Positive Aspects of Weight Loss...from Men! | Dr Cindy Gray

Positive aspects of weight loss... from men!

Background to the project

Rising levels of obesity are a major challenge to public health

Obesity levels among men in UK 2003 Obesity levels among men in UK 2008

25-27% 23-25% 21-23% 19-21% 17-19% Exclusion

25-27% 23-25% 21-23% 19-21% 17-19% Exclusion

Background to the project

Rising levels of obesity are a major challenge to public health

Obesity levels among men in UK 2003 Obesity levels among men in UK 2008

25-27% 23-25% 21-23% 19-21% 17-19% Exclusion

25-27% 23-25% 21-23% 19-21% 17-19% Exclusion

Men and weight loss 5-10% weight loss can produce significant health

benefits (NICE 2006; SIGN 2010) BUT: Men are reluctant to attend traditional weight

management services Less than 15% of referrals to

commercial sector (Jebb et al Lancet 2011) Only 23% of attendees at NHS

weight management services (Counterweight Br J Gen Pract 2008)

BUT...... Growing recognition of professional sports

clubs potential to improve mens health

e.g. Scottish Professional Football League Clubs

Partner with local organisation(s)

Weight-management for men through increasing physical activity and eating a healthier diet

Free of charge, group-based programme

12 weekly, weight loss sessions with classroom education and training at Scotland's top professional football clubs

PLUS

Incremental, daily pedometer-based homework

THEN

Light touch ongoing maintenance to 12 months (1 reunion session at club and 6 email prompts)

Gender-sensitised

1) Content - healthy eating, not a diet, focus on PA and alcohol 2) Context - football clubs, male-only, club community coaches 3) Delivery participative, peer-supported, banter Gray, Hunt, Mutrie et al,

BMC Public Health 2013

Effectiveness

Setting: 13 top Scottish football clubs Participants: men, 35-65 years, BMI28 kg/m2

Measurement: baseline, 12 weeks (post-FFIT) and 12 months Primary outcome: objectively-measured weight loss at 12 months

In 2011-12, first-ever RCT of healthy lifestyle programme in professional sports clubs

Secondary outcomes Objective Self-reported Cost effectiveness

Waist circumference Physical Activity (IPAQ) Resource Use

BMI Food Frequency (DINE)

Body Composition (% Body Fat) Alcohol Intake (7-day diary)

Resting BP (Systolic/Diastolic) Self-esteem (Rosenberg)

Positive and Negative Affect (PANAS)

Health-related Quality of Life (SF-12)

12 month measurement (95%, n=355)

Loss to follow-up (7%, n=27)

Loss to follow up (12%, n=44)

Complete intervention 12 week measurement

(88%, n=330)

12 month measurement (89%, n=333)

Analyzed (89%, n=333)

Analyzed (95%, n=355)

Analysis

Loss to follow-up (11%, n=41)

Loss to follow-up (5%, n=19)

Excluded (n=177) Did not wish to participate (n= 101) Ineligible (BMI < 28kg/m2)

(n=76) Excluded (n=306) Allocated to FFIT programme groups that are not included in RCT

Allocation

Randomization

FFIT Enrollment Baseline measurement

(n=1,231)

Allocated to intervention group (n=374)

Allocated to comparison group (n=373) *

Follow-Up

12 week measurement (93%, n=347)

Multi-faceted recruitment 1) Media-based

e.g. newspapers, radio, websites 2) Club-based

e.g. match day adverts, manager/player endorsement 3) Other

e.g. signposting from NHS, workforce mail shots

*After randomisation, one participant

requested to have all of his data

destroyed.

RCT Design and Participant Flow

Results

High risk men 747 measured at baseline

Mean age: 47.1 (8.0) yrs

Mean BMI: 35.3 (4.9) kg/m2

Mean BP: 140.3 (16.3) mmHg systolic 88. 8 (10.2) mmHg diastolic

BMI Category %

Overweight (BMI 28-29.9) 7.6

Obese I (BMI 30-34.9) 44.0

Obese II (BMI 35-39.9) 31.2

Obese III (BMI 40) 17.1

Hunt, Gray, MacLean et al. BMC Public Health 2014

High risk men BMI Category %

Overweight (BMI 28-29.9) 7.6

Obese I (BMI 30-34.9) 44.0

Obese II (BMI 35-39.9) 31.2

Obese III (BMI 40) 17.1

Weight loss activities in last 3 months (%) Commercial programme NHS Services

Not at all 96.4 98.3

1-2 times per month 27 13

Hunt, Gray, MacLean et al. BMC Public Health 2014

747 measured at baseline

Mean age: 47.1 (8.0) yrs

Mean BMI: 35.3 (4.9) kg/m2

Mean BP: 140.3 (16.3) mmHg systolic 88. 8 (10.2) mmHg diastolic

Wide reach across SES

Est. from Scottish Index of Multiple Deprivation 2012 http://www.scotland.gov.uk/Topics/Statistics/SIMD

