{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T20:17:15Z","timestamp":1792181835768,"version":"4.4.0"},"reference-count":62,"publisher":"National Institute for Health and Care Research","issue":"4","license":[{"start":{"date-parts":[[2017,1,1]],"date-time":"2017-01-01T00:00:00Z","timestamp":1483228800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.nationalarchives.gov.uk\/doc\/non-commercial-government-licence\/non-commercial-government-licence.htm"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment programme","doi-asserted-by":"publisher","award":["09\/127\/19"],"award-info":[{"award-number":["09\/127\/19"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Health Technol Assess"],"abstract":"<jats:sec id=\"abs1-1\"><jats:title>Background<\/jats:title><jats:p>Behavioural counselling with intensive follow-up for obesity is effective, but in resource-constrained primary care settings briefer approaches are needed.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-2\"><jats:title>Objectives<\/jats:title><jats:p>To estimate the clinical effectiveness and cost-effectiveness of an internet-based behavioural intervention with regular face-to-face or remote support in primary care, compared with brief advice.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-3\"><jats:title>Design<\/jats:title><jats:p>Individually randomised three-arm parallel trial with health economic evaluation and nested qualitative interviews.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-4\"><jats:title>Setting<\/jats:title><jats:p>Primary care general practices in the UK.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-5\"><jats:title>Participants<\/jats:title><jats:p>Patients with a body mass index of \u2265\u200930\u2009kg\/m<jats:sup>2<\/jats:sup>(or \u2265\u200928 kg\/m<jats:sup>2<\/jats:sup>with risk factors) identified from general practice records, recruited by postal invitation.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-6\"><jats:title>Interventions<\/jats:title><jats:p>Positive Online Weight Reduction (POWeR+) is a 24-session, web-based weight management intervention completed over 6 months. Following online registration, the website randomly allocated participants using computer-generated random numbers to (1) the control intervention (<jats:italic>n<\/jats:italic>\u2009=\u2009279), which had previously been demonstrated to be clinically effective (brief web-based information that minimised pressure to cut down foods, instead encouraging swaps to healthier choices and increasing fruit and vegetables, plus 6-monthly nurse weighing); (2) POWeR+F (<jats:italic>n<\/jats:italic>\u2009=\u2009269), POWeR+ supplemented by face-to-face nurse support (up to seven contacts); or (3) POWeR+R (<jats:italic>n<\/jats:italic>\u2009=\u2009270), POWeR+ supplemented by remote nurse support (up to five e-mails or brief telephone calls).<\/jats:p><\/jats:sec><jats:sec id=\"abs1-7\"><jats:title>Main outcome measures<\/jats:title><jats:p>The primary outcome was a modelled estimate of average weight reduction over 12 months, assessed blind to group where possible, using multiple imputation for missing data. The secondary outcome was the number of participants maintaining a 5% weight reduction at 12 months.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-8\"><jats:title>Results<\/jats:title><jats:p>A total of 818 eligible individuals were randomised using computer-generated random numbers. Weight change, averaged over 12 months, was documented in 666 out of 818 participants (81%; control,<jats:italic>n<\/jats:italic>\u2009=\u2009227; POWeR+F,<jats:italic>n<\/jats:italic>\u2009=\u2009221; POWeR+R,<jats:italic>n<\/jats:italic>\u2009=\u2009218). The control group maintained nearly 3\u2009kg of weight loss per person (mean weight per person: baseline, 104.4\u2009kg; 6 months, 101.9\u2009kg; 12 months, 101.7\u2009kg). Compared with the control group, the estimated additional weight reduction with POWeR+F was 1.5\u2009kg [95% confidence interval (CI) 0.6 to 2.4\u2009kg;<jats:italic>p<\/jats:italic>\u2009=\u20090.001] and with POWeR+R was 1.3\u2009kg (95% CI 0.34 to 2.2\u2009kg;<jats:italic>p<\/jats:italic>\u2009=\u20090.007). By 12 months the mean weight loss was not statistically significantly different between groups, but 20.8% of control participants, 29.2% of POWeR+F participants (risk ratio 1.56, 95% CI 0.96 to 2.51;<jats:italic>p<\/jats:italic>\u2009=\u20090.070) and 32.4% of POWeR+R participants (risk ratio 1.82, 95% CI 1.31 to 2.74;<jats:italic>p<\/jats:italic>\u2009=\u20090.004) maintained a clinically significant 5% weight reduction. The POWeR+R group had fewer individuals who reported doing another activity to