A team of researchers based in the West Country has been awarded nearly £2.5 million from the National Institute for Health Research (NIHR).

The researchers at the University of Plymouth and the University of Exeter Medical School will work with the NHS, patients, the NIHR Applied Research Collaboration South West Peninsula (PenARC), and the Peninsula Clinical Trials Unit (PenCTU) to investigate whether an intensive group-based behavioural programme called PROGROUP is less costly and more effective than usual care for people with severe obesity, and can save money.

The research involves the Plymouth and West Devon Weight Management Service, which is provided by Livewell Southwest Community Interest Company and has been sponsored by University Hospitals Plymouth.

It comes at a time when supporting people to lose weight in a healthy way is a national priority in light of the link between obesity and severe COVID-19. This means that services supporting people with severe obesity for weight loss are having to be comprehensively redesigned to maintain social distancing, with far greater emphasis on online and virtual delivery.

Jonathan Pinkney, Professor of Endocrinology and Diabetes at the University of Plymouth and University Hospitals Plymouth NHS Trust co-leads the study. He explained,

“Obesity is one of the most serious public health challenges of our time, and is a particular concern in the era of COVID-19. A staggering 15 million adults in the UK are now obese. However, around five million of these are severely obese and 1.5 million middle-aged adults are extremely obese.
"While severe obesity was unusual a generation ago, over the course of a few decades it has become commonplace, and it is significantly more frequent in deprived communities and minority groups. Obesity is a very sensitive issue, and it has long been neglected in both research and healthcare. This research seeks to improve treatment and offer hope for people with the more severe forms of obesity.”

Severe obesity reduces life expectancy substantially due to the development of complications such as diabetes, heart disease and cancer. Yet this has been poorly recognised in society and healthcare systems. People with severe obesity also experience significant detriments to their quality of life and opportunities.

It has also recently become known that carrying excess weight significantly increases the risks of dying from COVID-19, particularly for people with severe obesity. Indeed, weight loss may be the main potentially “reversible” risk factor for mortality from COVID-19.

One potential treatment option that people with severe obesity could choose is weight-loss surgery, but few people opt for this, and other treatment options are currently uncertain. There is a major need to develop more effective treatment options.

Dr Mark Tarrant of the University of Exeter Medical School, who co-leads the study, said,

“At the moment, treatment for severe obesity varies greatly across the country. How effective NHS services are is unclear. This research will aim to develop best practice for group-based treatment within these services. The goal is to find the best way to optimise the group-based treatment of people with severe obesity. We know that obesity is linked to a wide range of health problems, yet there’s very little consistency in how people are treated or evidence about what’s effective. The aim is to develop a gold standard for effective group-based care that can be rolled out across the country.”

The PROGROUP study, which also involves the University of Liverpool, will test a new group programme which uniquely aims to establish a strong sense of connectedness between people. The programme will then build on these links to support people in making and sustaining lifestyle changes necessary for weight loss and improved wellbeing. The programme was developed by the research team and builds upon the programme provided by Plymouth and West Devon Weight Management Service, as well as research and evidence from the behavioural and psychological sciences. The programme will last for six months with 20 group sessions supported by several one-to-one patient meetings.

Dr Gary Minto, Director of Research and Development at University Hospitals Plymouth, said,

“We are delighted that the PROGROUP team, led from Plymouth and Exeter, has received this substantial NIHR funding. This trial tests a group-based approach to behaviour change to help patients address obesity and reduce future illnesses related to lifestyle – tremendously important to economically disadvantaged communities in our locality.”

The initial study will see 120 people randomly allocated at three clinics nationwide receiving weight management services with or without the new treatment programme. If successful, the study will move to a larger trial involving 1,100 people from a wide range of communities at 10 different sites across the UK, which will be centrally coordinated by PenCTU, part of the University of Plymouth's Faculty of Health.

PenCTU is a fully registered clinical trials unit in the UK Clinical Research Collaboration (UKCRC) and currently receives National Institute for Health Research (NIHR) CTU support funding. This funding has been awarded to support the Unit in developing and supporting NIHR trials. PenCTU helped to develop the successful funding application and will support the delivery of the programme by providing expert clinical trial management, the development of data capture systems, data management, methodological expertise, statistical programming and analysis and reporting.

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