Attrition and weight loss outcomes for patients with complex obesity, anxiety and depression attending a weight management programme with targeted psychological treatment. Clinical Obesity, 6(2), pp. 133-142. (doi:10.1111/cob.12136) This is the author's final accepted version.There may be differences between this version and the published version. You are advised to consult the publisher's version if you wish to cite from it.http://eprints.gla.ac.uk/118709/ What is already known about this subject?• Baseline depression is associated with greater attrition rates from weight management programmes and is also with poorer weight loss success.• There is little evidence regarding the role of baseline anxiety as a predictor of attrition or weight loss in weight management programmes.• There is some evidence that patients with baseline mood disorders achieve similar weight loss to controls in weight management programmes with an integrated psychological component What this study adds• This study confirms that baseline anxiety and depression (identified using HADS) is associated with higher attrition of patients from a weight management programme with an integrated psychology service.• Despite a significantly less favourable case-mix of risk-factors for poor weight loss:o Patients with severe anxiety at baseline achieve similar weight loss outcomes to those without baseline anxiety.o Significantly greater weight loss is seen in participants with severe baseline depression at all stages of follow-up in the Glasgow and Clyde Weight Management Service. AbstractObjective: To investigate the effect of baseline anxiety and depression, using different definitions for caseness, on attrition and weight outcomes following a multidisciplinary weight management programme.Design: Prospective observational study. The Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety and depression with 'caseness' scoring ≥11 and severity ≥14. Participants:All patients who began a weight management programme between 1 October 2008 and September 2009 (n=1838).Setting: Glasgow and Clyde Weight Management Service (GCWMS) is a specialist multidisciplinary service, which aims to achieve a minimum of ≥5kg weight loss. Patients with HADS score ≥14 were referred to the integrated psychology service for psychological assessment/intervention. Results:Patients with caseness (HADS ≥11) for anxiety (33%) and depression (27%) were significantly younger, heavier, more socioeconomically deprived and a higher proportion were female.There was a significant positive correlation between HADS anxiety and depression scores and increasing BMI (r 2 =0.094, p<0.001 and r 2 =0.175, p<0.001, respectively). Attendance and completion was lower throughout follow-up amongst patients with anxiety or depression. More patients with HADS score ≥11 achieved ≥5kg or ≥5% weight loss and by 12 months those with anxiety had a significantly higher mean weight loss (p=0.032). Participants who scored for severe anxiety (HADS ≥14) achieved similar weight loss to those ...

A real-life structured weight management intervention in patients with diabetes can reduce weight in the medium term, result in improved glycaemic control with fewer medications, and may be more effective than pharmacological alternatives. Challenges include getting a higher proportion of patients referred to and engaged with interventions.

Aim To compare weight change in a lifestyle-based weight management programme between participants taking weight-gaining, weight-neutral/loss and mixed diabetes medications.Methods Electronic health records for individuals (≥ 18 years) with Type 2 diabetes who had been referred to a nonsurgical weight management programme between February 2008 and May 2014 were studied. Diabetes medications were classified into three categories based on their effect on body weight. In this intervention cohort study, weight change was calculated for participants attending two or more sessions.Results All 998 individuals who took oral diabetes medications and attended two or more sessions of weight management were included. Some 59.5% of participants were women, and participants had a mean BMI of 41.1 kg/m 2 (women) and 40.2 kg/m 2 (men). Of the diabetes medication combinations prescribed, 46.0% were weight-neutral/loss, 41.3% mixed and 12.7% weight-gaining. The mean weight change for participants on weight-gaining and weightneutral/loss diabetes medications respectively was À2.5 kg [95% confidence interval (CI) À3.2 to À1.8) and À3.3 kg (95% CI À3.8 to À2.9) (P = 0.05) for those attending two or more sessions (n = 998). Compared with those prescribed weight-neutral medications, participants prescribed weight-gaining medication lost 0.86 kg less (95% CI 0.02 to 1.7; P = 0.045) in a model adjusted for age, sex, BMI and socio-economic status.Conclusions Participants on weight-neutral/loss diabetes medications had a greater absolute weight loss within a weight management intervention compared with those on weight-gaining medications. Diabetes medications should be reviewed ahead of planned weight-loss interventions to help ensure maximal effectiveness of the intervention.