help lose weight [control, 47.1% (64\/136); POWeR+F, 37.2% (51\/137); POWeR+R, 26.7% (40\/150)]. The incremental cost to the health service per kilogram weight lost, compared with the control group, was \u00a318 (95% CI \u2013\u00a3129 to \u00a3195) for POWeR+F and \u2013\u00a325 (95% CI \u2013\u00a3268 to \u00a3157) for POWeR+R. The probability of being cost-effective at a threshold of \u00a3100 per kilogram was 88% and 98% for POWeR+F and POWeR+R, respectively. POWeR+R was dominant compared with the control group. No harms were reported and participants using POWeR+ felt more enabled in managing their weight. The qualitative studies documented that POWeR+ was viewed positively by patients and that health-care professionals generally enjoyed supporting patients using POWeR+.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-9\"><jats:title>Study limitations<\/jats:title><jats:p>Maintenance of weight loss after 1 year is unknown.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-10\"><jats:title>Future work<\/jats:title><jats:p>Identifying strategies for longer-term engagement, impact in community settings and increasing physical activity.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-11\"><jats:title>Conclusion<\/jats:title><jats:p>Clinically valuable weight loss (&gt;\u20095%) is maintained in 20% of individuals using novel written materials with brief follow-up. A web-based behavioural programme and brief support results in greater mean weight loss and 10% more participants maintain valuable weight loss; it achieves greater enablement and fewer participants undertaking other weight-loss activities; and it is likely to be cost-effective.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-12\"><jats:title>Trial registration<\/jats:title><jats:p>Current Controlled Trials ISRCTN21244703.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-13\"><jats:title>Funding<\/jats:title><jats:p>This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in<jats:italic>Health Technology Assessment<\/jats:italic>; Vol. 21, No. 4. See the NIHR Journals Library website for further project information.<\/jats:p><\/jats:sec>","DOI":"10.3310\/hta21040","type":"journal-article","created":{"date-parts":[[2017,1,25]],"date-time":"2017-01-25T13:49:21Z","timestamp":1485352161000},"page":"1-62","update-policy":"https:\/\/doi.org\/10.3310\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":44,"title":["Randomised controlled trial and economic analysis of an internet-based weight management programme: POWeR+ (Positive Online Weight Reduction)"],"prefix":"10.3310","volume":"21","clinical-trial-number":[{"clinical-trial-number":"isrctn21244703","registry":"10.18810\/isrctn","type":"results"}],"author":[{"given":"Paul","family":"Little","sequence":"first","affiliation":[{"name":"Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, 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UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine J","family":"Bradbury","sequence":"additional","affiliation":[{"name":"Centre for Applications of Health Psychology (CAHP), Faculty of Social and Human Sciences, University of Southampton, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Hughes","sequence":"additional","affiliation":[{"name":"Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter WF","family":"Smith","sequence":"additional","affiliation":[{"name":"Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael V","family":"Moore","sequence":"additional","affiliation":[{"name":"Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mike EJ","family":"Lean","sequence":"additional","affiliation":[{"name":"Human Nutrition, School of Medicine, University of Glasgow, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barrie M","family":"Margetts","sequence":"additional","affiliation":[{"name":"Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher D","family":"Byrne","sequence":"additional","affiliation":[{"name":"National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Griffin","sequence":"additional","affiliation":[{"name":"Medical Research Council (MRC) Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mina","family":"Davoudianfar","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Hooper","sequence":"additional","affiliation":[{"name":"Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guiqing","family":"Yao","sequence":"additional","affiliation":[{"name":"Health Economic Analyses Team (HEAT), Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shihua","family":"Zhu","sequence":"additional","affiliation":[{"name":"Health Economic Analyses Team (HEAT), Primary Care and 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