A pragmatic randomised controlled trial in primary care of the Camden Weight Loss (CAMWEL) programme
- Kiran Nanchahal1,
- Tom Power1,
- Elizabeth Holdsworth1,
- Michelle Hession1,
- Annik Sorhaindo1,
- Ulla Griffiths1,
- Joy Townsend1,
- Nicki Thorogood1,
- David Haslam2,
- Anthony Kessel1,3,
- Shah Ebrahim1,
- Mike Kenward1,
- Andrew Haines1
- 1London School of Hygiene & Tropical Medicine, London, UK
- 2Watton Place Clinic, Watton-At-Stone, UK
- 3Health Protection Agency, London, UK
- Correspondence to Kiran Nanchahal;
- Received 20 December 2011
- Accepted 30 March 2012
- Published 4 May 2012
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/m2 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.
All authors, external and internal, had full access to all the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.
To cite: Nanchahal K, Power T, Holdsworth E, et al. A pragmatic randomised controlled trial in primary care of the Camden weight loss (CAMWEL) programme. BMJ Open 2012;2:e000793. doi:10.1136/bmjopen-2011-000793
Contributors KN, JLT, NT, DH, AK, SE and AH contributed to conception and design. MH, JLT, KN, EH, AS and UG contributed to acquisition of data, KN, TP, EH, MK and AH contributed to analysis and interpretation of data, and KN drafted the article. KN, JLT and AH revised it critically for important intellectual content. All authors contributed to the final approval of the version to be published.
Funding This work was supported by Camden Primary Care Trust (NHS Camden). The funding source had no role in the design or conduct of the study; collection, management, analysis or interpretation of the data and preparation, review or approval of the manuscript.
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.
Ethics approval Ethics approval was provided by the London School of Hygiene & Tropical Medicine Ethics Committee, the Camden and Islington Community Research Ethics Committee (reference number 09/H0722/22) and the North Central London Research Consortium.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data available.
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