Dr Cindy Gray's keynote speech 'Positive Aspects of Weight Loss...from Men!' at the SCPN's 'Be Active Against Cancer' conference, Tuesday 4th February 2014.

1. Positive aspects of weight loss...
from men!

2. Background to the project
• Rising levels of obesity are a major challenge to public health
Obesity levels among men in UK 2003 Obesity levels among men in UK 2008
25-27%
23-25%
21-23%
19-21%
17-19%
Exclusion
25-27%
23-25%
21-23%
19-21%
17-19%
Exclusion

3. Background to the project
• Rising levels of obesity are a major challenge to public health
Obesity levels among men in UK 2003 Obesity levels among men in UK 2008
25-27%
23-25%
21-23%
19-21%
17-19%
Exclusion
25-27%
23-25%
21-23%
19-21%
17-19%
Exclusion

4. Men and weight loss
• 5-10% weight loss can produce significant health
benefits (NICE 2006; SIGN 2010)
BUT:
• Men are reluctant to attend traditional weight
management services
 Less than 15% of referrals to
commercial sector
(Jebb et al Lancet 2011)
 Only 23% of attendees at NHS
weight management services
(Counterweight Br J Gen Pract 2008)

5. BUT......
Growing recognition of professional sports
clubs’ potential to improve men’s health
e.g. Scottish Professional Football League
Clubs
Partner with local organisation(s)

6. Weight-management for men through increasing physical
activity and eating a healthier diet
Free of charge, group-based programme
12 weekly, weight loss sessions with ‘classroom’ education
and ‘training’ at Scotland's top professional football clubs
PLUS
Incremental, daily pedometer-based homework
THEN
Light touch ongoing maintenance to 12 months (1 reunion
session at club and 6 email prompts)
Gender-sensitised
1) Content - healthy eating, not a diet, focus on PA and alcohol
2) Context - football clubs, male-only, club community coaches
3) Delivery – participative, peer-supported, banter Gray, Hunt, Mutrie et al,
BMC Public Health 2013

7. Effectiveness
• Setting: 13 top Scottish football clubs
• Participants: men, 35-65 years, BMI≥28 kg/m2
• Measurement: baseline, 12 weeks (post-FFIT) and 12 months
• Primary outcome: objectively-measured weight loss at 12 months
• In 2011-12, first-ever RCT of healthy lifestyle
programme in professional sports clubs
Secondary outcomes
Objective Self-reported Cost effectiveness
Waist circumference Physical Activity (IPAQ) Resource Use
BMI Food Frequency (DINE)
Body Composition (% Body Fat) Alcohol Intake (7-day diary)
Resting BP (Systolic/Diastolic) Self-esteem (Rosenberg)
Positive and Negative Affect (PANAS)
Health-related Quality of Life (SF-12)

8. 12 month measurement
(95%, n=355)
Loss to follow-up
(7%, n=27)
Loss to follow up
(12%, n=44)
Complete intervention
12 week measurement
(88%, n=330)
12 month measurement
(89%, n=333)
Analyzed
(89%, n=333)
Analyzed
(95%, n=355)
Analysis
Loss to follow-up
(11%, n=41)
Loss to follow-up
(5%, n=19)
Excluded (n=177)
Did not wish to participate
(n= 101)
Ineligible (BMI < 28kg/m2)
(n=76) Excluded (n=306)
Allocated to FFIT programme
groups that are not included in RCT
Allocation
Randomization
FFIT Enrollment
Baseline measurement
(n=1,231)
Allocated to intervention group
(n=374)
Allocated to comparison group
(n=373) *
Follow-Up
12 week measurement
(93%, n=347)
Multi-faceted recruitment
1) Media-based
e.g. newspapers, radio, websites
2) Club-based
e.g. match day adverts, manager/player endorsement
3) Other
e.g. signposting from NHS, workforce mail shots
*After
randomisation,
one participant
requested to have
all of his data
destroyed.
RCT Design and Participant Flow

9. Results

10. High risk men
• 747 measured at baseline
• Mean age: 47.1 (±8.0) yrs
• Mean BMI: 35.3 (±4.9) kg/m2
• Mean BP: 140.3 (±16.3) mmHg systolic
88. 8 (±10.2) mmHg diastolic
BMI Category %
Overweight (BMI 28-29.9) 7.6
Obese I (BMI 30-34.9) 44.0
Obese II (BMI 35-39.9) 31.2
Obese III (BMI ≥40) 17.1
Hunt, Gray, MacLean et al. BMC Public Health 2014

11. High risk men
BMI Category %
Overweight (BMI 28-29.9) 7.6
Obese I (BMI 30-34.9) 44.0
Obese II (BMI 35-39.9) 31.2
Obese III (BMI ≥40) 17.1
• Weight loss activities in last 3 months (%)
Commercial programme NHS Services
Not at all 96.4 98.3
≥ 1-2 times per month 27 13
Hunt, Gray, MacLean et al. BMC Public Health 2014
• 747 measured at baseline
• Mean age: 47.1 (±8.0) yrs
• Mean BMI: 35.3 (±4.9) kg/m2
• Mean BP: 140.3 (±16.3) mmHg systolic
88. 8 (±10.2) mmHg diastolic

12. Wide reach across SES
Est. from Scottish Index of Multiple Deprivation 2012 http://www.scotland.gov.uk/Topics/Statistics/SIMD
17.5 17.5
16.3
22.2
25.1
0
5
10
15
20
25
30
1 2 3 4 5
SIMD Quintile*

13. Programme delivery
• Fidelity good: coaches delivered 86% of key tasks
• High attendance: 78.9% men at 6 or more sessions
What FFIT is not
For women… ‘I think ladies, to come to something that
we’ve been on for the twelve weeks, wouldn’t maybe
appreciate the language that’s used. You know, it’s all
guys that’s there and, you know, it’s football’
A diet … ‘ if someone said diet, I don’t think any of us
would have been here’
The gym… ‘I don’t want to go to a gym and see all the
younger ones, the fitter ones – and you got a kinda, you
look roon [around] and you think they’re looking at ye
[you]. “He’s that fat he cannae even dae that.”

