion service at HMP Brixton provides a health trainers clinic to address lifestyle issues but found that it was sometimes challenging to identify appropriate patients and that the service was inefficient as a result. Analysis of our referral sources suggested that taking steps to increase the proportion of referrals made during screening and other clinics might lead to more appropriate and engaged patients. In this study, we set out to use quality improvement methods to increase referral from these sources. This involved improvements to the processes involved in delivering National Health Service Health Checks that were the primary source of referrals for health trainers and by improving links between the health trainer team and other clinicians. The changes were successful in increasing referrals from these sources. This work was completed during a period of exceptional disruption in the prison service and is relevant to secure healthcare sites that aim to ensure prevention activities are efficient and targeted.

Effect of a Gender-Tailored eHealth Weight Loss Program on the Depressive Symptoms of Overweight and Obese Men: Pre-Post Study

BACKGROUND

Obesity and depression are of two of the largest contributors to the global burden of disease in men. Although lifestyle behavior change programs can improve participants' weight and depressive symptoms, the evidence is limited by a lack of male participants and a reliance on face-to-face treatment approaches, which are not accessible or appealing for many men.

OBJECTIVE

This study examined the effect of a gender-tailored electronic health (eHealth) program on the depressive symptoms of a community sample of overweight and obese men with or without depression. A secondary aim was to determine whether the eHealth, self-directed format of the program was a feasible and acceptable treatment approach for the subgroup of men with depression at baseline.

METHODS

In total, 209 overweight/obese men from the Hunter Region of Australia were assessed before and after completing a self-administered eHealth weight loss program over 3 months. To increase engagement, most program elements were socio-culturally targeted to appeal specifically to men and included printed materials, a DVD, motivational text messages, online- or app-based self-monitoring, and other weight loss tools (eg, pedometer). Depressive symptoms were measured with the validated 8-item Patient Health Questionnaire (PHQ-8). Program feasibility and acceptability were assessed with a process questionnaire plus recruitment and retention rates. Changes in depressive symptoms and weight were examined using intention-to-treat linear mixed models, adjusted for the centered baseline score and other covariates. Effect sizes were estimated with Cohen's d.

RESULTS

At baseline, the mean weight and age of the sample was 105.7 kg (standard deviation [SD] 14.0) and 46.6 years (SD 11.3), respectively. Overall, 36 men (36/209, 17.2%) were experiencing depression (PHQ-8 score ≥10). Retention rates were comparable between men with and without depression (32/36, 88.9% vs 145/173, 83.8%; P=.44). At posttest, depressive symptoms had reduced by 1.8 units (95% CI 1.3 to 2.3; P<.001; d=0.5) for the whole sample. These improvements were particularly notable in the subgroup of men with depression (-5.5 units; P<.001; d=1.0) and 72.2% (26/36) of this subgroup no longer met the criterion for depression at posttest. A corresponding, albeit smaller, intervention effect on depressive symptoms was also observed in men without depression (-1.0 units; P<.001; d=0.4). The overall intervention effect on weight was -4.7 kg (d=1.3), which did not vary significantly by depression status. Program acceptability, feasibility, and online engagement metrics were also comparable between men with and without depression.

CONCLUSIONS

A gender-tailored eHealth lifestyle program generated short-term improvements in the mental health of overweight and obese men, particularly for men with depression at baseline. Despite receiving no personalized support, men with depression reported high levels of satisfaction and engagement with the program. As such, a longer-term controlled trial testing an adapted version of the program for this subgroup is warranted.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry: ACTRN12612000749808; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=362575 (Archived by WebCite at http://www.webcitation.org/6wJvbRsNW).

Improving Health Screening Uptake in Men: A Systematic Review and Meta-analysis

CONTEXT

Globally, uptake of health screening in men remains low and the effectiveness of interventions to promote screening uptake in men is not well established. This review aimed to determine the effectiveness of interventions in improving men's uptake of and intention to undergo screening, including interventions using information and communication technology and a male-sensitive approach.

