Weight regain after behavioural weight management programmes and its impact on quality of life and cost effectiveness: evidence synthesis and health economic analyses

Aims We used data from a recent systematic review to investigate weight regain after behavioural weight management programmes (BWMPs, sometimes referred to as lifestyle modification programmes) and its impact on quality-of-life and cost-effectiveness. Materials and Methods Trial registries, databases and forward-citation searching (latest search December 2019) were used to identify randomized trials of BWMPs in adults with overweight/obesity reporting outcomes at ≥12 months, and after programme end. Two independent reviewers screened records. One reviewer extracted data and a second checked them. The differences between intervention and control groups were synthesized using mixed-effect, meta-regression and time-to-event models. We examined associations between weight difference and difference in quality-of-life. Cost-effectiveness was estimated from a health sector perspective. Results In total, 155 trials (n > 150 000) contributed to analyses. The longest follow-up was 23 years post-programme. At programme end, intervention groups achieved –2.8 kg (95%CI –3.2 to –2.4) greater weight loss than controls. Weight regain after programme end was 0.12-0.32 kg/year greater in intervention relative to control groups, with a between-group difference evident for at least 5 years. Quality-of-life increased in intervention groups relative to control at programme end and thereafter returned to control as the difference in weight between groups diminished. BWMPs with this initial weight loss and subsequent regain would be cost-effective if delivered for under £560 (£8.80-£3900) per person. Conclusions Modest rates of weight regain, with persistent benefits for several years, should encourage health care practitioners and policymakers to offer obesity treatments that cost less than our suggested thresholds as a cost-effective intervention to improve long-term weight management

Estimating the potential impact of the UK government’s sugar reduction programme on child and adult health: modelling study

Objective To estimate the impact of the UK government’s sugar reduction programme on child and adult obesity, adult disease burden, and healthcare costs. Design Modelling study. Setting Simulated scenario based on National Diet and Nutrition Survey waves 5 and 6, England. Participants 1508 survey respondents were used to model weight change among the population of England aged 4-80 years. Main outcome measures Calorie change, weight change, and body mass index change were estimated for children and adults. Impact on non-communicable disease incidence, quality adjusted life years, and healthcare costs were estimated for adults. Changes to disease burden were modelled with the PRIMEtime-CE Model, based on the 2014 population in England aged 18-80. Results If the sugar reduction programme was achieved in its entirety and resulted in the planned sugar reduction, then the calorie reduction was estimated to be 25 kcal/day (1 kcal=4.18 kJ=0.00418 MJ) for 4-10 year olds (95% confidence interval 23 to 26), 25 kcal/day (24 to 28) for 11-18 year olds, and 19 kcal/day (17 to 20) for adults. The reduction in obesity could represent 5.5% of the baseline obese population of 4-10 year olds, 2.2% of obese 11-18 year olds, and 5.5% of obese 19-80 year olds. A modelled 51 729 quality adjusted life years (95% uncertainty interval 45 768 to 57 242) were saved over 10 years, including 154 550 (132 623 to 174 604) cases of diabetes and relating to a net healthcare saving of £285.8m (€332.5m, $373.5m; £249.7m to £319.8m). Conclusions The UK government’s sugar reduction programme could reduce the burden of obesity and obesity related disease, provided that reductions in sugar levels and portion sizes do not prompt unanticipated changes in eating patterns or product formulation.</p

Dataset: Small area estimates of BMI distribution by age, sex and lower tier local authority (England)

Published final results from the paper "Estimating BMI distributions by age and sex for local authorities in England: a small area estimation study". This paper used a small area estimation method to estimate the distribution of BMI for local areas in England, by age and sex

Estimating BMI distributions by age and sex for local authorities in England: a small area estimation study

Objectives Rates of overweight and obesity vary across England, but local rates have not been estimated for over 10 years. We aimed to produce new small area estimates of body mass index (BMI) by age and sex for each lower tier and unitary local authority in England, to provide up-to-date and more detailed estimates for the use of policy-makers and academics working in non-communicable disease risk and health inequalities. Design We used generalised linear modelling to estimate the relationship between BMI with social/demographic markers in a cross-sectional survey, then used this model to impute a BMI for each adult in locally-representative populations. These groups were then disaggregated by 5-year age group, sex and local authority group. Setting The Health Survey for England 2018 (cross-sectional BMI data for England) and Census microdata 2011 (locally representative). Participants A total of 6174 complete cases aged 16 and over were included. Outcome measures Modelled group-level BMI as mean and SD of log-BMI. Extensive internal validation was performed, against the original data and external validation against the National Diet and Nutrition Survey and Active Lives Survey and previous small area estimates. Results In 94% of age–sex are groups, mean BMI was in the overweight or obese ranges. Older and more deprived areas had the highest overweight and obesity rates, which were particularly in coastal areas, the West Midlands, Yorkshire and the Humber. Validation showed close concordance with previous estimates by local area and demographic groups. Conclusion This work updated previous estimates of the distribution of BMI in England and contributes considerable additional detail to our understanding of the local epidemiology of overweight and obesity. Raised BMI now affects the vast majority of demographic groups by age, sex and area in England, regardless of geography or deprivation.</p