17.5 17.5 16.3

22.2 25.1

0

5

10

15

20

25

30

1 2 3 4 5

SIMD Quintile*

Programme delivery

Fidelity good: coaches delivered 86% of key tasks High attendance: 78.9% men at 6 or more sessions

What FFIT is not

For women I think ladies, to come to something that weve been on for the twelve weeks, wouldnt maybe appreciate the language thats used. You know, its all guys thats there and, you know, its football

A diet if someone said diet, I dont think any of us would have been here

The gym I dont want to go to a gym and see all the younger ones, the fitter ones and you got a kinda, you look roon [around] and you think theyre looking at ye [you]. Hes that fat he cannae even dae that.

Weight loss (%)

(Error bars represent 95% confidence intervals)

Adjusted between-group difference 12 weeks 471% (CI 5.44, 3.98) p

Participants achieving 5% weight loss 46.8

39.0

6.9 11.3

0

5

10

15

20

25

30

35

40

45

50

12 weeks 12 months

% P

artic

ipan

ts

InterventionComparison

Relative risk 12 weeks 6.77 (CI 4.52, 10.13)

Relative risk 12 months 3.47 (CI 2.51, 4.78)

Increase in self-reported PA

Adjusted ratio geometric means 12 weeks 2.38 (CI 1.90, 2.98) p

Dietary Improvements

(Error bars represent 95% confidence intervals)

-5.6

-4.5

1.6

0.8

-2.1

-1.3 -1.4 -1.7

0.2 0.3

-0.7 -0.5

-7.0

-6.0

-5.0

-4.0

-3.0

-2.0

-1.0

0.0

1.0

2.0

3.0

Mea

n ch

ange

in D

INE

scor

es

InterventionComparison

Fatty Foods Fruit and veg Sugary foods 12 wks 12 mths 12 wks 12 mths 12 wks 12 mths

Dietary Improvements

Fatty foods Adjusted between-group difference 12 weeks -4.39 (CI -5.16, -3.61) p

Lower alcohol consumption

12 months 12 weeks

Adjusted between-group difference 12 weeks -4.47 (CI -6.09, -2.86) p

Feel better in myself

0.00.10.10.20.20.30.30.4

12 weeks 12 months

Mea

n ch

ange

in

Rose

nber

g

-0.4

-0.2

0.0

0.2

0.4

0.6

0.8

Mea

n ch

ange

in P

ANAS

12wks 12mths 12wks 12mths

Positive affect Negative affect Self esteem

Within trial analysis Total cost: FFIT - 680 per man; comparison group - 475 per man

Gain in QALYs from FFIT: 0015 (0003, 0027) Incremental cost-effectiveness: 13,847 per QALY gained Probability of cost-effectiveness: 0.72 (20,000/QALY); 0.89 (30,000/QALY)

FFIT is cost effective

Derek Spence Hibernian FFIT Autumn 2011

FFIT website: www. ffit.org.uk

From the horses mouth

Thanks to Participants, coaches, MRC/CSO SPHSU Survey Office, Tayside Clinical Trials Unit

Collaborators Sally Wyke, Kate Hunt, Cindy M Gray, Chris Bunn, Annie Anderson, Shaun Treweek, Peter Donnan, Nanette Mutrie, Jim Leishman Elizabeth Fenwick, Alan White, Adrian Brady, Petra Rauchaus, Eleanor Grieve, Nicki Boyer

FFIT Programme Delivery SPFL Trust Billy Singh, Euan Miller, Stuart McPhee, Mark Dunlop and Iain Blair

FFIT Programme Funding Scottish Government, Football Pools

Research Funding: National Institute of Health Research Public Health Research (NIHR PHR) programme (project number 09/3010/06). The views expressed here are those of the authors and not necessarily those of the NIHR PHR programme or the Department of Health

Acknowledgements

Slide Number 1Background to the projectBackground to the projectMen and weight lossBUT......Growing recognition of professional sports clubs potential to improve mens healthe.g. Scottish Professional Football LeagueClubs Slide Number 6EffectivenessSlide Number 8ResultsHigh risk menHigh risk menWide reach across SESProgramme deliveryWeight loss (%)Participants achieving 5% weight lossIncrease in self-reported PADietary ImprovementsDietary ImprovementsLower alcohol consumptionFeel better in myselfSlide Number 21From the horses mouthAcknowledgements