CRediT contribution statement
Amy L Ahern (https://orcid.org/0000-0001-5069-4758): Conceptualisation, Methodology, Supervision, Funding acquisition, Writing – original draft, Writing – reviewing and editing.
Julia Mueller (https://orcid.org/0000-0002-4939-7112): Methodology, Formal analysis, Investigation, Writing – original draft, Writing – reviewing and editing.
Penny Breeze (https://orcid.org/0000-0002-4189-8676): Methodology, Formal analysis, Writing – original draft, Writing – reviewing and editing.
Stephen J Sharp (https://orcid.org/0000-0003-2375-1440): Conceptualisation, Methodology, Supervision, Funding acquisition, Writing – reviewing and editing.
Fiona Whittle (https://orcid.org/0000-0001-5461-521X): Project administration, Investigation, Writing – reviewing and editing.
Alan Brennan (https://orcid.org/0000-0002-1025-312X): Conceptualisation, Methodology, Supervision, Funding acquisition, Writing – reviewing and editing.
Andrew J Hill (https://orcid.org/0000-0003-3192-0427): Conceptualisation, Methodology, Funding acquisition, Writing – reviewing and editing.
Robbie Duschinsky (https://orcid.org/0000-0003-2023-5328): Conceptualisation, Methodology, Supervision, Funding acquisition, Writing – reviewing and editing.
Carly A Hughes (https://orcid.org/0000-0001-9560-7873): Conceptualisation, Methodology, Funding acquisition, Writing – reviewing and editing.
Francesco Fusco (https://orcid.org/0000-0001-5515-3977): Methodology, Formal analysis, Writing – reviewing and editing.
Stephen Morris (https://orcid.org/0000-0002-5828-3563): Conceptualisation, Methodology, Formal analysis, Funding acquisition, Writing – original draft, Writing – reviewing and editing.
Jennifer Bostock (https://orcid.org/0000-0001-9261-9350): Conceptualisation, Funding acquisition, Writing – reviewing and editing.
Simon J Griffin (https://orcid.org/0000-0002-2157-4797): Conceptualisation, Methodology, Supervision, Funding acquisition, Writing – reviewing and editing.
Other contributions
Clare Boothby: Data curation, Writing – reviewing and editing.
Beckie Jones: Project administration, Methodology, Investigation, Formal analysis, Writing – original draft, Writing – reviewing and editing.
Becky Richards: Methodology, Investigation, Formal analysis, Writing – original draft, Writing – reviewing and editing.
Emma Lawlor: Methodology, Investigation, Formal analysis, Writing – original draft, Writing – reviewing and editing.
Nazrul Islam: Methodology, Formal analysis, Writing – original draft, Writing – reviewing and editing.
Katharine Pidd: Formal analysis, Writing – original draft, Writing – reviewing and editing.
Sarah Bates: Methodology, Formal analysis, Writing – original draft, Writing – reviewing and editing.
Daniel Pollard: Methodology, Formal analysis, Writing – reviewing and editing.
Jenny Woolston: Project administration, Investigation, Writing – reviewing and editing.
Emma Lachassseigne: Project administration, Project administration, Investigation, Writing – reviewing and editing.
Marie Stubbings: Project administration, Project administration, Investigation, Writing – reviewing and editing.
Christine Grainger: Project administration.
Laura Kudlek: Investigation, Writing – reviewing and editing.
Michelle Chester: Investigation, Writing – reviewing and editing.
Carlotta Schwertel: Investigation, Writing – reviewing and editing.
Acknowledgements
We are grateful to the contributions of the Cambridge Epidemiology and Trials Unit, the NIHR Cambridge BRC measurement platform, and the MRC Epidemiology Unit Functional Teams (including Study Coordination, Data Management, Communications, IT, and Business Operations) for supporting conduct of the studies in this programme. We also thank Cambridgeshire and Peterborough ICB Research and Development Team and the Research Delivery Networks (previously Clinical Research Networks) who supported delivery of this research programme. We are grateful to the NIHR Cambridge Biomedical Research Centre Core Biochemical Assay Laboratory at Addenbrookes Hospital for analysing the blood samples and the NIHR Cambridge BRC Patient and Public Involvement Team for supporting engagement and PPI activities. The NIHR Cambrdige BRC grant number is (NIHR203312).
Patient and public involvement group
Frances Amrani, Holly Anderson, Rosemary Bentley, Ron Clifton, Tony Morris, Gill Pountain, Iain Smith, Nick Timmings, Mike Willis.
