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Trial registered on ANZCTR

Registration number

ACTRN12616001163493p

Ethics application status

Submitted, not yet approved

Date submitted

14/08/2016

Date registered

26/08/2016

Date last updated

19/09/2016

Type of registration

Prospectively registered

Titles & IDs

Public title

GP based obesity program; Dr Mark McGrath/ University of Queensland
“The Non-Diet Approach To Healthy Eating Program”

Scientific title

A prospective cohort study (+/- control) on the effectiveness of psychological intervention + diet & exercise advice on overweight & obese adults in a general practice setting utilising allied health professionals.

Secondary ID [1]

Nil Known

Universal Trial Number (UTN)

Trial acronym

Linked study record

Health condition

Health condition(s) or problem(s) studied:

Obesity

Condition category

Condition code

Diet and Nutrition

Obesity

Intervention/exposure

Study type

Interventional

Description of intervention(s) / exposure

Structured general practice consultations - beginning with 6 prolonged visits (ie >40mins) to introduce the basic concepts of the intervention, invite participants to practice a skill at home then return to troubleshoot and learn the next skill/ concept. Patients who are interested will begin with a 1-2 hour group session which acts as an introduction and to see whether they are interested in progressing on. The sessions are one on one thereafter. There is an initial medical examination, consent and paperwork session then 6 one on one visits with GP occurring fortnightly.

Obesity Program Summary
0.Medical Assessment, Consent, Shifting Focus From Weight
*Screen for causes & comorbidities
*Arrange Ix including DEXA scan
*Consent
*Discuss visceral fat & waist circumference
*Introduce values
1. The Basics - Values & Mindfulness
*Introduce Values, explain why important; Generate values statement
*Introduction to ACT & Mindfulness; practice
(Notice; these don’t specifically relate to eating/ food at this time)
2. Mindful eating
*Analyse values statement
*Mindfulness applied to eating when hungry & Mindful eating
*“Choice point model”
3. Over-eating, hunger, cravings
*Eating until satisfied not full
*Hunger scale
*Cravings
*Tie in with values & choice point model
4. REVISION & FOOD QUALITY, DIETICIAN REFERRAL
*Revise 4 main points;
a.Eat when you’re hungry
b.Eat mindfully
c.Eat until satisfied not full (hunger scale)
d.Cravings
*Priming/ body self-regulates
*unprocessed food
*+/-drinks
*+/- treats
5. EXERCISE “Movement”, REFER EXERCISE PHYSIOLOGIST
*Benefits of exercise (least of all weight loss)
*A more or less approach
6. Values, deeper issues, psychology, REFER PSYCHOLOGIST
*Not living in alignment with values/ ‘Subconscious’ factors/ psychologist referral
*not eating to manage uncomfortable feelings

Thereafter sessions will be approximately monthly. They will involve troubleshooting, assessing progress, introducing new concepts as relevant to the patient as an individual. The GP will suggest the interval but it is at the discretion of the patient. The sessions may become more spaced out as time progresses according to need. I anticipate 2-3 years of ongoing sessions but there is not maximum per se. There will be significant individual variation. It is hoped that these sessions will foster adherence until the patient is self-sufficient. If patients do drop out they are likely to remain patients of the practice so follow-up will still be possible and it will be easy to commence where they left off should they choose to do so in the future.

The intervention is based mainly on the psychological principles of ACT (acceptance and commitment therapy).
All patients will be referred to a Psychologist, Dietitian & Exercise physiologist who all practice in a similar manner based around ACT so that patients will receive a consistent message,
As per any usual referral from the GP to an allied health professional, the GP does not dictate the content of the sessions. They will be tailored to suit the individual at the discretion of the allied health professional. The point of difference is that each allied health professional will be familiar with and incorporate ACT techniques into their practice and be familiar with the philosophy of the program. I anticipate that most patients will spend a higher proportion of their visits with the psychologist, then the dietician and the least with the exercise physiologist. The interval between visits will be determined by both the patient and allied health professional. This is likely to impact the interval of visits back to the GP. For example if in a two-month the patients has numerous visits each of the three allied health professionals they are not likely to require frequent troubleshooting with their GP.

Phone calls/ letters or email may also be used to improve adherence. All patients will be encouraged to read one of three self-help books to also improve adherence and skills.

Self Help books;
*Neuroslimming – Dr Helena Popovic
*The Diet Trap – Jason Lillis, Joanne Dahl, Sandra Weineland (audiobook & hard copy)
*The Weight Escape – Joseph Ciarocchi, Ann Bailey & Russ Harris Headspace – Mindful eating

Intervention code [1]

Behaviour

Intervention code [2]

Treatment: Other

Comparator / control treatment

Participants will be prospectively enrolled. I hope to also prospectively recruit use a control group if possible consisting of a group of overweight, obese or morbidly obese patients from the GP practice next door. Data collected will include annual height, weight, waist circumference, QOL scale and whether they participated in 'standard' treatment for obesity with their GP, no treatment or commercial treatment. Any treatment received by the control group will be at the discretion of their usual GP (ie the GP clinic next door).

Control group

Active

Outcomes

Primary outcome [1]

The Impact of Weight on Quality of Life-Lite (IWQOL-Lite)
Weight will be measured by the doctor.

