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McCombie L.,Counterweight Ltd | Lean M.E.J.,University of Glasgow | Tigbe W.W.,University of Warwick
Medicine (United Kingdom) | Year: 2015

Limitations in epidemiological data means that most health economic analyses have provided incomplete estimates of the total financial burden of obesity on healthcare: more complete data are needed on multiple disease risks and costs attributable to overweight and obesity, stratified by age, sex and BMI, particularly for severe and complicated obesity. UK primary care data indicate that the annual healthcare costs of patients with BMI 20-21 kg/m2 (ideal body weight) are about half those at BMI 40 kg/m2, for both men and women. Cost-effectiveness of structured weight management is high over patients' lifetimes (potentially cost-saving). Drug treatments and bariatric surgery are also highly cost-effective, but have greater unit costs and so afford less net benefit at a population level. Before these interventions can reduce the spiralling healthcare costs associated with obesity, short-term spending is necessary to establish services that will become cost-effective over a longer period. © 2014 Elsevier Ltd. All rights reserved.

Morrison D.,University of Glasgow | McLoone P.,University of Glasgow | Brosnahan N.,Counterweight Ltd | McCombie L.,Counterweight Ltd | And 2 more authors.
BMC Public Health | Year: 2013

Background: Community pharmacies may offer an accessible way of delivering weight-management programmes but there have been few trials that use clinically significant weight loss outcomes, objective measures of weight and follow-up to 12 months. We aimed to evaluate weight change among patients who used the Counterweight weight management programme delivered by community pharmacies. Methods. The Counterweight Programme was introduced into community pharmacies in Fife, Scotland in 2009 for patients with a BMI ≥ 30 kg/ m§ssup§2§esup§ or a BMI ≥ 2830 kg/ m§ssup§2§esup§ with a co-morbidity in localities in which Counterweight was not available at GP practices. The aim was to achieve an energy deficit of 500-600 kcal per day. Counterweight specialist dietitians delivered training, support and patient information materials to community pharmacies. Patient weight was measured by pharmacy staff at each weight management session. Weight data recorded at each weight management session were used to estimate weight change and attendance at 3, 6 and 12 months. Results: Between March 2009 and July 2012, 458 patients were enrolled by the community pharmacies. Three-quarters of patients were women, mean age was 54 (SD 7.4) years and mean BMI 36.1 (SD 5.9) kg/m§ssup§2§esup§. Of 314 patients enrolled for at least 12 months, 32 (10.2% on an intention to treat basis) had achieved the target weight loss of ≥5%; this was 41.6% of those who attended at 12 months representing a mean weight loss of 4.1 kg. Using Last Observation Carried Forward, 15.9% achieved the target weight loss within 12 months of enrolling. There was no significant effect of sex, baseline BMI or age on weight loss. Conclusions: The Counterweight pharmacy programme has a similar effectiveness to other primary care based weight management programmes and should be considered as part of a range of services available to a community to manage overweight and obesity. © 2013 Morrison et al.; licensee BioMed Central Ltd.

Lean M.,Royal Infirmary | Brosnahan N.,Counterweight Ltd | McLoone P.,University of Glasgow | McCombie L.,Counterweight Ltd | And 9 more authors.
British Journal of General Practice | Year: 2013

Background: There is no established primary care solution for the rapidly increasing numbers of severely obese people with body mass index (BMI) >4 0 kg/m2. Aim: This programme aimed to generate weight losses of >15 kg at 12 months, within routine primary care. Design and setting: Feasibility study in primary care. Method: Patients with a BMI >4 0 kg/m2 commenced a micronutrient-replete 810-833 kcal/day lowenergy liquid diet (LELD), delivered in primary care, for a planned 12 weeks or 20 kg weight loss (whichever was the sooner), with structured food reintroduction and then weight-loss maintenance, with optional orlistat to 12 months. Results: Of 91 patients (74 females) entering the programme (baseline: weight 131 kg, BMI 48 kg/m2, age 46 years), 58/91(64%) completed the LELD stage, with a mean duration of 14.4 weeks (standard deviation [SD] = 6.0 weeks), and a mean weight loss of 16.9 kg (SD = 6.0 kg). Four patients commenced weight-loss maintenance omitting the food-reintroduction stage. Of the remaining 54, 37(68%) started and completed food reintroduction over a mean duration of 9.3 weeks (SD = 5.7 weeks), with a further mean weight loss of 2.1 kg (SD = 3.7 kg), before starting a long-term low-fat-diet weight-loss maintenance plan. A total of 44/91 (48%) received orlistat at some stage. At 12 months, weight was recorded for 68/91 (75%) patients, with a mean loss of 12.4 kg (SD = 11.4 kg). Of these, 30 (33% of all 91 patients starting the programme) had a documented maintained weight loss of >1 5 kg at 12 months, six (7%) had a 10-15 kg loss, and 11 (12%) had a 5-10 kg loss. The indicative cost of providing this entire programme for wider implementation would be £861 per patient entered, or £2611 per documented 15 kg loss achieved. Conclusion: A care package within routine primary care for severe obesity, including LELD, food reintroduction, and weight-loss maintenance, was well accepted and achieved a 12-monthmaintained weight loss of >15 kg for one-third of all patients entering the programme. © British Journal of General Practice.

Leslie W.S.,University of Glasgow | Ford I.,University of Glasgow | Sattar N.,University of Glasgow | Hollingsworth K.G.,Northumbria University | And 16 more authors.
BMC Family Practice | Year: 2016

Background: Despite improving evidence-based practice following clinical guidelines to optimise drug therapy, Type 2 diabetes (T2DM) still exerts a devastating toll from vascular complications and premature death. Biochemical remission of T2DM has been demonstrated with weight loss around 15kg following bariatric surgery and in several small studies of non-surgical energy-restriction treatments. The non-surgical Counterweight-Plus programme, running in Primary Care where obesity and T2DM are routinely managed, produces >15 kg weight loss in 33 % of all enrolled patients. The Diabetes UK-funded Counterpoint study suggested that this should be sufficient to reverse T2DM by removing ectopic fat in liver and pancreas, restoring first-phase insulin secretion. The Diabetes Remission Clinical Trial (DiRECT) was designed to determine whether a structured, intensive, weight management programme, delivered in a routine Primary Care setting, is a viable treatment for achieving durable normoglycaemia. Other aims are to understand the mechanistic basis of remission and to identify psychological predictors of response. Methods/Design: Cluster-randomised design with GP practice as the unit of randomisation: 280 participants from around 30 practices in Scotland and England will be allocated either to continue usual guideline-based care or to add the Counterweight-Plus weight management programme, which includes primary care nurse or dietitian delivery of 12-20weeks low calorie diet replacement, food reintroduction, and long-term weight loss maintenance. Main inclusion criteria: men and women aged 20-65years, all ethnicities, T2DM 0-6years duration, BMI 27-45 kg/m2. Tyneside participants will undergo Magnetic Resonance (MR) studies of pancreatic and hepatic fat, and metabolic studies to determine mechanisms underlying T2DM remission. Co-primary endpoints: weight reduction ≥ 15 kg and HbA1c <48 mmol/mol at one year. Further follow-up at 2 years. Discussion: This study will establish whether a structured weight management programme, delivered in Primary Care by practice nurses or dietitians, is a viable treatment to achieve T2DM remission. Results, available from 2018 onwards, will inform future service strategy. Trial registration: Current Controlled Trials ISRCTN03267836. Date of Registration 20/12/2013 © 2016 Leslie et al.

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