14. Weight loss (%)
(Error bars represent
95% confidence intervals)
Adjusted between-group difference 12 weeks 4·71% (CI 5.44, 3.98) p<.0001
Adjusted between-group difference 12 months 4.36% (CI 5.08,3.64) p<.0001
5.2 5.0
0.4
0.5
0.0
1.0
2.0
3.0
4.0
5.0
6.0
12 weeks 12 months
Meanweightloss(%)
Intervention
Comparison
Hunt, Wyke, Gray et al. Lancet 2014

15. Participants achieving ≥ 5% weight loss
46.8
39.0
6.9
11.3
0
5
10
15
20
25
30
35
40
45
50
12 weeks 12 months
%Participants
Intervention
Comparison
Relative risk 12 weeks 6.77 (CI 4.52, 10.13)
Relative risk 12 months 3.47 (CI 2.51, 4.78)

16. Increase in self-reported PA
Adjusted ratio geometric means 12 weeks 2.38 (CI 1.90, 2.98) p<.0001
Adjusted ratio geometric means 12 months 1.49 (CI 1.11, 1.99) p=.008
(Error bars represent
IQ range)
1485
1219
0
375
-2000
-1000
0
1000
2000
3000
4000
MedianincreaseintotalPA
(MET-mins/week)
Intervention
Comparison
12 months12 weeks

17. Dietary Improvements
(Error bars represent
95% confidence intervals)
-5.6
-4.5
1.6
0.8
-2.1
-1.3
-1.4 -1.7
0.2 0.3
-0.7 -0.5
-7.0
-6.0
-5.0
-4.0
-3.0
-2.0
-1.0
0.0
1.0
2.0
3.0
MeanchangeinDINEscores
Intervention
Comparison
Fatty Foods Fruit and veg Sugary foods
12 wks 12 mths 12 wks 12 mths 12 wks 12 mths

18. Dietary Improvements
Fatty foods
Adjusted between-group difference 12 weeks -4.39 (CI -5.16, -3.61) p<.0001
Adjusted between-group difference 12 months -2.74 (CI-3.52, -1.96) p<.0001
Fruit and
vegetables
Adjusted between-group difference 12 weeks 1.32 (CI 1.07, 1.57) p<.0001
Adjusted between-group difference 12 months 0.54 (CI 0.29, 0.79) p<.0001
Sugary
foods
Adjusted between-group difference 12 weeks -1.52 (CI -1.83, 1.21) p<.0001
Adjusted between-group difference 12 months -0.87 (CI -1.18, -0.56) p<.0001

19. Lower alcohol consumption
12 months12 weeks
Adjusted between-group difference 12 weeks -4.47 (CI -6.09, -2.86) p<.0001
Adjusted between-group difference 12 months -2.59 (CI -4.21, -0.97) p=.0017
(Error bars represent
95% confidence intervals)
-6.2
-4.2
-2.1
-9.0
-8.0
-7.0
-6.0
-5.0
-4.0
-3.0
-2.0
-1.0
0.0
1.0
2.0
Meanchange7daytotal
alcoholconsumption(units)
Intervention
Comparison-2.2

20. Feel better in myself
0.0
0.1
0.1
0.2
0.2
0.3
0.3
0.4
12 weeks 12 months
Meanchangein
Rosenberg
-0.4
-0.2
0.0
0.2
0.4
0.6
0.8
MeanchangeinPANAS
12wks 12mths 12wks 12mths
Positive affect Negative affect
Self esteem

21. Within trial analysis
• Total cost:
FFIT - £680 per man;
comparison group - £475 per man
• Gain in QALYs from FFIT:
0·015 (0·003, 0·027)
• Incremental cost-effectiveness:
£13,847 per QALY gained
• Probability of cost-effectiveness:
0.72 (20,000/QALY); 0.89 (£30,000/QALY)
FFIT is cost effective

22. Derek Spence
Hibernian FFIT Autumn 2011
FFIT website: www. ffit.org.uk
From the horse’s mouth…

23. Thanks to Participants, coaches, MRC/CSO SPHSU Survey Office,
Tayside Clinical Trials Unit
Collaborators Sally Wyke, Kate Hunt, Cindy M Gray, Chris Bunn,
Annie Anderson, Shaun Treweek, Peter Donnan, Nanette
Mutrie, Jim Leishman Elizabeth Fenwick, Alan White, Adrian
Brady, Petra Rauchaus, Eleanor Grieve, Nicki Boyer
FFIT Programme Delivery SPFL Trust – Billy Singh, Euan Miller,
Stuart McPhee, Mark Dunlop and Iain Blair
FFIT Programme Funding Scottish Government, Football Pools
Research Funding: National Institute of Health Research Public Health
Research (NIHR PHR) programme (project number 09/3010/06). The views
expressed here are those of the authors and not necessarily those of the NIHR
PHR programme or the Department of Health
Acknowledgements