Losing weight is hard. Losing weight and maintaining that weight loss is even harder. So anything that can possibly help lighten the load of this arduous task is worth further consideration. Promising research from the University of Southampton has shown there may be one more effective weapon in the battle against obesity: an online behavioural counselling tool called POWeR+

In a large scale study, the amount of weight lost by one group using the tool after 12 months was on average 4.3kg, compared to an average loss of 3 kg achieved by a control group receiving more conventional NHS weight loss advice, as would be given out as standard treatment to overweight/obese patients in the UK. Those using POWeR+ were also more likely to maintain clinically significant weight loss by 12 months, compared to the control group.

What makes this app particularly appealing is the possible cost savings to the NHS. When compared to the control group, which can be considered as equivalent to the cost of conventional NHS advice/treatment, the cost per kg lost was £25 lower for a POWeR+ using group.

The online tool called the Positive Online Weight Reduction (POWeR+) programme, was developed by Professor Paul Little of the Primary Care Research Department. He knew that behavioural counselling is effective in helping people lose weight but it is very costly due to the intensive counselling and support that is required.

The POWeR+ app aims to teach participants self-regulation and cognitive behavioural techniques via online behavioural intervention, enabling sustainable eating and physical activity habits to form, supported by brief contact with a practice nurse. It supplies the user with novel content, links to external content and email reminders. Little says:

Large patient numbers, limited staff training and time pressures mean that delivering face-to-face behavioural interventions in practice can be resource intensive. 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

Obesity is a growing problem in the UK. The World Health Organisation (WHO) reported in 2014 that 28% of adults were clinically obese, that is having a Body Mass Index (BMI) of over 30, this is a huge rise over obesity levels in 1980 when around 7% of adults were obese.

Their are a number of serious health problems linked to obesity including: diabetes, heart disease, hypertension and stroke. This ill health, as well as causing misery to the ill, also has cost implications to society as a whole. The cost to the NHS of dealing with obesity/overweight related disease in 2015 was between £6bn and £8bn, this is predicted to rise to between £10bn and £12bn by 2030.

The study, published in *The Lancet Diabetes & Endocrinology, consisted of 818 people with a BMI of over 30. These were randomly allocated to one of three groups, who all took part in 24 web based sessions over 6 months and had a follow up session at 12 months.

The control group used an existing online intervention to receive evidence based diet advice to replace unhealthy foods with similar but healthier choices, and increase fruit and vegetable intake. They also had brief visits to a nurse at 6 months and 12 months, similar to all groups, which did not provide counselling.

The POWeR+F group received automated behavioural counselling through the app, and three scheduled face-to-face nurse support sessions in the first three months. Four optional face-to face sessions were available in the following three months, the nurse would be alerted that a patient needed help if weight gains were recorded on two consecutive logins to the app.

The POWeR+R used the app but had less professional support than the +F group. Patients received the same automated counselling but the face-to-face contacts were replaced by phone or email contacts.

Although all the groups lost weight, the groups receiving help from the POWeR+ app lost more, and were more likely to have maintained clinically important weight loss (CIWL), which is when 5% weight loss is maintained at the12 month mark:

• Control – lost 3 kg (avg) during 12 months, 21% maintained CIWL

• POWeR+F – lost 4.5 kg (avg) during 12 months, 29% maintained CIWL

• POWeR+R – lost 4.3 kg (avg) during 12 months, 32% maintained CIWL

Little said of the results:

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.

The costs to the NHS

The intial results on weight loss alone look impressive but become even more so when combined with the cost savings to the NHS possible when using a tool like POWeR+.

The National Institue for Health and Care Excellence (NICE)has estimated that any intervention costing a *£100 per kg of weight lost, if maintained for life, would be a cost effective way of reducing the NHS spend on obesity/overweight related disease.

The estimated incremental overall NHS cost per kg lost of the POWeR+ groups, compared to the control group, was £18 for POWeR+F and – £25 for POWeR+R; meaning POWeR+R cost less or was more cost effective than the control strategy.

Both POWeR+ interventions achieve cost per kg weight losses below the NICE threshold (according to the report’s conclusions), even though the POWER+ interventions were only for 6 months, CIWL remained steady upto the 12 month mark.

To give a ball park figure of the possible cost saving involved we can take the figure for the adult population of the UK in 2014 at 64.6 million. If the 28% of these who were obese were to lose 1kg each, using this app, the ball park figure for money saved comes to £452.2 million; and that doesn’t include costs saved down the line due to treating less obesity related disease.

With such promising results you may be wondering when this online tool will be made available for public use. A University of Southampton spokesperson had this to say:

we can’t give a definitive timescale of the intervention going to market but we hope it is very soon as we have had widespread interest from various health organisations in the UK

The WHO rate obesity as being a major preventable causes of death. With rates continuing to rise across the UK and the western world, it is good to see new tools being created that can promote the health of the nation. And with this particular tool’s estimated cost effectiveness, if verified, it wont be long until cash strapped organisations like the NHS bring it into use.

How does it compare to other weight loss programs

The weight loss seen when using the POWeR+ tool compares well to the results seen from a trial of the commercially available weight watchers scheme. That study recruited 772 participants with a BMI of between 27 and 35. Paricipants were randomly assigned to either 12 months free membership of Weight Watchers or a group following national treatment guidelines for obesity; i.e. advice from their GP or other health proffesional.

At twelve months the Weight Watchers group had lost on average 5.1 kg compared to 2.3 kg for those receiving standard care. However some criticisms have been levelled at the study, it was funded by Weight Watchers and participants received a free 12 monthsWeight Watchers membership, which currently can cost upto £325/year.

Conrad Bower

Featured image via Wikimedia Commons