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.
The international journal of behavioral nutrition and physical activity 2021 ; 18: 146.
PubMed ID : 34743721
PMCID : PMC8574009
Low attendance and engagement in behavioural weight management trials are common. Mental health may play an important role, however previous research exploring this association is limited with inconsistent findings. We aimed to investigate whether mental health was associated with attendance and engagement in a trial of behavioural weight management programmes.
This is a secondary data analysis of the Weight loss referrals for adults in primary care (WRAP) trial, which randomised 1267 adults with overweight or obesity to brief intervention, WW (formerly Weight Watchers) for 12-weeks, or WW for 52-weeks. We used regression analyses to assess the association of baseline mental health (depression and anxiety (by Hospital Anxiety and Depression Scale), quality of life (by EQ5D), satisfaction with life (by Satisfaction with Life Questionnaire)) with programme attendance and engagement in WW groups, and trial attendance in all randomised groups.
Every one unit of baseline depression score was associated with a 1% relative reduction in rate of WW session attendance in the first 12 weeks (Incidence rate ratio [IRR] 0.99; 95% CI 0.98, 0.999). Higher baseline anxiety was associated with 4% lower odds to report high engagement with WW digital tools (Odds ratio [OR] 0.96; 95% CI 0.94, 0.99). Every one unit of global quality of life was associated with 69% lower odds of reporting high engagement with the WW mobile app (OR 0.31; 95% CI 0.15, 0.64). Greater symptoms of depression and anxiety and lower satisfaction with life at baseline were consistently associated with lower odds of attending study visits at 3-, 12-, 24-, and 60-months.
Participants were less likely to attend programme sessions, engage with resources, and attend study assessments when reporting poorer baseline mental health. Differences in attendance and engagement were small, however changes may still have a meaningful effect on programme effectiveness and trial completion. Future research should investigate strategies to maximise attendance and engagement in those reporting poorer mental health.
The original trial ( ISRCTN82857232 ) and five year follow up ( ISRCTN64986150 ) were prospectively registered with Current Controlled Trials on 15/10/2012 and 01/02/2018.
What is the aim of this study?
Low attendance and engagement are common for behavioural weight management programmes, and we do not yet fully understand why. Some research suggests that poor mental health may be a reason as it can make you feel unmotivated and can make you more likely to avoid people and activities you usually enjoy. In this study, we aimed to understand whether mental health was related to attendance at WW (previously known as Weight Watchers) sessions and engagement with the WW digital resources.
We also aimed to understand whether mental health was related to whether a participant did or did not attend the study visits for follow-up assessments at 3 months, 1 year, 2 years, and 5 years after starting the study. This is important because those with poor mental health will not be properly represented in the research findings if they do not complete follow-up assessments.
Those who feel more depressed and anxious when starting WW are less likely to attend WW sessions, use the WW digital resources, and attend study visits for follow-up assessments. Differences in attendance and engagement are small but may still have meaningful effects.
What was studied?
This study used data from the Weight loss Referrals for Adults in Primary care (WRAP) trial, which randomly assigned 1267 adults with overweight or obesity to one of three interventions:
(1) WW for 12 weeks, (2) WW for 52 weeks,
or (3) Brief intervention (in the form of self-help materials)
These adults completed questionnaires which measured their symptoms of anxiety and depression at the start of the trial and then at 3 months, 1 year, 2 years, and 5 years after beginning the trial. We also collected information how often they attended the WW sessions and how much they used the WW digital resources. We examined how participants’ symptoms of depression and anxiety when they started WW were related to attendance at the WW sessions and use of the WW digital resources.
What were the main results of the study?
We found that those with more symptoms of depression and anxiety when they started WW were…
• More likely to attend fewer WW sessions
• More likely to be less engaged with the WW digital resources
• More likely to not attend study visits for follow-up assessments
The differences in attendance and engagement were small but may still have important and meaningful effects on how effective the intervention is at improving participant’s health. It is important to identify how to better support people with poor mental health to attend and engage with these interventions.