{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T10:05:38Z","timestamp":1784714738426,"version":"3.55.0"},"reference-count":43,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"unspecified","delay-in-days":19,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009708","name":"Novo Nordisk Foundation","doi-asserted-by":"crossref","award":["NNF22SA0080921"],"award-info":[{"award-number":["NNF22SA0080921"]}],"id":[{"id":"10.13039\/501100009708","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,4,3]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Effective treatment for clinical obesity is available but is rarely offered by healthcare systems, which often treat complications without treating the underlying cause. The LightWAY trial will investigate the clinical benefits and harms as well as cost-effectiveness of an intensive weight loss intervention compared with existing weight management programmes for people with clinical obesity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>\n                      LightWAY is an investigator-initiated, international, randomised, parallel-group clinical superiority trial with blinded outcome assessment. Six hundred people seeking treatment for clinical obesity (body mass index \u226535\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      with comorbidities) will be recruited in centres in the UK and Denmark and randomised 1:1 to one of two groups. The experimental group will be offered a 2-year intensive weight loss programme providing support and advice to follow a total diet replacement programme, followed by gradual transition to an energy-reduced diet in combination with increased physical activity and if needed, prescription of weight loss medication. The control group will receive usual care, typically comprising brief behavioural support for weight loss and treatment of the complications of obesity or occasionally referral to specialist weight management services. The two co-primary outcomes are cardiometabolic risk, assessed with metabolic syndrome severity Z-score, and body weight assessed at 2 years. The secondary outcomes include the Short Form-36 mental component scale, 4-metre gait speed and proportion of participants achieving \u226520%\u2009weight loss. The key adverse effects will be the proportion of participants with at least one serious adverse event, incidence of eating disorders and disproportional loss of bone mass. Incremental cost-effectiveness will be assessed over the trial period and over the lifetime through modelling.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethical approval was granted in the UK (August 2024, 24\/SC\/0211) and Denmark (December 2023, H-23065222). Findings will be disseminated through peer-reviewed journals and scientific conferences and to participants in the trial and clinicians.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT06321458\">NCT06321458<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-107240","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T14:10:20Z","timestamp":1779286220000},"page":"e107240","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Intensive weight loss intervention versus usual care for adults with severe and complex obesity: the LightWAY randomised trial protocol"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct06321458","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct06321432","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct06309238","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1766-882X","authenticated-orcid":false,"given":"Sarah","family":"Wane","sequence":"first","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1802-4217","authenticated-orcid":false,"given":"Paul","family":"Aveyard","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabrina","family":"Wiels\u00f8e","sequence":"additional","affiliation":[{"name":"Department of Respiratory Diseases and Endocrinology, Amager and Hvidovre Hospital, Copenhagen University Hospital Hvidovre, Hvidovre, Capital Region of Denmark, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0838-9378","authenticated-orcid":false,"given":"Sofus Christian","family":"Larsen","sequence":"additional","affiliation":[{"name":"Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Capital Region of Denmark, Denmark"},{"name":"Research Unit for Diet and Health at The Parker Institute, Frederiksberg and Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Capital Region of Denmark, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jadine","family":"Scragg","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0891-8129","authenticated-orcid":false,"given":"Jane","family":"Lindschou","sequence":"additional","affiliation":[{"name":"Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital