A pragmatic randomised controlled trial in primary care of the Camden Weight Loss (CAMWEL) programme

Kiran Nanchahal, Tom Power, Elizabeth Holdsworth, Michelle Hession, Annik Sorhaindo, Ulla Griffiths, Joy Townsend, Nicki Thorogood, David Haslam, Anthony Kessel, Shah Ebrahim, Mike Kenward, Andrew Haines, Kiran Nanchahal, Tom Power, Elizabeth Holdsworth, Michelle Hession, Annik Sorhaindo, Ulla Griffiths, Joy Townsend, Nicki Thorogood, David Haslam, Anthony Kessel, Shah Ebrahim, Mike Kenward, Andrew Haines

Abstract

Objectives: To evaluate effectiveness of a structured one-to-one behaviour change programme on weight loss in obese and overweight individuals.

Design: Randomised controlled trial.

Setting: 23 general practices in Camden, London.

Participants: 381 adults with body mass index ≥25 kg/m(2) randomly assigned to intervention (n=191) or control (n=190) group.

Interventions: A structured one-to-one programme, delivered over 14 visits during 12 months by trained advisors in three primary care centres compared with usual care in general practice.

Outcome measures: Changes in weight, per cent body fat, waist circumference, blood pressure and heart rate between baseline and 12 months.

Results: 217/381 (57.0%) participants were assessed at 12 months: missing values were imputed. The difference in mean weight change between the intervention and control groups was not statistically significant (0.70 kg (0.67 to 2.17, p=0.35)), although a higher proportion of the intervention group (32.7%) than the control group (20.4%) lost 5% or more of their baseline weight (OR: 1.80 (1.02 to 3.18, p=0.04)). The intervention group achieved a lower mean heart rate (mean difference 3.68 beats per minute (0.31 to 7.04, p=0.03)) than the control group. Participants in the intervention group reported higher satisfaction and more positive experiences of their care compared with the control group.

Conclusions: Although there is no significant difference in mean weight loss between the intervention and control groups, trained non-specialist advisors can deliver a structured programme and achieve clinically beneficial weight loss in some patients in primary care. The intervention group also reported a higher level of satisfaction with the support received. Primary care interventions are unlikely to be sufficient to tackle the obesity epidemic and effective population-wide measures are also necessary.

Clinical trial registration number: Trial registrationClincaltrials.gov NCT00891943.

Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that KN, TP, EH, MH, AS, UG and JLT had salary support from NHS Camden for the submitted work. AK was Director of Public Health at Camden Primary Care Trust between 2004 and 2009. The views expressed here are personal, and no financial support was received for the other authors' involvement in the CAMWEL Trial. No authors have had a relationship with companies that might have an interest in the submitted work in the previous 3 years nor do their spouses, partners or children have financial relationships that may be relevant to the submitted work. DH is on the scientific advisory board for LighterLife and no other authors have non-financial interests that may be relevant to the submitted work.

Figures

Figure 1
Figure 1
CAMWEL intervention framework.
Figure 2
Figure 2
Flow of participants through the trial.

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Source: PubMed

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