Background Providing effective weight management to adults with intellectual disabilities is necessary to challenge the high rates of obesity. The aim of this process evaluation was to explore the feasibility of conducting a full-scale clinical trial of the TAKE 5 multi-component weight management programme. Methods The study was a 12-month pilot clusterrandomised controlled trial. Adults with intellectual disabilities and obesity were randomised to either TAKE 5, which included an energy deficit diet (EDD) or Waist Winners Too, based on health education principles. A mixed-methods process evaluation was conducted focussing on the reach, recruitment, fidelity, implementation, dose (delivered/received) and context. ResultsThe study successfully recruited adults with intellectual disabilities. Both weight management programmes were delivered with high fidelity and implemented as intended. Only one weight management programme, TAKE 5, demonstrated potential efficacy in reducing body weight and body composition. The effectiveness was largely attributed to the EDD and social support from carers. Conclusions The extensive process evaluation illustrated that a full-scale trial of a multi-component programme including an EDD is feasible and an acceptable approach to weight management for adults with intellectual disabilities and obesity. RandomisationParticipants were randomised using clusterrandomisation to minimise potential risk of contamination between programmes, clustering of outcomes, and to minimise imbalance between study groups. Participants who were supported by the same 50 L. Harris et al. • Weight loss and intellectual disabilities *Adjusted for cluster, baseline value and stratification variables (number of participants within a cluster, level of intellectual disability and presence of Down syndrome). **Data are present for objective measures on physical activity ad sedentary behaviour only due to concerns over the validity and reliability of self-report measures using the International Physical Activity Questionnaire-Short version. CI, confidence interval; cm, centimetres; ED-5D, European Quality of Life-5 dimensions; ICC, interclass correlation coefficient; kg, kilogram; m 2 , metres squared; %, percentage; MVPA, moderate to vigorous physical activity; PA, physical activity.

Background Guidelines for the management of type 2 diabetes universally recommend that adults with type 2 diabetes and obesity be offered individualized interventions to encourage weight loss. Yet despite the existing recommendations, provision of weight management services is currently patchy around the United Kingdom and where services are available, high attrition rates are often reported. In addition, individuals often fail to take up services, that is, after discussion with a general practitioner or practice nurse, individuals are referred to the service but do not attend for an appointment. Qualitative research has identified that the initial discussion raising the issue of weight, motivating the patient, and referring to services is crucial to a successful outcome from weight management. Objective Our aim was to evaluate the effectiveness of an Internet-based training program and practice implementation toolkit with or without face-to-face training for primary care staff. The primary outcome is the change in referral rate of patients with type 2 diabetes to National Health Service adult weight management programs, 3 months pre- and postintervention. Methods We used the Behavior Change Wheel to develop an intervention for staff in primary care consisting of a 1-hour Internet-based eLearning package covering the links between obesity, type 2 diabetes, and the benefits of weight management, the treatment of diabetes in patients with obesity, specific training in raising the issue of weight, local services and referral pathways, overview of weight management components/ evidence base, and the role of the referrer. The package also includes a patient pamphlet, a discussion tool, a practice implementation checklist, and an optional 2.5-hour face-to-face training session. We have randomly assigned 100 practices in a 1:1 ratio to either have immediate access to all the resources or have access delayed for 4 months. An intention-to-treat statistical analysis will be performed. Results Recruitment to the study is now complete. We will finalize follow-up in 2018 and publish in early 2019. Conclusions This protocol describes the development and randomized evaluation of the effectiveness of an intervention to improve referral and uptake rates of weight management programs for adults with type 2 diabetes. At a time when many new dietary and pharmacological weight management interventions are showing large clinical benefits for people with type 2 diabetes, it is vital that primary care practitioners are willing, skilled, and able to discuss weight and make appropriate referrals to services. Trial Registration ClinicalTrials.gov NCT03360058; https://clinicaltrials.gov/ct2/show/NCT03360058 (Archived by WebCite at http://www.webcitation.org/74HI8ULfn) International Registered Report Identifier (IRRID) DERR1-10.2196/12162