EVIDENCE ACQUISITION

Studies were sourced from five electronic databases (October 2015), experts, and references of included studies. This study included RCTs or cluster RCTs that recruited men and reported uptake of or intention to undergo screening. Two researchers independently performed study selection, appraisal, and data extraction. The interventions were grouped into those that increase uptake and those that promote informed decision making. They were further sub-analyzed according to types of intervention, male-sensitive, and web- and video-based interventions. The analysis was completed in December 2016.

EVIDENCE SYNTHESIS

This review included 58 studies. Most studies were on prostate cancer (k=31) and HIV (k=11) screening. Most of the studies had low methodologic quality (79.3%) and after excluding them from the analysis, one study found that educational intervention (which was also male-sensitive) was effective in improving men's intention to screen (risk ratio=1.36, 95% CI=1.23, 1.50, k=1) and partner educational intervention increased men's screening uptake (risk ratio=1.77, 95% CI=1.48, 2.12, k=1). Video-based educational interventions reduced prostate cancer screening uptake (risk ratio=0.89, 95%CI=0.80, 0.99, k=1) but web-based interventions did not change men's screening intention or uptake.

CONCLUSIONS

This review highlights the need to conduct more robust studies to provide conclusive evidence on the effectiveness of different interventions to improve men's screening behavior.

Theoretical and Behavioral Mediators of a Weight Loss Intervention for Men

OBJECTIVE

Men are currently underrepresented in weight loss trials despite similar obesity rates, which limit our understanding about the most effective elements of treatment for men. The purpose of this study was to test the theoretical (autonomous motivation, self-efficacy, outcome expectancies, and self-regulation) and behavioral (calorie intake, physical activity, self-weighing) mediators of a men-only, Internet-delivered weight loss intervention focused on innovative and tailored treatment elements specifically for men.

METHOD

Data comes from a 6-month randomized trial (N = 107) testing the intervention compared to a waitlist control group. Changes in the theoretical mediators between baseline and 3 months were tested as mediators of the intervention effect on weight change at 6 months in both single and multiple mediator models. Changes in behaviors between baseline and 6 months were tested in the same manner.

RESULTS

The intervention produced greater weight losses compared to the control group (-5.57 kg ± 6.6 vs. -0.65 kg ± 3.3, p < 0.001) and significant changes (p's < 0.05) in most of the theoretical and behavior mediators. In multiple mediator models, changes in diet-related autonomous motivation, self-efficacy, and self-regulation all significantly mediated the relationship between the intervention and weight loss. The intervention effect was also mediated by changes in dietary intake and self-weighing frequency.

CONCLUSIONS

By testing the theoretical mediators of this intervention in a multiple mediator context, this study contributes to current knowledge related to the development of weight loss interventions for men and suggests that interventions should target diet-focused constructs.

Effects of weight loss interventions for adults who are obese on mortality, cardiovascular disease, and cancer: systematic review and meta-analysis

Objective To assess whether weight loss interventions for adults with obesity affect all cause, cardiovascular, and cancer mortality, cardiovascular disease, cancer, and body weight.Design Systematic review and meta-analysis of randomised controlled trials (RCTs) using random effects, estimating risk ratios, and mean differences. Heterogeneity investigated using Cochran's Q and I² statistics. Quality of evidence assessed by GRADE criteria.Data sources Medline, Embase, the Cochrane Central Register of Controlled Trials, and full texts in our trials' registry for data not evident in databases. Authors were contacted for unpublished data.Eligibility criteria for selecting studies RCTs of dietary interventions targeting weight loss, with or without exercise advice or programmes, for adults with obesity and follow-up ≥1 year.Results 54 RCTs with 30 206 participants were identified. All but one trial evaluated low fat, weight reducing diets. For the primary outcome, high quality evidence showed that weight loss interventions decrease all cause mortality (34 trials, 685 events; risk ratio 0.82, 95% confidence interval 0.71 to 0.95), with six fewer deaths per 1000 participants (95% confidence interval two to 10). For other primary outcomes moderate quality evidence showed an effect on cardiovascular mortality (eight trials, 134 events; risk ratio 0.93, 95% confidence interval 0.67 to 1.31), and very low quality evidence showed an effect on cancer mortality (eight trials, 34 events; risk ratio 0.58, 95% confidence interval 0.30 to 1.11). Twenty four trials (15 176 participants) reported high quality evidence on participants developing new cardiovascular events (1043 events; risk ratio 0.93, 95% confidence interval 0.83 to 1.04). Nineteen trials (6330 participants) provided very low quality evidence on participants developing new cancers (103 events; risk ratio 0.92, 95% confidence interval 0.63 to 1.36).Conclusions Weight reducing diets, usually low in fat and saturated fat, with or without exercise advice or programmes, may reduce premature all cause mortality in adults with obesity.Systematic review registration PROSPERO CRD42016033217.

