Table 1 Characteristics of weight management programmes

Professional background of therapist

Successful group members selected through interview process. No formal qualifications required prior to training and selection.

Successful group members selected through interview process. No formal qualifications required prior to training and selection.

Varied, may be successful slimmers. No formal qualifications required prior to training and selection.

Food advisors recruited from local community. No formal qualifications required prior to training and selection.

GP: practice nurse or general practitioner

Pharmacy: pharmacist

Training of therapist

4 visits to meetings to observe and deliver elements, admin workshop;

3 day residential workshop;

Further 4 meetings delivering practical elements, one admin workshop.

4 day foundation training course; 4 advanced training courses.

OCR Exercise to music training.

Certificate in applied nutrition and weight management.

Business management and marketing.

Attendance at annual training conferences and convention.

NVQ level 3, 12 × 2.5 hour training sessions from dieticians and nutritionists. 18 assessments.

2 day adult weight management course.

Assessment of therapist's competence

Assessed by area manager, who has observed all training sessions apart from 3-day workshop.

Completion of training course and 4 diploma exams. Observations at 1^st and 6^th sessions (minimum); twice yearly development visits by manager.

Theoretical papers and practical assessment by independent body.

Assessed taking class once started.

Annual business review.

Observed running session prior to passing the course.

Observed during the training course by leader e.g. Q&A, mock-interviewing.

Fidelity checking of intervention

Regular observations by area service manager. Buddy system during first year.

Weekly planning and training phone call with manager; regular observations of groups. Monitoring of retention to group, weight loss achieved.

Mystery shoppers used.

Random checks.

Monthly supervision meetings.

None.

Programme Characteristics

Weight Watchers

Slimming World

Rosemary Conley

NHS Size Down

General practice/pharmacy

Group or individual

Group. 1-2-1 for new members and when weighed. Group talk from leader with discussion.

Group. 1-2-1 when weighed. Group used to share progress and lapses and to find and share solutions.

Group. 1-2-1 when weighed and to establish calorie allowance.

Also, additional support available via email/telephone 1-2-1.

Group. Group used to share progress and lapses and to find and share solutions. All group members start in same week and progress as a closed group.

Individual

Duration of sessions, frequency, programme length and setting

1 hour sessions.

12 weekly sessions provided as part of Lighten Up.

Community based venues.

1 1/2 hour sessions.

12 weekly sessions provided as part of Lighten Up.

Access to website, magazines and 1-2-1 telephone support from consultant or other members.

Community based venues.

1 1/2 hours

12 weekly sessions provided as part of Lighten Up.

Community based venues.

2 hour duration;

groups weekly × 6 weeks; drop-in at 9 and 12 weeks.

Community based venues. All group members start in same week and progress as a closed group.

1^st session 30 minutes, follow up sessions 15-20 minutes

12 weekly sessions provided as part of Lighten Up - although may not have taken place weekly in all cases.

In surgery or pharmacy.

Content of sessions

Core programme material delivered over 5-weeks: food points system (based on age, gender, height, weight & activity), beating hunger, taking more physical activity, eating out and keeping motivated. Other sessions delivered to whole group cover recipes, health and nutrition and keeping active.

Encouraged to eat mainly low energy dense foods to achieve satiety, plus some extras rich in calcium and fibre, with controlled amounts of high energy dense foods.

Weight loss and improved diet, fitness and improvement of physical condition, motivation and self esteem, use of group support.

Use of portion pots.

Motivational video.

Managing behaviour around food and relapse prevention; eatwell plate [25]; nutrition information; interactive style used.

Planning strategies to deal with lapses into previous dietary behaviours.

Sessions client led and based around a problem solving approach.

Weight and dieting history; exploration of goals & expectations of patients; eatwell plate; setting goals to reduce calorie intake & increase physical activity.

Planning strategies to deal with challenging situations. Use of food diaries.

Maintaining weight loss

Weight-loss goal

0.5 to 1 kg per week (plan aims for 500 kcals deficit/day)

Set by individual.

Staged goals: either 1-1.5 kgs per week with goal of (1 stone) loss or 0.5-1 kg per week with 3.2 kg (7 lb) initial goal.

Participants told they can lose 2% of body weight in 12 weeks

5-10% of starting body weight, at a rate of 0.5-1 kg per week over 3-6 months, followed by maintenance

Relative emphasis on diet and exercise

Diet>exercise.

Physical activity encouraged, objective to gradually build up to 10,000 steps daily.

Diet>exercise.

Physical activity encouraged, with gradual build up to 30 mins moderately intense activity 5 days a week.

Diet=exercise

45 mins (of 11/2 hour sessions devoted to optional exercise class. Extra exercise sessions may be offered for additional fee.

Diet>activity, but time spent on benefits of physical activity, setting goals and finding activities to fit into life.

Diet=exercise

Aim to slowly increase activity levels to achieve 30 minutes of moderate activity, 5 days each week;

Intervention theoretical background

Not stated

Transactional analysis, motivational interviewing; awareness of Ego States.

Not stated

Process of change [26] (Prochaska & diClemente)

Stages of change; motivational interviewing

Predominant behavioural change techniques used

Stages of change, food and activity diaries, goal setting and evaluation of progress.

Rewards for every 3.2 kg (7 lbs) lost, 5% and 10% of body weight.

Weekly weighing; group support, group praise for weight loss, new decisions and continued commitment even in absence of weight loss. Awards for 3.2 kg (7 lbs) lost and loss of 10% of body weight. Individual support if needed using self-monitoring of food and emotions, for and against evaluations, visualisation techniques, personal eating plans.

Role modelling, group support. Visualisation and reframing to support behaviour change.

Rewards for slimmers who maintain weight or lose, slimmer of the week and certificates for 3.2 and 6.35 kg (7 lb and 1stone) milestones.

Goal setting; stages of change; self-monitoring via food diary.

Goal setting; self-monitoring via food diaries, hunger scale, waist measurements and physical activity. Resources to provide as homework to then discuss in next session or act as personal reflection. Encouraged to make rewards to self for success.

Behavioural change techniques used (Michie categories*)

1, 4, 11, 12, 13, 14, 7, 14, 19

1, 8, 10, 11, 13, 5, 7, 23, 14, 19, 25

1, 6, 8, 4, 12, 13, 14, 19

1, 6, 8, 4, 10, 11, 12, 5, 23, 18, 26

1, 4, 12, 13, 5, 23,25, 26