Independent Programme Steering Committee/Trial Steering Committee
Lucy Yardley, Andrew Farmer, Edel Doherty, Thomas Fanshawe, Graham Rhodes, Hazel Patel, Norma Scullion.
Data-sharing statement
All data requests should be submitted to the corresponding author for consideration. Access to all anonymised data may be granted following review by the data-sharing committee (datasharing@mrc-epid.cam.ac.uk). The data dictionary for WRAP can be accessed here https://epidata-ext.mrc-epid.cam.ac.uk/ddic/overview/WRAP/. The data dictionary for the GLoW trial is available here https://epidata-ext.mrc-epid.cam.ac.uk/ddic/overview/GLOW/; data dictionaries for the SWiM-C and SWiM feasibility studies are available on request. Study documents (study protocol, statistical analysis plan, informed consent form, participant information sheet, analytic code) are available within the trial registry entries or on request. For GLoW, the fully executable code, simulated individuals and simulated parameters used to conduct the economic analyses are available under a GPL version 2 or later licence at: https://doi.org/10.15131/shef.data.24999692.v1
Ethics statement
WRAP trial: Ethical approval was obtained from West Midlands-Coventry and Warwickshire Research Ethics Committee on 8 December 2017 (17/WM/0432).
GLoW trial: Ethical approval was obtained from East of Scotland Research Ethics Service (18/ES/0048).
SWiM feasibility study: Ethical approval was obtained from Cambridge South Research Ethics Committee (ref: 21/EE/0024).
SWiM-COVID: Ethical approval was obtained from the Cambridge Psychology Research Ethics Committee (Application No: PRE.2020.049) on 24 April 2020.
Information governance statement
The University of Cambridge is committed to handling all personal information in line with the UK Data Protection Act (2018) and the General Data Protection Regulation (EU GDPR) 2016/679. Under the Data Protection legislation, the University of Cambridge is the Data Controller, and you can find out more about how we handle personal data, including how to exercise your individual rights, and the contact details for our Data Protection Officer here: www.cam.ac.uk/about-this-site/privacy-policy
Disclosure of interests
Full disclosure of interests: Completed ICMJE forms for all authors, including all related interests, are available in the toolkit on the NIHR Journals Library report publication page at https://doi.org/10.3310/DHYT8854.
Primary conflicts of interest: Amy L Ahern is a member of the Scientific Advisory Board for WW (payment to institution). Julia Mueller is a member of the Operations Committee for the Association of the Study of Obesity (unpaid role) and has organised educational events funded by Boehringer Ingelheim Ltd and Rhythm Pharmaceuticals. Fiona Whittle, Penny Breeze, Robbie Duschinsky, Stephen J Sharp and Alan Brennan report no conflicts of interest. Andrew J Hill has consulted for Slimming World UK. CAH reports consulting fees, payment or honoraria or support for attending meetings and/or travel from Ethicon and Novo Nordisk. Francesco Fusco is currently employed by Novo Nordisk but completed all the work related to this project before the initiation of his activities with Novo Nordisk. Stephen Morris is currently (2022–) a member of the SBRI Healthcare panel. Stephen Morris was formerly a member of the NIHR RfPB: Under-represented disciplines and specialisms – Methodologists Committee (2023–5), the NIHR HS&DR Programme Funding Committee (2014–6), the NIHR HS&DR Evidence Synthesis Sub Board (2016), the NIHR Unmet Need Sub Board (2019), the NIHR HTA Clinical Evaluation and Trials Board (2007–9), the NIHR HTA Commissioning Board (2009–13), the NIHR PHR Research Funding Board (2011–7), and the NIHR PGfAR expert subpanel (2015–9). He was also an associate member of the NIHR HS&DR Commissioned Board (2014–5) and associate member of the NIHR HS&DR Board (2015–8). His post is funded in part by RAND Europe, a non-profit research organisation. Stephen Morris is Deputy Director of Applied Research Collaboration East of England (NIHR ARC EoE) at Cambridgeshire and Peterborough NHS Foundation Trust. Jennifer Bostock was a member of the HS&DR Funding Committee (19 September 2018–30 September 2020) and is currently on the HTA Clinical Evaluation and Trials Committee (1 November 2020–present). Simon J Griffin has received honoraria from Astra Zeneca and Eli Lilly for contributing to postgraduate educational meetings and is a former Trustee for the Novo Nordisk UK Research Foundation. The University of Cambridge receives support for the salary of Simon J Griffin from the NHS via the Clinical Academic Reserve. WW provided the intervention for the WRAP trial and the GLoW trial at no cost but had no role in the design, data collection, data analysis, data interpretation or writing of the report.
