Sriwisit, Sukhumaphorn
(2013)
The effectiveness of commercial weight loss programmes : a systematic review and evaluation of a pharmacist-led weight management clinic.
PhD thesis, University of Nottingham.
Abstract
Commercial weight loss programmes (CWLPs) are structured weight loss programmes, which are provided to the public by commercial organisations for profit. These programmes offer a weight management service for overweight or obese adults who are willing and able to pay for their participation. There are few studies that have shown CWLPs are more effective than either usual or standard care in various healthcare settings. The extent to which elements of CWLPs contribute to weight reduction is not clear from these studies.
The studies presented in this thesis aimed to i) systematically review the effectiveness of CWLPs in randomised controlled trials and ii) to evaluate the effectiveness of a pharmacist-led weight management clinic, Boots Pharmacy Weight Loss Programme (BPWLP), in achieving meaningful weight loss of the initial body weight at three months in overweight and obese clients who received a combination of orlistat, and diet and exercise advice.
The systematic review evaluated percentage weight loss or change and used a narrative synthesis. Nine electronic databases (1980-2011) were searched. The review studies published in English were included and their quality was assessed, including assessment of risk of bias. The number of total titles, abstracts and full articles reviewed were 8484, 772 and 153, respectively. The final number of papers included in the review was 20 randomised studies of CWLPs, which were selected based on the application of inclusion and exclusion criteria.
The evaluation of the BPWLP involved analysis of data from randomly collected customer record forms (CRFs) for clients who participated in the programme from January 2006 to January 2009. Five hundred and fifty-seven records were collected from 10 Boots pharmacies. Demographics data, history information, biometric data and information about the supply of orlistat were collected. Change in body weight (kg) was compared at baseline and three months using Wilcoxon Signed Rank Test.
Seventy percent of the studies included in the systematic review were conducted in the US. There were three potential elements of effective CWLPs, which were calorie restriction, exercise and support. At 12 weeks, mean weight loss ranged from 3.3 to 12.7 kg.
The mean weight loss in the BPWLP was 5.8 kg (p < 0.001). Similarly, sensitivity analysis using last-observation-carried-forward (LOCF) showed a statistically significant weight loss (p < 0.001) associated with the BPWLP. Sixty-two percent of clients, who completed the BPWLP, lost at least 5% of their initial body weight at three months. Although the BPWLP had a high dropout rate (70%), clients mainly left the programme because they achieved their desired weight loss.
The studies presented in this thesis have shown that CWLPs are effective in helping clients to lose weight. The systematic review shows that the combination of calorie restriction, structured exercise and support is an effective first-line strategy in obesity treatment. The BPWLP, which uses orlistat 120 mg in combination with advice and support on diet and exercise, was shown to be effective in achieving weight loss for clients and is considered a second-line treatment. Health care professionals and policy makers should acknowledge and adopt such strategies in order to tackle the problem of obesity. In particular, pharmacists have an important role to play in facilitating effective weight reduction through the provision of dietary and exercise advice and the prescribing of orlistat. Further study should focus on the factors which contribute to long-term weight maintenance and the cost-effectiveness of CWLPs.
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