Rigshospitalet, Copenhagen, Capital Region of Denmark, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janus Christian","family":"Jakobsen","sequence":"additional","affiliation":[{"name":"Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital Rigshospitalet, Copenhagen, Capital Region of Denmark, Denmark"},{"name":"Department of Regional Health Research, University of Southern Denmark Faculty of Health Sciences, Odense, Region Syddanmark, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janus","family":"Engstr\u00f8m","sequence":"additional","affiliation":[{"name":"Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital Rigshospitalet, Copenhagen, Capital Region of Denmark, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3114-4715","authenticated-orcid":false,"given":"Ina Olmer","family":"Specht","sequence":"additional","affiliation":[{"name":"Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Capital Region of Denmark, Denmark"},{"name":"Research Unit for Diet and Health at The Parker Institute, Frederiksberg and Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Capital Region of Denmark, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3917-9151","authenticated-orcid":false,"given":"Ann-Kathrin Lindahl","family":"Christiansen","sequence":"additional","affiliation":[{"name":"Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Capital Region of Denmark, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aksel Karl Georg","family":"Jensen","sequence":"additional","affiliation":[{"name":"Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Capital Region of Denmark, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6884-1971","authenticated-orcid":false,"given":"Thomas","family":"Bandholm","sequence":"additional","affiliation":[{"name":"Department of Clinical Research, Amager and Hvidovre Hospital, Copenhagen University Hospital Hvidovre, Hvidovre, Capital Region of Denmark, Denmark"},{"name":"Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Amager and Hvidovre Hospital, Copenhagen University Hospital Hvidovre, Hvidovre, Capital Region of Denmark, Denmark"},{"name":"Department of Orthopedic Surgery, Amager and Hvidovre Hospital, Copenhagen University Hospital Hvidovre, Hvidovre, Capital Region of Denmark, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Albury","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gritt","family":"Overbeck","sequence":"additional","affiliation":[{"name":"Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Capital Region of Denmark, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4990-142X","authenticated-orcid":false,"given":"Susanne","family":"Reventlow","sequence":"additional","affiliation":[{"name":"Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Capital Region of Denmark, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim Rose","family":"Olsen","sequence":"additional","affiliation":[{"name":"Department of Public Health, DaCHE, University of Southern Denmark, Odense, Region Syddanmark, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Fahr","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1962-5302","authenticated-orcid":false,"given":"Kirstine Nyvold","family":"Bojsen-M\u00f8ller","sequence":"additional","affiliation":[{"name":"Department of Respiratory Diseases and Endocrinology, Amager and Hvidovre Hospital, Copenhagen University Hospital Hvidovre, Hvidovre, Capital Region of Denmark, Denmark"},{"name":"Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6809-4504","authenticated-orcid":false,"given":"Berit Lilienthal","family":"Heitmann","sequence":"additional","affiliation":[{"name":"Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Capital Region of Denmark, Denmark"},{"name":"Research Unit for Diet and Health at The Parker Institute, Frederiksberg and Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Capital Region of Denmark, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frans Boch","family":"Waldorff","sequence":"additional","affiliation":[{"name":"Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Capital Region of Denmark, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sten","family":"Madsbad","sequence":"additional","affiliation":[{"name":"Department of Respiratory Diseases and Endocrinology, Amager and Hvidovre Hospital, Copenhagen University Hospital Hvidovre, Hvidovre, Capital Region of Denmark, Denmark"},{"name":"Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carsten","family":"Dirksen","sequence":"additional","affiliation":[{"name":"Department of Respiratory Diseases and Endocrinology, Amager and Hvidovre Hospital, Copenhagen University Hospital Hvidovre, Hvidovre, Capital Region of Denmark, Denmark"},{"name":"Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9190-2920","authenticated-orcid":false,"given":"Susan Ann","family":"Jebb","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"2026072202451600000_16.5.e107240.1","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1016\/S0140-6736(16)30054-X","article-title":"Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19\u00b72 million participants","volume":"387","author":"N. C. D. Risk Factor","year":"2016","journal-title":"The Lancet"},{"key":"2026072202451600000_16.5.e107240.