Copyright and credit statement
Every effort has been made to obtain the necessary permissions for reproduction, to credit original sources appropriately and to respect copyright requirements. However, despite our diligence, we acknowledge the possibility of unintentional omissions or errors, and we welcome notifications of any concerns regarding copyright or permissions.
Publications
Lawlor ER, Islam N, Griffin SJ, Hill AJ, Hughes CA, Ahern AL. Third-wave cognitive behaviour therapies for weight management: systematic review and network meta-analysis protocol. BMJ Open 2018;8:e023425. https://doi.org/10.1136/bmjopen-2018-023425
Ahern AL, Woolston J, Wells E, Sharp SJ, Islam N, Lawlor ER, et al. Clinical and cost-effectiveness of a diabetes education and behavioural weight management programme versus a diabetes education programme in adults with a recent diagnosis of type 2 diabetes: study protocol for the Glucose Lowering through Weight management (GLoW) randomised controlled trial. BMJ Open 2020;10:e035020. https://doi.org/10.1136/bmjopen-2019-035020
Lawlor ER, Islam N, Bates S, Griffin SJ, Hill AJ, Hughes CA, et al. Third-wave cognitive behaviour therapies for weight management: a systematic review and network meta-analysis. Obes Rev 2020;21:e13013. https://doi.org/10.1111/obr.13013
Lawlor ER, Hughes CA, Duschinsky R, Pountain GD, Hill AJ, Griffin SJ, et al. Cognitive and behavioural strategies employed to overcome ‘lapses’ and prevent ‘relapse’ among weight-loss maintainers and regainers: a qualitative study. Clin Obes 2020;10:e12395. https://doi.org/10.1111/cob.12395
Ahern AL, Griffin SJ, Wheeler GM, Sharp SJ, Aveyard P, Boyland EJ, et al. The effect of referral to an open-group behavioural weight-management programme on the relative risk of normoglycaemia, non-diabetic hyperglycaemia and type 2 diabetes: secondary analysis of the WRAP trial. Diabetes Obes Metab 2020;22:2069–76. https://doi.org/10.1111/dom.14123
Jones RA, Mueller J, Sharp SJ, Vincent A, Duschinsky R, Griffin SJ, et al. The impact of participant mental health on attendance and engagement in a trial of behavioural weight management programmes: secondary analysis of the WRAP randomised controlled trial. Int J Behav Nutr Phys Act 2021;18:146. https://doi.org/10.1186/s12966-021-01216-6
Richards R, Jones RA, Whittle F, Hughes CA, Hill AJ, Lawlor ER, et al. Development of a web-based, guided self-help, acceptance and commitment therapy-based intervention for weight loss maintenance: evidence-, theory-, and person-based approach. JMIR Form Res 2022;6:e31801. https://doi.org/10.2196/31801
Bates S, Norman P, Breeze P, Brennan A, Ahern AL. Mechanisms of action in a behavioral weight-management program: latent growth curve analysis. Ann Behav Med 2022;56:64–77. https://doi.org/10.1093/abm/kaab019
Bates SE, Thomas C, Islam N, Ahern AL, Breeze P, Griffin S, et al. Using health economic modelling to inform the design and development of an intervention: estimating the justifiable cost of weight loss maintenance in the UK. BMC Public Health 2022;22:290. https://doi.org/10.1186/s12889-022-12737-5
Mueller J, Richards R, Jones R, Whittle F, Woolston J, Stubbings M, et al. Supporting weight management during COVID-19: a randomized controlled trial of a web-based, ACT-based, guided self-help intervention. Obes Facts 2022;15:550–9. https://doi.org/10.1159/000524031
Jones R, Mueller J, Sharp S, Duschinsky R, Griffin S, Ahern A. Participant characteristics associated with changes in mental health in a trial of behavioural weight management programmes: secondary analysis of the WRAP trial. Obes Facts 2022;15:508–18. https://doi.org/10.1159/000522083
Ahern AL, Richards R, Jones RA, Whittle F, Mueller J, Woolston J, et al. Acceptability and feasibility of an acceptance and commitment therapy-based guided self-help intervention for weight loss maintenance in adults who have previously completed a behavioural weight loss programme: the SWiM feasibility study protocol. BMJ Open 2022;12:e058103. https://doi.org/10.1136/bmjopen-2021-058103
Ahern AL, Breeze P, Fusco F, Sharp SJ, Islam N, Wheeler GM, et al. Effectiveness and cost-effectiveness of referral to a commercial open group behavioural weight management programme in adults with overweight and obesity: 5-year follow-up of the WRAP randomised controlled trial. Lancet Public Health 2022;7:e866–75. https://doi.org/10.1016/s2468-2667(22)00226-2
