Abstract:PURPOSEWe explored participants' accounts of weight loss interventions to illuminate the reasons behind the greater weight loss observed among those attending a commercial program compared with those receiving standard care in a recent large-scale trial. We further wanted to examine how participants' general explanatory model of being overweight related to the 2 different interventions.
METHODSOur study was based on thematic analysis of semistructured telephone interviews with a purposeful sample of 16 female … Show more
“…We identified 21 studies reported in 26 papers that reported service‐user views on WMPs (see Figure for PRISMA figure presenting flow of studies through the review). The 21 studies reported the views of 507 service users, and there was a good range in terms of gender, age and socio‐economic status, but limited data from minority‐ethnic service users; just one study focused on a programme specifically for a minority‐ethnic group and most others which provided information on the ethnicity of participants stated that they were predominantly white British.…”
Section: Resultsmentioning
confidence: 99%
“…Service users in about half of the studies discussed dietary (n = 12 studies) and exercise (n = 11 studies) features of WMPs, and views on these programme aspects were divergent with respect to perceived relevance and utility. For example, whilst 9 studies included positive service‐user statements about the focus of WMPs on diet, participants in 7 studies indicated a perceived lack of need for dietary advice, for instance:Perhaps counter to public health assumptions, none of the participants talked about needing an intervention to include education about food, eating, or diet as they believed they already had the necessary knowledge.…”
BackgroundExtensive research effort shows that weight management programmes (WMPs) targeting both diet and exercise are broadly effective. However, the critical features of WMPs remain unclear.ObjectiveTo 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 strategyWe identified qualitative studies from existing reviews and updated the searches of one review.Inclusion criteriaWe included UK studies capturing the views of adult WMP users.Data extraction and synthesisThematic analysis was used inductively to code and synthesize the evidence.Main resultsService 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 conclusionsThe 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.
“…We identified 21 studies reported in 26 papers that reported service‐user views on WMPs (see Figure for PRISMA figure presenting flow of studies through the review). The 21 studies reported the views of 507 service users, and there was a good range in terms of gender, age and socio‐economic status, but limited data from minority‐ethnic service users; just one study focused on a programme specifically for a minority‐ethnic group and most others which provided information on the ethnicity of participants stated that they were predominantly white British.…”
Section: Resultsmentioning
confidence: 99%
“…Service users in about half of the studies discussed dietary (n = 12 studies) and exercise (n = 11 studies) features of WMPs, and views on these programme aspects were divergent with respect to perceived relevance and utility. For example, whilst 9 studies included positive service‐user statements about the focus of WMPs on diet, participants in 7 studies indicated a perceived lack of need for dietary advice, for instance:Perhaps counter to public health assumptions, none of the participants talked about needing an intervention to include education about food, eating, or diet as they believed they already had the necessary knowledge.…”
BackgroundExtensive research effort shows that weight management programmes (WMPs) targeting both diet and exercise are broadly effective. However, the critical features of WMPs remain unclear.ObjectiveTo 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 strategyWe identified qualitative studies from existing reviews and updated the searches of one review.Inclusion criteriaWe included UK studies capturing the views of adult WMP users.Data extraction and synthesisThematic analysis was used inductively to code and synthesize the evidence.Main resultsService 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 conclusionsThe 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.
“…We ensured that patients who agreed to referral left the practice with an appointment. Finally, we drew on evidence that external accountability is an important component of behavioural programmes 23 and we trained physicians to ask the participant to return in 4 weeks to assess their progress (panel). …”
SummaryBackgroundObesity is a common cause of non-communicable disease. Guidelines recommend that physicians screen and offer brief advice to motivate weight loss through referral to behavioural weight loss programmes. However, physicians rarely intervene and no trials have been done on the subject. We did this trial to establish whether physician brief intervention is acceptable and effective for reducing bodyweight in patients with obesity.MethodsIn this parallel, two-arm, randomised trial, patients who consulted 137 primary care physicians in England were screened for obesity. Individuals could be enrolled if they were aged at least 18 years, had a body-mass index of at least 30 kg/m2 (or at least 25 kg/m2 if of Asian ethnicity), and had a raised body fat percentage. At the end of the consultation, the physician randomly assigned participants (1:1) to one of two 30 s interventions. Randomisation was done via preprepared randomisation cards labelled with a code representing the allocation, which were placed in opaque sealed envelopes and given to physicians to open at the time of treatment assignment. In the active intervention, the physician offered referral to a weight management group (12 sessions of 1 h each, once per week) and, if the referral was accepted, the physician ensured the patient made an appointment and offered follow-up. In the control intervention, the physician advised the patient that their health would benefit from weight loss. The primary outcome was weight change at 12 months in the intention-to-treat population, which was assessed blinded to treatment allocation. We also assessed asked patients' about their feelings on discussing their weight when they have visited their general practitioner for other reasons. Given the nature of the intervention, we did not anticipate any adverse events in the usual sense, so safety outcomes were not assessed. This trial is registered with the ISRCTN Registry, number ISRCTN26563137.FindingsBetween June 4, 2013, and Dec 23, 2014, we screened 8403 patients, of whom 2728 (32%) were obese. Of these obese patients, 2256 (83%) agreed to participate and 1882 were eligible, enrolled, and included in the intention-to-treat analysis, with 940 individuals in the support group and 942 individuals in the advice group. 722 (77%) individuals assigned to the support intervention agreed to attend the weight management group and 379 (40%) of these individuals attended, compared with 82 (9%) participants who were allocated the advice intervention. In the entire study population, mean weight change at 12 months was 2·43 kg with the support intervention and 1·04 kg with the advice intervention, giving an adjusted difference of 1·43 kg (95% CI 0·89–1·97). The reactions of the patients to the general practitioners' brief interventions did not differ significantly between the study groups in terms of appropriateness (adjusted odds ratio 0·89, 95% CI 0·75–1·07, p=0·21) or helpfulness (1·05, 0·89–1·26, p=0·54); overall, four (<1%) patients thought their intervention was inapprop...
“…14 Findings from a study of explanatory models of people attending primary care or commercial weight loss programs have implications for tailored interventions that balance patients' valuation of motivation, education, and group vs individual support. 15 In a cohort study featured in Annals Journal Club, Lisman-van Leeuwen and colleagues fi nd a surprisingly high prevalence and long duration of chronic abdominal pain among children complaining of abdominal pain in primary care. 16 A study of presentations at the Society of Teachers of Family Medicine and the North American Primary Care Research Group fi nds that a surprising (to me at least) number or presentations become publications, and (not surprisingly) appear in a wide variety of journals.…”
Section: Other Interesting Research In This Issuementioning
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