Obesity is recognised worldwide as a primary determinant of ill health, especially in diabetes and cardiovascular disease.
The incidence of obesity in the UK population has risen dramatically since the 1990s, with a recent Health Survey for England predicting that 60% of adult men and 50% of adult women will be obese by 2050.
The cost to the NHS related to overweight and obesity is projected to be almost £10bn over the same time scale.
GPs in West Oxfordshire were particularly concerned about the increasing incidence of overweight and obesity within their practices.
This prompted a group to seek an independent, external investigation into alternative methods of sustained weight loss, while maintaining the current interventions of advice and medication.
In conjunction with Buckinghamshire New University and the Knowledge Transfer Partnership, it was decided to explore a novel programme of weight reduction, which relied substantially on internet and mobile technology.
Weight loss website
The GPs supported the use of internet and mobile technology to see whether an effective and sustainable weight loss programme for healthy patients with a BMI ?30 could be developed.
The programme, which lasted 12 months, was designed to allow individual participation using a website and regular email and text messages. Psychological and educational approaches were used to facilitate changes in diet and exercise.
A local exercise provider was invited to offer a variety of physical activities specifically for the patients who were taking part in the study. These sessions were offered at a reduced cost to encourage participation.
A programme leader maintained the website and kept in touch with patients by sending regular updates, information on local exercise opportunities and encouragement as people reported their current weight. It was designed so that confidentiality was maintained, yet patients could interact with the programme leader via the internet as often as was required.
Three quarters of the completing patients lost weight over a 12-month period. Nearly half lost at least 5% of their initial body weight, an amount considered to be highly beneficial for enhanced health.
Most patients showed improvements in self-reported quality of life, physical activity and diet. One of the most striking outcomes was the high number of men who lost weight (almost 90%), because men are often more reluctant to become involved in weight loss programmes.
In terms of the programme content, one of the most successful aspects was a weekly web-based weight loss 'league table', where anonymised patients reported changes in weight and could be compared with others. An evaluation, using focus groups, showed that regularity of contact with the programme leader (via the internet) was also a major feature of its success. Emails and text messages clearly provide a basis for motivating patients in a cost-effective manner.
IT provides a mechanism for personal interaction without the need for face-to-face meetings, which men in particular often find a barrier to involvement. There is little doubt that the quality of the website is an important factor in losing weight and it is encouraging to see the number of websites now available to aid weight loss at little or no cost.
An internet-based programme can involve GPs in the weight loss of a large number of patients in a cost-effective manner. This would require a skilled, knowledgeable, empathetic programme leader.
However, if GPs do nothing else but recommend that obese patients explore the available websites, it is possible this could contribute to improved health for some.
In addition, the strong relationship between weight loss and a self-reported increase in physical activity highlights the importance of encouraging patients to become more active, rather than simply focusing on a change in diet.
Having an effective exercise referral programme in place, offering a variety of activities and run by instructors who understand this patient group, is likely to encourage exercise uptake in obese patients.
Implications for GPs
The main benefit of the programme is that it dramatically reduces the cost of face-to-face time with patients, freeing up healthcare professionals for other activities.
Its main limitation is the initial cost of the website. However, since this work began, a substantial number of health-promoting websites have become available and these could act as a basis for the important text messages and emails which link the patient and the leader.
The future demography of obesity levels and consequent diseases should be sufficient for GPs and commissioners to consider such alternative strategies. IT-based programmes, appealing to men and women, could become an effective tool for successful and sustained weight loss.
- Professor Brodie is emeritus professor of cardiovascular health, Dr Radhakrishnan was a PhD student and Dr Shaw is visiting reader in health psychology, all at Buckinghamshire New University. Ms Doyle was an associate for the Knowledge Transfer Partnership.
- There are no conflicts of interest for any of the authors.