Breeze P, Gray LA, Thomas C, Bates SE, Brennan A. Estimating the impact of changes in weight and BMI on EQ-5D-3L: a longitudinal analysis of a behavioural group-based weight loss intervention. Qual Life Res 2022;31:3283–92. https://doi.org/10.1007/s11136-022-03178-z
Jones RA, Richards R, Palat R, Hughes C, Hill AJ, Vincent A, et al. Participants’ experiences of mental health during a COVID-19 tailored ACT-based behavioural weight management intervention: a qualitative study. Int J Qual Stud Health Well-being 2022;17:2123093. https://doi.org/10.1080/17482631.2022.2123093
Jones RA, Mueller J, Sharp SJ, Griffin SJ, Ahern AL. Long-term impact of a behavioral weight management program on depression and anxiety symptoms: 5-year follow-up of the WRAP trial. Obesity 2022;30:2396–403. https://doi.org/10.1002/oby.23570
Mueller J, Richards R, Jones RA, Whittle F, Woolston J, Stubbings M, et al. Supporting Weight Management during COVID-19 (SWiM-C): twelve-month follow-up of a randomised controlled trial of a web-based, ACT-based, guided self-help intervention. Int J Obes 2023;47:51–9. https://doi.org/10.1038/s41366-022-01232-x
Birch JM, Mueller J, Sharp SJ, Griffin SJ, Kelly MP, Halford JCG, et al. Association between indicators of inequality and weight change following a behavioural weight loss intervention. Obes Facts 2023;16:194–203. https://doi.org/10.1159/000528135
Kudlek L, Jones RA, Hughes C, Duschinsky R, Hill A, Richards R, et al. Experiences of emotional eating in an Acceptance and Commitment Therapy based weight management intervention (SWiM): a qualitative study. Appetite 2024;193:107138. https://doi.org/10.1016/j.appet.2023.107138
Bates S, Breeze P, Thomas C, Jackson C, Church O, Brennan A. Cross-model validation of public health microsimulation models; comparing two models on estimated effects of a weight management intervention. BMC Public Health 2024;24:764. https://doi.org/10.1186/s12889-024-18134-4
Yin R, Ahern AL, Lafortune L, Griffin SJ, Strelitz JM, Mueller J. The association between patterns of weight change, diabetes status and glycaemia among adults with overweight and obesity. Diabet Res Clin Pract 2024;210:111607. https://doi.org/10.1016/j.diabres.2024.111607
Jones RA, Mueller J, Richards R, Woolston J, Stubbings M, Whittle F, et al. An acceptance-based guided self-help program for weight loss maintenance in adults who have previously completed a behavioral weight loss program: the SWiM feasibility study. Obes Sci Pract 2025;11:e70048. https://doi.org/10.1002/osp4.70048
Pidd KBP, Ahern A, Griffin S, Brennan A. The effects of weight loss and weight gain on HbA1c, systolic blood pressure and total cholesterol in three subgroups defined by blood glucose: a pooled analysis of two behavioural weight management trials in England. BMJ Open 2025;15:e095046. https://doi.org/10.1136/bmjopen-2024-095046
Mueller J, Breeze P, Fusco F, Sharp SJ, Pidd K, Brennan A, et al. Glucose Lowering through Weight management (GLoW): a randomised controlled trial of the clinical and cost effectiveness of a diabetes education and behavioural weight management programme versus a diabetes education programme in adults with a recent diagnosis of type 2 diabetes. Diabetologia 2025;68:969–80. https://doi.org/10.1007/s00125-024-06355-6
Breeze P, Pidd K, Pollard D, Ren S, Bates S, Thomas C, Brennan A. Assessing the value for money, from a policy maker prospective, of 24 randomised controlled trial designs for an online weight maintenance guided self-help intervention: an expected value of sample information analysis. Int J Obes 2025;49:1598–607. https://doi.org/10.1038/s41366-025-01804-7
Disclaimers
This article presents independent research funded by the National Institute for Health and Care Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, CCF, PGfAR or the Department of Health and Social Care. If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the interviewees and do not necessarily reflect those of the authors, those of the NHS, the NIHR, the PGfAR programme or the Department of Health and Social Care.