Modifying Alcohol Consumption to Reduce Obesity: A Randomized Controlled Feasibility Study of a Complex Community-based Intervention for Men

OBJECTIVES

Being obese and drinking more than 14 units of alcohol per week places men at very high risk of developing liver disease. This study assessed the feasibility of a trial to reduce alcohol consumption. It tested the recruitment strategy, engagement with the intervention, retention and study acceptability.

METHODS

Men aged 35-64 years who drank >21 units of alcohol per week and had a BMI > 30 were recruited by two methods: from GP patient registers and by community outreach. The intervention was delivered by a face to face session followed by a series of text messages. Trained lay people (Study Coordinators) delivered the face to face session. Participants were followed up for 5 months from baseline to measure weekly alcohol consumption and BMI.

RESULTS

The recruitment target of 60 was exceeded, with 69 men recruited and randomized. At baseline, almost all the participants (95%) exceeded the threshold for a 19-fold increase in the risk of dying from liver disease. The intervention was delivered with high fidelity. A very high follow-up rate was achieved (98%) and the outcomes for the full trial were measured. Process evaluation showed that participants responded as intended to key steps in the behaviour change strategy. The acceptability of the study methods was high: e.g. 80% of men would recommend the study to others.

CONCLUSIONS

This feasibility study identified a group at high risk of liver disease. It showed that a full trial could be conducted to test the effectiveness and cost-effectiveness of the intervention.

TRIAL REGISTRATION

Current controlled trials: ISRCTN55309164.

TRIAL FUNDING

National Institute for Health Research Health Technology Assessment (NIHR HTA).

SHORT SUMMARY

This feasibility study recruited 69 men at high risk of developing liver disease. The novel intervention, to reduce alcohol consumption through the motivation of weight loss, was well received. A very high follow-up rate was achieved. Process evaluation showed that participants engaged with key components of the behaviour change strategy.

Modifying Alcohol Consumption to Reduce Obesity (MACRO): development and feasibility trial of a complex community-based intervention for men

BACKGROUND

Obese men who consume alcohol are at a greatly increased risk of liver disease; those who drink > 14 units of alcohol per week have a 19-fold increased risk of dying from liver disease.

OBJECTIVES

To develop an intervention to reduce alcohol consumption in obese men and to assess the feasibility of a randomised controlled trial (RCT) to investigate its effectiveness.

DESIGN OF THE INTERVENTION

The intervention was developed using formative research, public involvement and behaviour change theory. It was organised in two phases, comprising a face-to-face session with trained laypeople (study co-ordinators) followed by a series of text messages. Participants explored how alcohol consumption contributed to weight gain, both through direct calorie consumption and through its effect on increasing food consumption, particularly of high-calorie foodstuffs. Men were encouraged to set goals to reduce their alcohol consumption and to make specific plans to do so. The comparator group received an active control in the form of a conventional alcohol brief intervention. Randomisation was carried out using the secure remote web-based system provided by the Tayside Clinical Trials Unit. Randomisation was stratified by the recruitment method and restricted using block sizes of randomly varying lengths. Members of the public were involved in the development of all study methods.

SETTING

Men were recruited from the community, from primary care registers and by time-space sampling (TSS). The intervention was delivered in community settings such as the participant's home, community centres and libraries.