Weight regain after behavioural weight management programmes and its impact on quality of life and cost effectiveness: evidence synthesis and health economic analyses

Aims: We used data from a recent systematic review to investigate weight regain after behavioural weight management programmes (BWMPs, sometimes referred to as lifestyle modification programmes) and its impact on quality-of-life and cost-effectiveness. Materials and methods: Trial registries, databases, and forward-citation searching (latest search Dec-19) were used to identify randomised trials of BWMPs in adults with overweight/obesity reporting outcomes at ≥12 months, and after programme end. Two independent reviewers screened records. One reviewer extracted data; a second checked them. Differences between intervention and control groups were synthesised using mixed-effect, meta-regression, and time-to-event models. We examined associations between weight difference and difference in quality-of-life. Cost-effectiveness was estimated from a health sector perspective. Results: 155 trials (n>150,000) contributed to analyses. Longest follow-up was 23 years post-programme. At programme end, intervention groups achieved -2.8kg (95%CI -3.2 to -2.4) greater weight loss than controls. Weight regain after programme end was 0.12-0.32kg/year greater in intervention relative to control groups, with a between-group difference evident for at least five years. Quality-of-life increased in intervention groups relative to control at programme end and thereafter returned to control as the difference in weight between groups diminished. BWMPs with this initial weight loss and subsequent regain would be cost-effective if delivered for under £560 (£8.80 to £3900) per person. Conclusions: Modest rates of weight regain, with persistent benefits for several years, should encourage healthcare practitioners and policymakers to offer obesity treatments that cost less than our suggested thresholds as a cost-effective intervention to improve long term weight management. Aims: We used data from a recent systematic review to investigate weight regain after behavioural weight management programmes (BWMPs, sometimes referred to as lifestyle modification programmes) and its impact on quality-of-life and cost-effectiveness. strong>Materials and methods: Trial registries, databases, and forward-citation searching (latest search Dec-19) were used to identify randomised trials of BWMPs in adults with overweight/obesity reporting outcomes at ≥12 months, and after programme end. Two independent reviewers screened records. One reviewer extracted data; a second checked them. Differences between intervention and control groups were synthesised using mixed-effect, meta-regression, and time-to-event models. We examined associations between weight difference and difference in quality-of-life. Cost-effectiveness was estimated from a health sector perspective. Results: 155 trials (n>150,000) contributed to analyses. Longest follow-up was 23 years post-programme. At programme end, intervention groups achieved -2.8kg (95%CI -3.2 to -2.4) greater weight loss than controls. Weight regain after programme end was 0.12-0.32kg/year greater in intervention relative to control groups, with a between-group difference evident for at least five years. Quality-of-life increased in intervention groups relative to control at programme end and thereafter returned to control as the difference in weight between groups diminished. BWMPs with this initial weight loss and subsequent regain would be cost-effective if delivered for under £560 (£8.80 to £3900) per person. Conclusions: Modest rates of weight regain, with persistent benefits for several years, should encourage healthcare practitioners and policymakers to offer obesity treatments that cost less than our suggested thresholds as a cost-effective intervention to improve long term weight management.</p

Public acceptability of proposals to manage new takeaway food outlets near schools: cross-sectional analysis of the 2021 International Food Policy Study

Global trends indicate that takeaway food is commonly accessible in neighbourhood food environments. Local governments in England can use spatial planning to manage the opening of new takeaway outlets in “takeaway management zones around schools” (known elsewhere as “exclusion zones”). We analysed data from the 2021 International Food Policy Study to investigate public acceptability of takeaway management zones around schools. Among adults living in Great Britain (n=3323), 50.8% supported, 8.9% opposed, and 37.3% were neutral about the adoption of these zones. Almost three-quarters (70.4%) believed that these zones would help young people to eat better. Among 16- 17 year olds (n=354), 33.3% agreed that young people would consume takeaway food less often if there were fewer takeaways near schools. Using adjusted logistic regression, we identified multiple correlates of public support for and perceived effectiveness of takeaway management zones. Odds of support were strongest among adults reporting that there were currently too many takeaways in their neighbourhood food environment (odds ratio: 2.32; 95% confidence intervals: 1.61, 3.35). High levels of support alongside limited opposition indicate that proposals for takeaway management zones around schools would not receive substantial public disapproval. Policy makers should not, therefore, use limited public support to rationalise policy inertia.This study was funded by the National Institute for Health Research (NIHR) Public Health Research Programme (Project number: NIHR130597). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. MK, NR, MW, JA and TB were supported by the Medical Research Council (grant number MC_UU_00006/7). OM was supported by a UKRI Future Leaders Fellowship (MR/T041226/1). Funding for the International Food Policy Study was provided by a Canadian Institutes of Health Research (CIHR) Project Grant (PJT 162167), with additional support from the National Institute for Health Research (NIHR13059). CT was supported by the NIHR Applied Research Collaboration (ARC) East of England