{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T06:05:08Z","timestamp":1790316308212,"version":"4.1.0"},"reference-count":25,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2018,11,22]],"date-time":"2018-11-22T00:00:00Z","timestamp":1542844800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Human Nutrition Diet"],"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Weight management including formula total diet replacement (TDR) is emerging as an effective intervention for severe and complex obesity, particularly with respect to type 2 diabetes (T2<jats:styled-content style=\"fixed-case\">DM<\/jats:styled-content>). However, no prospective audit and service evaluation of such programmes have been reported.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Following initial feasibility piloting, the Counterweight\u2010Plus programme was commissioned across a variety of healthcare providers. The programme includes: Screening, TDR (formula low energy diet), food reintroduction and weight loss maintenance, all delivered by staff with 8\u00a0h of training, in\u2010service mentoring, ongoing specialist support and access to medical consultant expertise. Anonymised data are returned centrally for clinical evaluation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Up to December 2016, 288 patients commenced the programme. Mean (<jats:styled-content style=\"fixed-case\">SD<\/jats:styled-content>) baseline characteristics were: age 47.5\u00a0(12.7)\u00a0years, weight 128.0\u00a0(32.0)\u00a0kg, <jats:styled-content style=\"fixed-case\">body mass index<\/jats:styled-content> 45.7\u00a0(10.1)\u00a0kg\u00a0m<jats:sup>\u22122<\/jats:sup>, <jats:italic>n<\/jats:italic>\u00a0=\u00a076 (26.5%) were male and <jats:italic>n<\/jats:italic>\u00a0=\u00a099 (34.5%) had T2<jats:styled-content style=\"fixed-case\">DM<\/jats:styled-content>. On an <jats:styled-content style=\"fixed-case\">intention\u2010to\u2010treat (ITT)<\/jats:styled-content> basis, a loss of \u226515\u00a0kg at 12\u00a0months was achieved by 48 patients, representing 22.1% of all who started and 40% of those who maintained engagement. For complete cases, mean (95% <jats:styled-content style=\"fixed-case\">confidence interval<\/jats:styled-content>) weight loss was 13.3 (12.1\u201314.4)\u00a0kg at 3\u00a0months, 16.0 (14.4\u201317.6)\u00a0kg at 6 months and 14.2 (12.1\u201316.3)\u00a0kg at 12\u00a0months (all <jats:italic>P\u00a0<\/jats:italic>&lt;<jats:italic>\u00a0<\/jats:italic>0.001), with losses to follow\u2010up of 10.8%, 29.3% and 44.2%, respectively. Mean loss at 12\u00a0months by <jats:styled-content style=\"fixed-case\">ITT<\/jats:styled-content> analyses was: single imputation \u201310.5\u00a0(9.5)\u00a0kg, <jats:styled-content style=\"fixed-case\">last observation carried forward<\/jats:styled-content> \u201310.9 (11.6)\u00a0kg and <jats:styled-content style=\"fixed-case\">baseline observation carried forward<\/jats:styled-content> \u20137.9 (11.1)\u00a0kg. The presence of diabetes had no significant impact on weight change outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This nonsurgical approach is effective for many individuals with severe and complex obesity, representing an option before considering surgery. The results are equally effective in terms of weight loss for people with T2<jats:styled-content style=\"fixed-case\">DM<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jhn.12611","type":"journal-article","created":{"date-parts":[[2018,12,19]],"date-time":"2018-12-19T13:49:40Z","timestamp":1545227380000},"page":"329-337","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":39,"title":["Filling the intervention gap: service evaluation of an intensive nonsurgical weight management programme for severe and complex obesity"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1944-1290","authenticated-orcid":false,"given":"L.","family":"McCombie","sequence":"first","affiliation":[{"name":"College of Medical, Veterinary and Life Sciences University of Glasgow Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Brosnahan","sequence":"additional","affiliation":[{"name":"College of Medical, Veterinary and Life Sciences University of Glasgow Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"Ross","sequence":"additional","affiliation":[{"name":"Counterweight Ltd London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Bell\u2010Higgs","sequence":"additional","affiliation":[{"name":"Counterweight Ltd London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Govan","sequence":"additional","affiliation":[{"name":"Phastar Statistical Consultancy Chiswick, London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. 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