PARTICIPANTS

Men aged 35-64 years who had a body mass index (BMI) of > 30 kg/m² and who drank > 21 units of alcohol per week.

RESULTS

The screening methods successfully identified participants meeting the entry criteria. Trial recruitment was successful, with 69 men (36 from 419 approached in primary care, and 33 from 470 approached via TSS) recruited and randomised in 3 months. Of the 69 men randomised, 35 were allocated to the intervention group and 34 to the control group. The analysis was conducted on 31 participants from the intervention group and 30 from the control group. The participants covered a wide range of ages and socioeconomic statuses. The average alcohol consumption of the men recruited was 47.2 units per week, more than twice that of the entry criterion (> 21 units per week). Most (78%) engaged in binge drinking (> 8 units in a session) at least weekly. Almost all (95%) exceeded the threshold for a 19-fold increase in the risk of dying from liver disease (BMI of > 30 kg/m² and > 14 units of alcohol per week). Despite this, they believed that they were at low risk of harm from alcohol, possibly because they seldom suffered acute harms (e.g. hangovers) and made few visits to a general practitioner or hospital.

INTERVENTION

The intervention was delivered with high fidelity. A high follow-up rate was achieved (98%) and the outcomes for the full RCT were measured. A process evaluation showed that participants engaged with the main components of the intervention. The acceptability of the study methods was high.

CONCLUSIONS

This feasibility study developed a novel intervention and evaluated all of the stages of a RCT that would test the effectiveness of the intervention. The main stages of a trial were completed successfully: recruitment, randomisation, intervention delivery, follow-up and measurement of study outcomes. Most of the men recruited drank very heavily and were also obese. This places them at a very high risk of liver disease, making them a priority for intervention.

FUTURE WORK

A RCT to test the effectiveness and cost-effectiveness of the intervention.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN55309164.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 19. See the NIHR Journals Library website for further project information.

Assessing the evidence for weight loss strategies in people with and without type 2 diabetes

This review will examine topical issues in weight loss and weight maintenance in people with and without diabetes. A high protein, low glycemic index diet would appear to be best for 12-mo weight maintenance in people without type 2 diabetes. This dietary pattern is currently being explored in a large prevention of diabetes intervention. Intermittent energy restriction is useful but no better than daily energy restriction but there needs to be larger and longer term trials performed. There appears to be no evidence that intermittent fasting or intermittent severe energy restriction has a metabolic benefit beyond the weight loss produced and does not spare lean mass compared with daily energy restriction. Meal replacements are useful and can produce weight loss similar to or better than food restriction alone. Very low calorie diets can produce weight loss of 11-16 kg at 12 mo with persistent weight loss of 1-2 kg at 4-6 years with a very wide variation in long term results. Long term medication or meal replacement support can produce more sustained weight loss. In type 2 diabetes very low carbohydrate diets are strongly recommended by some groups but the long term evidence is very limited and no published trial is longer than 12 mo. Although obesity is strongly genetically based the microbiome may play a small role but human evidence is currently very limited.

Weight Loss Strategies Utilized in a Men's Weight Loss Intervention

Men are underrepresented in weight loss programs and little is currently known about the weight loss strategies men prefer. This study describes the weight loss strategies used by men during a men-only weight loss program. At baseline, 3 months, and 6 months, participants reported how frequently they used 45 weight loss strategies including strategies frequently recommended by the program (i.e., mentioned during every intervention contact; e.g., daily self-weighing), strategies occasionally recommended by the program (i.e., mentioned at least once during the program; e.g., reduce calories from beverages), and strategies not included in the program (e.g., increase daily steps). At baseline participants ( N = 107, 44.2 years, body mass index = 31.4 kg/m², 76.6% White) reported regularly using 7.3 ± 6.6 ( M ± SD) strategies. The intervention group increased the number of strategies used to 19.1 ± 8.3 at 3 months and 17.1 ± 8.4 at 6 months with no changes in the waitlist group. The intervention group reported increased use of most of the strategies frequently recommended by the program (4 of 5), nearly half of the strategies occasionally recommended by the program (10 of 24), and one strategy not included in the program (of 16) at 6 months. The intervention effect at 6 months was significantly mediated by the number of strategies used at 3 months. This study adds to what is known about men's use of weight loss strategies prior to and during a formal weight loss program and will help future program developers create programs that are tailored to men.