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1614362"},{"key":"2026072202451600000_16.5.e107240.3","doi-asserted-by":"publisher","DOI":"10.1016\/s2213-8587(24)00316-4"},{"key":"2026072202451600000_16.5.e107240.4","doi-asserted-by":"publisher","DOI":"10.1038\/s41366-021-00788-4"},{"key":"2026072202451600000_16.5.e107240.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)30647-5"},{"key":"2026072202451600000_16.5.e107240.6","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.k3760","article-title":"Doctor Referral of Overweight People to Low Energy total diet replacement Treatment (DROPLET): pragmatic randomised controlled trial","volume":"362","author":"Astbury","year":"2018","journal-title":"BMJ"},{"key":"2026072202451600000_16.5.e107240.7","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/S2213-8587(19)30068-3","article-title":"Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial","volume":"7","author":"Lean","year":"2019","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2026072202451600000_16.5.e107240.8","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1016\/S2213-8587(20)30117-0","article-title":"Effect of intensive lifestyle intervention on bodyweight and glycaemia in early type 2 diabetes (DIADEM-I): an open-label, parallel-group, randomised controlled trial","volume":"8","author":"Taheri","year":"2020","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2026072202451600000_16.5.e107240.9","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2024-081477","article-title":"SPIRIT 2025 statement: updated guideline for protocols of randomised trials","volume":"389","author":"Chan","year":"2025","journal-title":"BMJ"},{"key":"2026072202451600000_16.5.e107240.10","doi-asserted-by":"publisher","DOI":"10.1016\/0197-2456(95)00263-4"},{"key":"2026072202451600000_16.5.e107240.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2013.11.011"},{"key":"2026072202451600000_16.5.e107240.12","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/61.6.1402S"},{"key":"2026072202451600000_16.5.e107240.13","doi-asserted-by":"publisher","DOI":"10.1017\/S136898001100351X"},{"key":"2026072202451600000_16.5.e107240.14","unstructured":"World Health Organization . WHO Guidelines on Physical Activity and Sedentary Behaviour. Geneva: World Health Organization, 2020."},{"key":"2026072202451600000_16.5.e107240.15","unstructured":"Borg G . Borg\u2019s perceived exertion and pain scales: human kinetics. 1998."},{"key":"2026072202451600000_16.5.e107240.16","unstructured":"Sundhedsstyrrelsen . 10 veje til v\u00e6gttab, Available: https:\/\/www.sst.dk\/da\/udgivelser\/2019\/10-veje-til-vaegttab"},{"key":"2026072202451600000_16.5.e107240.17","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.metabol.2013.10.006","article-title":"An examination of sex and racial\/ethnic differences in the metabolic syndrome among adults: a confirmatory factor analysis and a resulting continuous severity score","volume":"63","author":"Gurka","year":"2014","journal-title":"Metab Clin Exp"},{"key":"2026072202451600000_16.5.e107240.18","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1212914"},{"key":"2026072202451600000_16.5.e107240.19","doi-asserted-by":"publisher","DOI":"10.20463\/jenb.2016.09.20.3.7"},{"key":"2026072202451600000_16.5.e107240.20","unstructured":"ICH . Intergrated Addendum to ICH E6(R1): Guideline for Good Clinical Practice E6(R2). 2016."},{"key":"2026072202451600000_16.5.e107240.21","article-title":"Validation of Two Activity Monitors in Slow and Fast Walking Hospitalized Patients","volume":"2022","author":"Pedersen","year":"2022","journal-title":"Rehabil Res Pract"},{"key":"2026072202451600000_16.5.e107240.22","doi-asserted-by":"publisher","DOI":"10.1016\/S0165-0327(00)00309-8"},{"key":"2026072202451600000_16.5.e107240.23","first-page":"S80","article-title":"Understanding self-directed stigma: development of the weight bias internalization scale","volume":"16 Suppl 2","author":"Durso","year":"2008","journal-title":"Obesity (Silver Spring)"},{"key":"2026072202451600000_16.5.e107240.24","doi-asserted-by":"publisher","DOI":"10.1002\/1098-108X(199412)16:4&lt;363::AID-EAT2260160405&gt;3.0.CO;2-#"},{"key":"2026072202451600000_16.5.e107240.25","doi-asserted-by":"publisher","DOI":"10.2165\/00019053-199304050-00006"},{"key":"2026072202451600000_16.5.e107240.26","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.118.009754","article-title":"Assessing