A randomised controlled trial to test the clinical and cost-effectiveness of primary care referral to a commercial weight loss provider.

超重和肥胖是一个严重的公共卫生问题，因为它的患病率很高，并与II型糖尿病、心脏病和癌症等疾病有关。如果我们要减少与超重相关的健康问题，早期治疗和预防是很重要的，但是通过国民健康服务（NHS）提供的治疗方法很少，而且考虑到需要治疗的人数，那些可用的治疗方法可能非常昂贵。英国国家医疗服务体系（NHS）每年花费42亿英镑用于治疗与超重和肥胖有关的疾病，因此提供（经济有效的）减肥治疗方案符合其利益。整个社会的损失估计为160亿英镑。本研究旨在检验目前NHS提供的一种治疗方案——转介给商业减肥治疗提供者——并确定这种治疗方案在帮助人们减肥和保持体重方面是否具有成本效益。先前的研究表明，推荐患者与商业减肥提供者进行12次治疗可以产生一定程度的减肥效果，这对健康有很大的好处。这些转诊包以折扣价提供给NHS，但是没有研究正式评估这种方法的成本效益。当我们考虑到改善患者的健康状况以及在体重相关疾病的治疗上可能节省的费用时，这项研究将检验花在治疗上的钱是否值得。但在减肥治疗停止后体重反弹是很常见的，可能12周的时间不够长，不足以形成长期的行为改变。不难想象，与12周的治疗方案相比，12个月的治疗方案可能会导致更大的体重减轻和更长期的变化，而且这可能意味着更少的体重反弹。然而，可能增加的效果将以更高的成本为代价，这就留下了一个问题：“哪种选择更具成本效益？”这正是本研究试图检验的。我们也想更多地了解患者对减肥治疗的体验。先前的研究表明，许多超重和肥胖的成年人并不认为这是一个医学问题，这可能会影响他们通过NHS接受治疗的态度。通过提高我们对治疗态度和经验的理解，我们可以改善NHS提供的体重管理方式。在我们的试验中，1200名超重和肥胖的成年人将由他们的全科医生确定，并由研究团队招募。研究小组将随机将参与者分配到三个治疗组中的一个- 12个疗程转介给商业提供者，12个月转介给商业提供者，或“简短干预”（关于如何减肥和随访时称重的标准信息）。我们将在治疗结束后3个月、12个月和24个月（治疗结束后1年）对参与者进行随访，比较各组参与者的体重减轻量。我们还将观察每组中有多少参与者的体重减轻与健康状况的显著改善有关。我们将使用试验期间收集的数据和其他数据来检查哪种治疗方案最物有所值。这将在短期（试验持续时间）和长期进行审查，使用预期健康变化和相关费用的长期模型。我们还将采访一部分参与者，以获得对患者体验的更全面的看法，并探讨他们对减肥治疗和nhs商业伙伴关系的态度。这项研究将为全科医生和NHS治疗专员提供重要的信息，告诉他们哪种治疗方案最有效，哪种治疗方案最物有所值。试验结果和访谈结果将有助于为未来有关nhs -商业伙伴关系的决策提供信息

Overweight and obesity is a serious public health issue due to its high prevalence and association with illnesses, such as Type II diabetes, heart disease and cancer. Early treatment and prevention are important if we are to reduce the health problems associated with excess weight, but there are few treatments available through the National Health Service (NHS) and those that are available can be very costly when we consider the number of people requiring treatment. It is in the interests of the NHS to offer (cost-effective) weight loss treatment options, as they spend £4.2 billion each year on treating illness related to overweight and obesity. The cost to the wider community is estimated at £16 billion. This study seeks to examine one of the treatment options currently available on the NHS - referral to a commercial weight loss treatment provider - and to establish whether this treatment option is cost-effective in helping people to lose weight and keep it off. Previous research has shown that referring a patient for 12 sessions with a commercial weight loss provider can produce an amount of weight loss which has significant health benefits. These referral packages are offered to the NHS at a discounted price, however no studies have formally evaluated the cost-effectiveness of this approach. This study will examine whether the money spent on treatment is worthwhile when we consider the effect of improved health for patients and also potential cost savings on treatments for weight-related illness. But weight regain is common after weight loss treatment stops and it may be that 12 weeks is not long enough to develop long term changes in behaviour. It is not hard to imagine that a 12 month referral could lead to greater weight loss and more long term changes than a 12 week programme, and that this could mean less weight regain. However, the likely increased effect will come at a higher cost, leaving the question 'What is the more cost-effective option?'. This is precisely what this study seeks to examine. We also want to uderstand more about the patient experience of weight loss treatment. Previous research has shown that many adults with overweight and obesity do not consider this to be a medical problem and this may influence their attitudes to receiving treatment through the NHS. By improving our understanding of attitudes and experience of treatment, we can improve the way weight management is provided by the NHS.In our trial, 1200 adults with overweight and obesity will be identified by their GP and recruited by the research team. The research team will randomly assign participants to one of three treatment groups - a 12 session referral to a commercial provider, a 12 month referral to a commercial provider, or a 'brief intervention' (standard information about how to lose weight and weighing at follow up). We will follow participants up at 3 months, 12 months and 24 months (1 year after treatment has finished) to compare the amount of weight lost by participants in each group. We will also look at how many participants in each group lose an amount of weight that is associated with significant health improvements. We will use this and other data collected during the trial to examine which treatment option offers the best value for money. This will be examined over the short term (the duration of the trial) and the longer term, using long term modelling of anticipated health changes and associated costs. We will also interview a subset of participants to gain a more holistic view of the patient experience and to explore their attitudes to weight loss treatment and NHS-commercial partnerships.This research will provide important information to GPs and NHS treatment commissioners about which treatment option is most effective and which offers best value for money. Trial results and findings from interviews will help inform future decisions about NHS-commercial partnership