Archibald, D.

Avenell, S.

Boachie, C.

Boyers, D.

Douglas, F.

Hoddinott, P.

Robertson, C.

Stewart, F.

van Teijlingen, Edwin

English

Bournemouth University Research Online

HSRU is funded by the Chief Scientist Office of the Scottish Government Health Directorates.  The author accepts full responsibility for this talk.Health Services Research UnitUniversity of AberdeenShould weight loss programmes be designed differently for men and women? The ROMEO (Review Of MEn and Obesity) ProjectClare Robertsona, Alison Avenella, Charles Boachieb, Fiona Stewarta, Daryll Archibaldc, Flora Douglasd, Pat Hoddinotte, Edwin van Teijlingenf, Dwayne Boyersga Health Services Research Unit (HSRU), University of Aberdeenb Robertson Centre for Biostatistics, University of Glasgowc The Scottish Collaboration for Public Health Research (SCPHRP), University of Edinburghd Rowett Institute of Health and Nutrition, University of Aberdeene Nursing, Midwifery and Allied Health Professional Research Unit, University of Stirlingf Centre for Midwifery, Maternal & Perinatal Health, Bournemouth Universityg Health Economics Research Unit (HERU), University of AberdeenHealth Services Research UnitUniversity of AberdeenA collaborative project between Universities of Aberdeen, Stirling and Bournemouth, with a project advisory group from the Men’s Health ForumsProject grant holders Men’s Health Forums’ representativesAlison Avenell David Wilkins (England & Wales)Flora Douglas Tim Street (Scotland)Pat Hoddinott Paula Carroll, Colin Fowler (Ireland)Edwin van TeijlingenResearchersClare Robertson, Daryll Archibald, Dwayne Boyers, Fiona Stewart, Charles Boachie, Evie FioratouMen and weight• More men than women are overweight or obese in the UK• Men are– more likely to misperceive their weight– less likely to consider weight as a health problem or attempt weight loss– under-represented in weight loss servicesButland B, Jebb S, Kopelman P, McPherson K, Thomas S, Mardell J, et al. (2007). Foresight. Tackling Obesities: Future Choices -Project Report 2nd edition. Government Office for Science  Available from URL: http://www.bis.gov.uk/assets/foresight/docs/obesity/17.pdf Duncan DT, Wolin KY, Scharoun-Lee M, Ding EL, Warner ET, Bennett GG. Does perception equal reality? Weight misperception in relation to weight-related attitudes and behaviors among overweight and obese US adults. Int J Behav Nutr Phys Act 2011;8:20.Gregory CO, Blanck HM, Gillespie C, Maynard LM, Serdula MK. Perceived health risk of excess body weight among overweight and obese men and women: Differences by sex. Prev Med 2008;47:46-52.Aims of the ROMEO Project• To identify and describe effective weight loss and weight maintenance interventions for men• To identify barriers and facilitators in men’s experience of weight management• Integrated systematic reviews 1. 11 RCTs of long-term (>1yr) lifestyle or drug (orlistat) interventions for men2. 20 RCTs of long-term (>1yr) lifestyle or drug (orlistat) interventions for men compared to women3. 26 reports of interventions for men, or men compared to women from the UK4. 22 reports of qualitative research with men5. 5 economic evaluations of interventions for men, or men compared to womenWhat did we do?Inclusion criteria• Adult men and women with BMI ≥30kg/m2 (or BMI ≥28 kg/m2 with cardiac risk factors based on orlistat guidance)• Results presented separately by sex• Primary– weight change• Secondary– waist circumference, cardiac risk factors, disease specific, adverse events, quality of life, process outcomes, economic costsData analysis• Random effects meta-analysis (Review Manager 5.1) and narrative synthesis where pooling not possible• Risk difference calculated to compare attrition between men and women • Weighted mean difference calculated to compare weight loss between men and womenResultsStudies identified from primary searchesn = 5498Studies identified from other sources n = 17Selected for full text screening n = 254Excluded n = 228Included 20 RCTs (26 reports)Excludedn = 5261Results• 4584 men (36.6%); 7939 women (63.4%)• USA (9), Finland (6), Canada (1), Israel (1), Sweden (1), Switzerland (1), UK (1)• Moderate quality (Cochrane risk of bias tool)• 18 weight loss; 2 weight maintenance trials -20 combinations interventions/comparatorsAnalysis of attrition for men and women• Eight trials contributed to the analysisWeight loss between men and women• Eleven trials contributed to the analysis -2026 (36.7%) men and 3493(63.3%) women• Two analyses: the difference in mean weight change in kg and difference in percentage weight change between men and women• 3 trials reported different calorie deficits for men and women (Jolly 2011, Shai 2008, Wadden 2011)Difference between mean weight loss in kg from baseline between men and women -0.24kg [-1.04, 0.56] P=0.56Difference in % weight loss from baseline between men and women0.15% [-0.43, 0.73] P=0.62What works for men?• Reducing diet, physical activity & behaviour change techniques effective for both sexes• Men lost more weight with an intensive, low fat reducing diet than women– mean change -3.4kg (SD 4.34) versus -0.1kg (SD 4.06) p=0.004 (Shai 2008)• Women responded better to a Mediterranean diet than a low fat reducing diet– Mean change -6.2kg (SD 9.48) versus -0.1kg (SD 4.06) p=0.01 (Shai 2008)What works for men?• Groups when individual support or advice is also offered (but men were less likely to join groups/commercial providers) (Karvetti 1992, Jeffrey 1984, Wadden 2011, Hakala 1994, Jolly 2011)• Tailoring interventions by ethnicity might be more important for women (Wadden 2011)• Support from a spouse/partner more helpful for men than women (but not attending the same programme) (Golan 2010, Wing 1991)What doesn’t work for men?• Men were less able than women to maintain their weight with orlistat after intial weight loss (Richelsen 2007)– Women –9.7 kg (–8.4%) vs. –6.3 kg (–5.3%), reported p< 0.02 – Men      –8.9 kg (–8.3%) vs. –8.1 kg (–7.5%), reported NS• Men were less successful than women with interventions involving financial contracts for weight loss (reported p<0.05) and weight maintenance (reported p<0.006) (Jeffrey 1984)Conclusions• Few eligible trials, moderate quality• Men are less likely to join weight loss programmes but, once engaged, appear less likely to drop out than women• Men and women showed some differences in responses to different weight loss and weight maintenance interventionsConclusions• Description of interventions poor• Given that men have higher energy requirements for any given weight, should the– Difference between men and women be taken into consideration in prescribing diet and exercise?•Absolute calorie deficit be more for men?•%Calorie deficit be the same for men and women?What next?• Understanding the different views of men and women is likely to improve engagement and intervention effectiveness• Need more, better quality, long-term (>1 year) RCTs identifying men as a separate (heterogeneous) participant group to women• Report weight loss outcomes & drop-out separately for men and womenAcknowledgementsThis project was funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme (09/127/01) is published as a Health Technology Assessment monographhttp://www.journalslibrary.nihr.ac.uk/hta/volume-18/issue-35The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HTA programme, NIHR, NHS or the Department of HealthFollow HSRU on Twitter@hsru_aberdeenc.robertson@abdn.ac.ukThank youUK Congress on Obesity 2014University of Birmingham, Edgbaston CampusTuesday 16th September and Wednesday 17th September 2014

Should weight loss programmes be designed differently for men and women? The ROMEO (Review Of MEn and Obesity) Project

Should weight loss programmes be designed differently for men and women? The ROMEO (Review Of MEn and Obesity) Project

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