Counterweight - abstract

Counterweight is a weight management programme which includes both weight loss and weight loss maintenance as integral parts of the overall healthcare technology. The programme was put together in 2001 after synthesis of all the information available to ensure the best evidence base for weight loss and maintenance of that loss was the programmes foundation. The research aspects of the programme included an audit of obesity and its comorbidities within Primary Care in the UK across all BMI bands from 18 to >50 Kg/M2, followed by an intervention within Primary Care to effect clinically meaningful weight loss and maintenance over 2 years. The programme used the principles of continual improvement and was based on the MRC Complex Intervention Guidelines. The audit and intervention aspects ran from 2001 to 2005, the research phase, with ongoing development and refinement of the programme from 2006.

Counterweight is designed to be delivered in the community, initially through Primary Care but refined to allow delivery by healthcare workers and assistants working in the community but not attached to Primary Care Practices, pharmacists and pharmacy assistants, and by delivery through sport and recreation facilities. The programme was initially based on healthy eating approaches minus 600 Kcal in association with behaviour change technology and advise on physical activity. It is designed to train all of the above workers to a standard that they are able to achieve and maintain expertise in the management of weight. This is done over a period of time through group or one to one training in all aspects of weight management, followed by a period of mentoring on a regular basis over period of 6 months to 1 year.

The results of the initial research phase indicate 35% of all patients entered into the programme achieving >5% weight loss maintained over 2 years. In addition modelling was carried out to indicate the expected advantage of moving through the BMI bands in relation to the prevalence of various obesity associated disease. A health Economic analysis of the programme indicated that Counterweight was dominant under all aspects of outcome, ie. it was cheaper to have Counterweight in place than do nothing at all. To date it is the only evidence-based obesity management programme delivered in the community with clinically relevant outcomes, and has been accorded “gold standard” status by the World Health Authority.

More recently the programme has been further refined to deal with the seriously obese ( BMI >40Kg/M2), using formula diets delivered in the community, and producing weight loss comparable with reversal of type 2 diabetes (>15Kg). The evidence for the programme’s success can all be located at “Counterweight.org” where pdf’s all the published papers (10 to date) can be found. Research continues in the area of childhood obesity with family programmes being developed and evaluated.

The programme itself, in relation to patient management, is designed to be delivered to groups of patients or as an individual as one to one delivery. It can therefore be moulded to the individual’s requirements as well as that of the weight management counsellor.