Baseline and Temporal Changes in Cardiometabolic Risk Using Metabolic Syndrome Severity and Common Risk Scores","volume":"7","author":"Gurka","year":"2018","journal-title":"J Am Heart Assoc"},{"key":"2026072202451600000_16.5.e107240.27","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-031170","article-title":"Changes in quality of life 5 years after sleeve gastrectomy: a prospective cohort study","volume":"9","author":"Fl\u00f8lo","year":"2019","journal-title":"BMJ Open"},{"key":"2026072202451600000_16.5.e107240.28","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2032183"},{"key":"2026072202451600000_16.5.e107240.29","doi-asserted-by":"crossref","first-page":"1254","DOI":"10.1111\/1467-9566.12316","article-title":"Context and complexity: the meaning of self-management for older adults with heart disease","volume":"37","author":"Moore","year":"2015","journal-title":"Sociol Health Illn"},{"key":"2026072202451600000_16.5.e107240.30","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cmaa121"},{"key":"2026072202451600000_16.5.e107240.31","doi-asserted-by":"crossref","DOI":"10.1016\/j.appet.2022.106071","article-title":"The Family Meal Framework: A grounded theory study conceptualising the work that underpins the family meal","volume":"175","author":"Middleton","year":"2022","journal-title":"Appetite"},{"key":"2026072202451600000_16.5.e107240.32","doi-asserted-by":"crossref","DOI":"10.1186\/s13012-014-0113-0","article-title":"Protocol for the process evaluation of a complex intervention designed to increase the use of research in health policy and program organisations (the SPIRIT study)","volume":"9","author":"Haynes","year":"2014","journal-title":"Implement Sci"},{"key":"2026072202451600000_16.5.e107240.33","doi-asserted-by":"crossref","DOI":"10.1136\/fmch-2018-000057","article-title":"Semistructured interviewing in primary care research: a balance of relationship and rigour","volume":"7","author":"DeJonckheere","year":"2019","journal-title":"Fam Med Community Health"},{"key":"2026072202451600000_16.5.e107240.34","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0238645","article-title":"Participant experiences of a low-energy total diet replacement programme: A descriptive qualitative study","volume":"15","author":"Astbury","year":"2020","journal-title":"PLoS One"},{"key":"2026072202451600000_16.5.e107240.35","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.320.7227.114"},{"key":"2026072202451600000_16.5.e107240.36","doi-asserted-by":"crossref","unstructured":"Murray E , Treweek S , Pope C , et al . Normalisation process theory: a framework for developing, evaluating and implementing complex interventions. BMC Med 2010;8. doi:10.1186\/1741-7015-8-63","DOI":"10.1186\/1741-7015-8-63"},{"key":"2026072202451600000_16.5.e107240.37","doi-asserted-by":"publisher","DOI":"10.1177\/0038038509103208"},{"key":"2026072202451600000_16.5.e107240.38","doi-asserted-by":"publisher","DOI":"10.1186\/1741-7015-8-1"},{"key":"2026072202451600000_16.5.e107240.39","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.320.7226.50"},{"key":"2026072202451600000_16.5.e107240.40","doi-asserted-by":"publisher","DOI":"10.1111\/dme.13314"},{"key":"2026072202451600000_16.5.e107240.41","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1177\/0272989X20946758","article-title":"The Impact of Including Costs and Outcomes of Dementia in a Health Economic Model to Evaluate Lifestyle Interventions to Prevent Diabetes and Cardiovascular Disease","volume":"40","author":"Breeze","year":"2020","journal-title":"Med Decis Making"},{"key":"2026072202451600000_16.5.e107240.42","doi-asserted-by":"crossref","unstructured":"Athey S , Chetty R , Imbens GW , et al . The Surrogate Index: Combining Short-Term Proxies to Estimate Long-Term Treatment Effects More Rapidly and Precisely. NBER Working Papers National Bureau of Economic Research, Inc 2019.","DOI":"10.3386\/w26463"},{"key":"2026072202451600000_16.5.e107240.43","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.h2147","article-title":"The PRECIS-2 tool: designing trials that are fit for purpose","volume":"350","author":"Loudon","year":"2015","journal-title":"BMJ"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-107240","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T09:45:32Z","timestamp":1784713532000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-107240"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":43,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5,20]]},"published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1136\/bmjopen-2025-107240"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-107240","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]}}}