People given evidence-based information online that had been shown to help previously lost around 3kg, but using the Positive Online Weight Reduction (POWeR)+ online programme with very brief support from practice staff, participants lost over one kg more averaged over 12 months and were more likely to maintain clinically important weight loss by 12 months, according to research led by the University of Southampton, UK.
POWeR+ is an online behavioural intervention that is supported by brief contacts from a practice nurse. It teaches participants self-regulation and cognitive behavioural techniques to provide them with long-term, sustainable ways of forming healthy eating and exercise habits.
“Many people receiving the POWeR+ intervention were able to sustain weight loss over one year but also felt more enabled in managing their weight going forward, and fewer resorted to other activities such as commercial slimming programmes to lose weight,” said Professor Paul Little, Professor of Primary Care Research who developed POWeR+.
Paul Little
The NIHR Health Technology Assessment (HTA)-funded study, ‘An internet-based intervention with brief nurse support to manage obesity in primary care (POWeR ): a pragmatic, parallel-group, randomised controlled trial’, published in The Lancet Diabetes & Endocrinology journal, involved 818 people with a BMI>30 who took part in 24 web-based sessions over six months. They were randomly allocated to one of three groups; 1) control – an existing online intervention that encourages healthier options. 2) POWeR+ with face-to-face support from a nurse, and 3) POWeR+ with remote very brief support from a nurse (on average three email contacts and one phone contact). All patients were asked to come for appointments for weighing at six and also 12 months to see if weight loss was maintained.
They found that while people in all groups lost weight, the two groups receiving the POWeR+ intervention lost more. The control group lost an average of 3kg during 12 months and 21 per cent of people were able to maintain a clinically important amount of weight loss by 12 months. The POWeR+ group with face-to-face support lost 1.5kg more averaged over 12 months and 29 per cent of people had maintained important weight loss by 12 months. The POWeR+ group with remote support lost 1.3kg more averaged over 12 months with 32 per cent able to maintain clinically important weight loss by 12 months.
The incremental overall cost to the health service per kg weight lost with the POWeR+ interventions versus the control strategy was £18 (95% CI −129 to 195) for POWeR+F and –£25 (−268 to 157) for POWeR+R; the probability of being cost-effective at a threshold of £100 per kg lost was 88% and 98%, respectively.
“Large patient numbers, limited staff training and time pressures mean that delivering face-to-face behavioural interventions in practice can be resource intensive,” said Little. “This has the potential to save the NHS money if obesity-linked health problems can be prevented. The intervention was mostly delivered online, the costs of the intervention are low, it is easy to roll out, and likely to be very cost-effective for the NHS.”
Health Technology Assessment Programme of the National Institute for Health Research.