Timepoint [1]

annual for 3 years

Primary outcome [2]

Waist circumference - as measured by GP or practice nurse using a tape measure

Timepoint [2]

annual for 3 years

Primary outcome [3]

DEXA body fat scan

Timepoint [3]

annual for 3 years

Secondary outcome [1]

Blood Pressure - as measured by GP or practice nurse using a sphygmomanometer

Timepoint [1]

annual for 3 years

Secondary outcome [2]

Fasting lipids - as measured by blood tests collected by the local pathology provider

Timepoint [2]

annual for 3 years

Secondary outcome [3]

Fasting blood sugar & HBA1c (composite outcome measure; both are a reflection of impaired fasting glucose or insulin resistance) - as measured by blood tests collected by the local pathology provider

Timepoint [3]

annual for 3 years

Secondary outcome [4]

Liver function tests - as measured by blood tests collected by the local pathology provider

Timepoint [4]

annual for 3 years

Eligibility

Key inclusion criteria

Overweight, obese or morbidly obese adults

Minimum age

18 Years

Maximum age

No limit

Sex

Both males and females

Can healthy volunteers participate?

Key exclusion criteria

Frank eating disorder

Study design

Purpose of the study

Treatment

Allocation to intervention

Non-randomised trial

Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)

Methods used to generate the sequence in which subjects will be randomised (sequence generation)

Masking / blinding

Open (masking not used)

Who is / are masked / blinded?

Intervention assignment

Parallel

Other design features

Phase

Not Applicable

Type of endpoint/s

Statistical methods / analysis

Recruitment

Recruitment status

Not yet recruiting

Date of first participant enrolment

Anticipated

30/09/2016

Actual

Date of last participant enrolment

Anticipated

Actual

Date of last data collection

Anticipated

Actual

Sample size

Target

300

Accrual to date

Final

Recruitment in Australia

Recruitment state(s)

QLD

Funding & Sponsors

Funding source category [1]

Self funded/Unfunded

Name [1]

N/A

Address [1]

N/A

Country [1]

Primary sponsor type

University

Name

University of Queensland

Address

UQ Discipline of General Practice
The Universty of Queensland, St Lucia, Qld 4072

Country

Australia

Secondary sponsor category [1]

None

Name [1]

Address [1]

Country [1]

Ethics approval

Ethics application status

Submitted, not yet approved

Ethics committee name [1]

University of Queensland

Ethics committee address [1]

UQR&I Human Ethics Coordinators
The University of Queensland, St Lucia, Qld 4072

Ethics committee country [1]

Australia

Date submitted for ethics approval [1]

15/08/2016

Approval date [1]

Ethics approval number [1]

Summary

Brief summary

HYPOTHESIS – That a psychology based obesity intervention in a GP setting will result in sustainable improvements in both QOL (quality of life) of overweight, obese & morbidly obese patients and result in improvements in measurable outcome parameters such as reduced visceral fat, improved blood sugar, lipids and fatty liver.

Trial website

Trial related presentations / publications

Public notes

POTENTIAL RISKS

The radiation dose from DEXA scan is negligible. The patient will receive approximately the same amount of radiation that the public receives from background radiation in a single day. The operator sits right next to the patient in the room during the scan, which is completely safe to do because the radiation dose is so low. It has been approximated at 0.002 mSv (a seven hour aeroplane flight is approximated at 0.05 mSv ie 25 times the dose of a single scan).

All patients will be screened for eating disorders at the time of initial assessment using the Fairburn Eating Disorder Questionnaire EDE-Q6. If an eating disorder is suspected they will be referred on appropriately. Given the program isn’t aimed at weight loss and doesn’t encourage restrictive eating, any undetected eating disorders are unlikely to come to harm, other than a delay in more targeted therapy until they see a psychologist. 

Should other medical or psychological issues arise these will be addressed and managed appropriately. 

Patients will be screened medically at the initial consult. If they are considered at high-risk from a cardiac perspective of commencing exercise they will be offered appropriate investigations such as a Stress ECHO. Utilising an exercise physiologist will help to minimise injuries with recommencement of exercise. 

Attending a psychologist skilled in ACT & obesity/ eating disorders will help mitigate many psychological risks. Some foreseeable examples include coming to realise that they feel unsafe without their excessive weight as they may have been using it as a self-protective measure to make them less attractive to others sometimes as a result of trauma such as childhood abuse. Weight loss can also trigger feelings of uncertainty for significant others resulting in relationship issues. 

CONSENT
Patients will be made aware that they are anonymously contributing to medical research including publication.

Participants are free to leave at any time but will be asked to keep in contact for a minimum of two years for research purposes to document the reasons they chose to drop-out and ideally their progress after they leave. If they are long-term patients of the practice this should not pose a great problem and it is hoped that follow-up will be able to be achieved to three years or longer.

Informed financial consent will also be obtained. Costs will be in line with out-of-pocket costs patients would usually expect to pay for medical referrals & services. This project in unfunded and is intended to run self-sufficiently in a predominantly private-billing GP setting.

Contacts

Principal investigator

Name

Dr Mark McGrath

Address

Kenmore Family Medical Centre
1/2081 Moggill Rd
Kenmore Qld 4069

Country

Australia

Phone

+61 733782988

Fax

[email protected]

Contact person for public queries

Name

Mark McGrath

Address

Kenmore Family Medical Centre
1/2081 Moggill Rd
Kenmore Qld 4069

Country

Australia

Phone

+61 733782988

Fax

[email protected]

Contact person for scientific queries

Name

Mark McGrath

Address

Kenmore Family Medical Centre
1/2081 Moggill Rd
Kenmore Qld 4069

Country

Australia

Phone

+61 733782988

Fax

[email protected]

No information has been provided regarding IPD availability

What supporting documents are/will be available?

No Supporting Document Provided

Results publications and other study-related documents

Documents added manually

No documents have been uploaded by study researchers.

Documents added automatically

No additional documents have been identified.

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