Participants’ Explanatory Model of Being Overweight and Their Experiences of 2 Weight Loss Interventions

Amy L. Ahern; Emma J. Boyland; Susan A. Jebb; Simon R. Cohn

doi:10.1370/afm.1446

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Table 1

Characteristics of the Weight Loss Interventions

Intervention	Characteristics
Commercial program	Vouchers to attend Weight Watchers for 12 months
	Weekly group meetings in local community venue
	Promotes a hypoenergetic, balanced diet based on healthy eating principles
	Advice on increasing physical activity
	Weight measurement
	Group support
	Access to internet-based systems to monitor food intake, activity, and weight change; to participate in community discussion boards; and to access a library of information, recipes, and meal ideas
	Average participant attendance while in trial = 3 meetings per month
Standard care	In line with national guidelines (see http://www.nice.org.uk/CG043)
	Weight loss advice from primary care professional at local practice (usually practice nurse)
	1-on-1 meetings; minimum level of care = 6 visits over 12 months
	Weight measurement
	Dietary advice based on British Heart Foundation booklet So You Want To Lose Weight... For Good
	Average participant attendance while in trial = 1 meeting per month

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Table 2

Characteristics of Study Participants, and UK Trial Participants From Which They Are Drawn

	Commercial Program		Standard Care		Overall

Characteristic	UK RCT Participants (n=120)	Interview Sample (n=9)	UK RCT Participants (n=116)	Interview Sample (n=7)	UK RCT Participants (n=236)	Interview Sample (n=16)
Age, mean y	47	44	46	49	47	47
Entry BMI, mean kg/m²	31	30	31	31	31	31
Ethnicity, % white	95	100	95	89	95	94
Female, %	92	100	91	100	91	100

BMI = body mass index; RCT = randomized controlled trial; UK = United Kingdom.

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Table 3

Characteristics of the Individual Participants

Participant	Intervention	Completed	Time in Trial, mo	Baseline Weight (kg)	Weight Change, %
1	SC	Withdrew	4	81.0	1.98
2	SC	Completed	12	70.0	−7.43
3	CP	Completed	12	81.7	−17.87
4	CP	Withdrew	4	80.0	−3.5
5	SC	Completed	12	64.8	−0.77
6	CP	Completed	12	81.8	−13.57
7	SC	Completed	12	87.5	−13.71
8	CP	Withdrew	4	71.3	0.14
9	CP	Completed	12	86.8	−11.29
10	SC	Withdrew	Baseline only	90.7	–
11	SC	Completed	12	73.8	−9.08
12	SC	Withdrew	9	74.6	−0.94
13	SC	Withdrew	Baseline only	74.9	–
14	SC	Withdrew	2	76.8	−5.6
15	CP	Withdrew	2	87.2	−1.95
16	CP	Withdrew	9	88.6	−0.68

CP=commercial provider; SC=standard care.

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Table 4

Key Features of General Explanatory Model of Being Overweight in Relation to Standard Care and a Commercial Weight Loss Program

Explanatory Model	Standard Care	Commercial Program
Overweight not regarded as a disease needing medical treatment	Based in local physician’s practice Delivered by health care professionals	Based in various (nonmedical) community venues Delivered by community members who have lost weight with commercial provider
Need motivation and support for weight loss, rather than information	Health care professionals varied widely in their interest in weight loss and their ability to support and motivate Care primarily participant led	Key role of leader is to motivate the group Most participants experience the group environment as supportive, though not suitable for all
Frequent contact and accountability needed	Meetings arranged in advance by participants Appointments need not be at a regular time or day but must be on weekdays during “office hours” Can be difficult to get an appointment	Weekly meetings held in accessible community venues Local meetings at a variety of set days and times Participants can drop in
Cannot be treated or cured. Weight regain likely	On-going support possible, but would require specific additional care provision	Weight management is viewed as on-going process and continued provision offered Continued provision would require self-payment or further payment by primary care provider Members who have reached their goal weight can attend free of charge

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Supplemental Appendix

Supplemental Appendix. Participant Interview Schedule

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Supplemental data: Appendix - PDF file, 2 pages, 172 KB
The Article in Brief

Participants' Explanatory Model of Being Overweight and Their Experiences of 2 Weight Loss Interventions

Amy L. Ahern , and colleagues

Background Previous international research found that a commercial Weight Watchers program was more successful in helping people lose weight than a standard primary care-based intervention. In this study, researchers analyze the accounts of a small sample of 16 participants' experiences with these two programs.

What This Study Found Referral to a commercial weight loss provider resonates with participants' general explanatory model of being overweight; they want support and motivation rather than education in a medical context, and they value the ease of access and frequent contact the commercial provider offers. Many report a resistance to the medicalization of being overweight. Some patients prefer individual-level support through their physician, and, in this study, all were positive about the opportunity to access support through the primary care setting.

Implications

The authors conclude these findings support providing patients with a range of options for weight management in primary care, including commercial programs and other interventions outside the traditional medical setting, to find what best suits their needs and lifestyle.