What factors influence weight loss in participants of commercial weight loss programmes? Implications for health policy

BACKGROUND

Finding effective referral policies for weight management services would have important public health implications.

AIM

Here we compare percentage weight change by referral methods, BMI categories and participants who have had attended weight loss programmes multiple times.

DESIGN AND SETTINGS

A prospective cohort study of 15,621 participants referred to 12-week behavioural weight loss programmes funded by the public health service in Birmingham, UK.

METHODS

Comparisons were made between GP versus self-referrals, BMI ≥40kg/m²-<40kg/m² and multiple referrals compared to only one referral. Linear mixed modelling was used to assess percentage weight change after adjusting for covariates.

RESULTS

Participant's mean age was 48.5 years, 78.7% were of white ethnicity, 90.3% female and mean baseline BMI was 36.3kg/m². There were no significant differences in percentage weight loss, between participants that self-referred and those that were referred by their general practitioner (GP) and no significant differences between baseline BMI categories. Referral to a weight loss programme more than once was associated with less weight loss at subsequent attendances (0.92%, 95% CI 0.70-1.14, p<0.001).

CONCLUSION

Allowing self-referral to a weight loss programme widens access without compromising amount of weight lost. These programmes are beneficial for all categories of obesity, including those with a BMI ≥40kg/m². Attending weight management programmes more than once results in less weight loss and that swapping to a different program may be advisable.

Peer Positive Social Control and Men's Health-Promoting Behaviors

Men are generally thought to be less inclined to take care of their health. To date, most studies about men’s health have focused on deficits in self-care and difficulties in dealing with this sphere of their life. The present study reframes this perspective, using a salutogenic strengths-based approach and seeking to identify variables that influence men to take care of their health, rather than neglect it. This study focuses on the association between peer positive social control and men’s health behaviors, while controlling for other important individual and social determinants (sociodemographic characteristics, health self-efficacy, home neighborhood, spousal positive social control, and the restrictive emotionality norm). In a mixed-method study, 669 men answered a self-reported questionnaire, and interviews were conducted with a maximum variation sample of 31 men. Quantitative results indicated that, even after controlling for sociodemographic variables and other important factors, peer positive social control was significantly associated with the six health behaviors measured in the study (health responsibility, nutrition, physical activity, interpersonal relations, stress management, and spirituality). Interview results revealed that peer positive social control influenced men’s health behaviors through three different mechanisms: shared activity, being inspired, and serving as a positive role model for others. In summary, friends and coworkers could play a significant role in promoting various health behaviors among adult men in their daily life. Encouraging men to socialize and discuss health, and capitalizing on healthy men as role models appear to be effective ways to influence health behavior adoption among this specific population.

Novel Nonsurgical Endoscopic Approaches for the Treatment of Obesity

Globally, obesity is a leading cause of preventable death and is associated with >60 comorbid medical conditions, including 10 types of cancer that are strongly associated with body mass index. There are a number of traditional obesity treatments-for example, lifestyle management (eg, decreased caloric intake and increased expenditure), pharmacotherapy, and bariatric surgery. Recently, endoscopic approaches have emerged as a viable alternative for weight loss. Endoscopically placed intragastric balloons were introduced in the early 1980s for the treatment of medically complicated obesity but, unfortunately, had high rates of complications, such as premature deflation leading to obstruction. Despite these shortcomings, these devices have experienced a renewal, with a second generation of improved devices being approved for clinical use in 2015. In addition to the intragastric balloons, there are a number of other endoscopic approaches to weight loss that are either Food and Drug Administration approved or undergoing evaluation (aspiration therapy, duodenal jejunal bypass sleeve). The current review examines the literature available and discusses the practical clinical considerations involved.