BEYOND Weight Loss Study (BEYOND)

Body Composition and Energy Expenditure With Total Diet Replacement During Weight Loss and Maintenance

National guidelines recommend 15-20% weight loss for severe and complicated obesity. Weight loss maintenance can be achieved in around 33% of patients at 12 months.

The BEYOND study will administer Counterweight Plus; a nutritionally replete Total Diet Replacement Plan (TDR) of 800+ Calories followed by structured Food Reintroduction, and Weight Loss Maintenance programmes.

The study will incorporate three work packages with the aim of:

1. examining changes in body composition with substantial (target >15kg) non-surgical weight loss (work package 1, WP1)
2. characterizing the metabolic adaptations during weight loss and maintenance (work package 2, WP2)
3. examining Rescue Packages as a method of weight re-gain prevention (work package 3, WP3).

Study Overview

• Status: Completed
• Conditions: Obesity
• Intervention / Treatment: Dietary supplement: Counterweight Plus

Detailed Description

All participants will receive the Counterweight Plus dietary intervention. This consists of:

• 12-20 weeks 800+ calories/day Total Diet Replacement Plan, followed by
• 6-8 weeks Food Reintroduction, followed by
• up to 104 weeks Weight Loss Maintenance, based on maintaining daily calorie restriction.

All participants will undergo the following investigations at baseline and at regular intervals throughout the study period:

• height (baseline only)
• whole body MRI scans: total-body skeletal muscle volume and fat mass will be measured using whole-body multi-slice MRI (baseline and 12 weeks only)
• functional assessment: completion of the Western Ontario and McMaster Universities Arthritis Index (WOMAC) (baseline and 12 weeks only)
• gait and muscle strength assessment: biomechanical gait analysis will be carried out using an 8 camera VICON system during flat walking to determine maximum flexion and extension moments for both limbs and maximum adduction and abduction moments. Muscle strength will also be directly measured of both the upper (grip strength) and lower (quadriceps and hamstrings) limb using a dynamometer and myometer (baseline and 12 weeks only)
• anthropometric measurement: body weight; waist, hip, thigh, arm and calf circumferences
• indirect calorimetry: resting metabolic rate will be measured by a computerised open-circuit ventilated hood system
• fasting blood sampling: for measurement of HbA1C, lipid profile, leptin, thyroid hormones
• gut microbiota analysis from faecal samples
• Binge Eating Disorder and Quality of Life (EQ-5D) questionnaires

Participants will receive regular support/advice from a research dietician/ nutritionist during the two year study period.

• Study Type: Interventional
• Enrollment (Actual): 23
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United Kingdom
  • Scotland
    • Glasgow, Scotland, United Kingdom, G31 2ER
      • Glasgow Royal Infirmary

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

• confirmation from general practitioner (GP) of suitability for intervention
• written informed consent
• female
• BMI ≥30 kg/m2 and < 45kg/m2, weight<200 kg and <60 cm bore size

Exclusion Criteria:

• known illness such as heart disease, cancer, or any disability that would affect weight loss (diabetes not an exclusion) or prevent completion of the intervention
• implanted electronic devices that are MRI incompatible or MRI unsafe, ferromagnetic foreign bodies
• substance abuse
• myocardial infarction within previous 6 months
• learning difficulties and subjects having difficulty in understanding verbal or written English
• pregnant/ considering pregnancy
• patients who have required hospitalisation for depression or are on antipsychotic drugs
• people currently participating in another clinical research trial
• recent weight loss >5kg within the last 6 months
• current treatment with anti-obesity drugs
• diagnosed eating disorder

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Counterweight Plus Dietary Intervention; Weight management programme including total diet replacement with soups and shakes; approximately 800 calories/day	Dietary supplement: Counterweight Plus; A non-surgical, nutritionally replete weight management programme comprising a Total Diet Replacement Plan (TDR) of 800+ calories/day to produce a weight loss of >15kg over 12-20 weeks; followed by a structured Food Reintroduction phase for 6-8 weeks and a Weight Loss Maintenance phase; total intervention period 2 years.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
WP1: change in body composition with substantial, non-surgical, weight loss	Measurement of muscle mass before and after a weight loss programme using MRI	20 weeks
WP1: change in body composition with substantial, non-surgical, weight loss	Measurement of fat mass before and after a weight loss programme using MRI	20 weeks
WP2: metabolic adaptation during weight loss and maintenance	Change in resting metabolic rate before and after weight loss	2 years
WP3: weight regain prevention	% achieving >15kg weight loss at 12 and 24 months	2 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Muscle/fat mass of specific muscle groups	Relationship between predicted muscle and fat mass with the strength of specific muscle groups (by muscle strength, gait analysis and WOMAC questionnaire)	20 weeks
Adherence and acceptability of Rescue Packages to Patients	Number of participants requiring and completing rescue packages	2 years
Metabolic adaptive effect of weight loss	Comparison of leptin, ghrelin and thyroid hormone levels at baseline to those during weight loss and maintenance to establish	2 years
Weight regain prevention	changes in BED Questionnaire Rating Score	2 years
Weight regain prevention	% undertaking Rescue Package during Weight Loss Maintenance	2 years
Weight regain prevention	rate of weight regain during Weight Loss Maintenance	2 years

Collaborators and Investigators

• Sponsor: NHS Greater Glasgow and Clyde
• Collaborators: University of Glasgow
• Investigators: Principal Investigator: Michael EJ Lean, MA MB BChir MD, University of Glasgow

Study record dates

Study Major Dates

• Study Start: January 1, 2015
• Primary Completion (Actual): February 1, 2017
• Study Completion (Actual): February 1, 2017

Study Registration Dates

• First Submitted: December 19, 2014
• First Submitted That Met QC Criteria: January 13, 2015
• First Posted (Estimate): January 19, 2015

Study Record Updates

• Last Update Posted (Actual): January 19, 2018
• Last Update Submitted That Met QC Criteria: January 17, 2018
• Last Verified: January 1, 2018

More Information

Terms related to this study

• Keywords: Weight loss
• Additional Relevant MeSH Terms: Body Weight; Body Weight Changes; Weight Loss
• Other Study ID Numbers: GN14RA448