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Older men playing football to keep fit

NIHR Signal A football programme for overweight men achieves sustained weight loss

Published on 16 October 2018

doi: 10.3310/signal-000660

A 12-week weight management programme for men, centred on football, achieved 4.9kg weight loss at 12 months. Modest weight loss of 2.9kg was maintained at 3.5 years.

Rates of overweight and obesity are higher for men than women in the UK, and there is little evidence that interventions are effective in the longer term. This NIHR-funded study followed 488 of 747 men (65%), average age 47 years, originally allocated to a programme of behavioural advice and football training with a professional coach or to a waiting list control. In this follow-on study, the control group also received the intervention after 12 months.

Improvements in self-reported physical activity and diet were also maintained. The programme was estimated to be an effective use of NHS resources. It indicates that tailored programmes can work beyond the trial setting.

Evidence for what components of this programme were linked to its success could help design other interventions that don’t involve football.  

Share your views on the research.

Why was this study needed?

Being overweight or obese is an ongoing public health concern. In 2016, obesity prevalence in the UK was similar in both genders (26% of men and 27% of women), but more men were overweight (40% compared with 30% of women). The peak prevalence of obesity is among middle-aged and older adults, 45-75 years in men and 45-84 in women.

Multicomponent interventions centred on physical activity, diet and behaviour change are known to achieve short-term weight loss. But there’s little evidence whether weight loss is maintained long-term, particularly for men, and often weight is gradually put back on.

In 2011, the Football Fans in Training (FFIT) trial recruited 747 overweight/obese men (BMI ≥28kg/m2) aged 35-65 years. They were allocated to a 12-week programme of coach-led physical activity and dietary education delivered at 13 Scottish football clubs or put on a waiting list to act as a control. At 12 months the intervention group achieved 4.94kg greater weight loss. This follow-up study looked at whether weight loss was maintained over a longer period. 

What did this study do?

This cohort involved 488 men (65%) from this trial who completed re-assessments at 3.5 years. This comprised 62% of the intervention group and 68% of the control group. Compared with participants, men who did not complete follow-up had slightly higher baseline weight, BMI, waist circumference and blood pressure, were slightly younger and less likely to be in paid employment.

The waitlist control group had the option of taking part in the FFIT programme after the initial 12 month trial period. Therefore there is no comparison group who received no intervention for this longer follow-up. Twelve-month outcomes for the waitlist group who completed the programme under non-randomised conditions were not available separately.

What did it find?

  • The original intervention group and the waitlist control group who received the intervention at 12 months both sustained weight loss out to 3.5 years. The intervention group lost 2.9kg (95% confidence interval [CI] 1.78 to 4.02) or 2.5% body weight by 3.5 years. The control group lost 2.7kg (95% CI 1.65 to 3.77) or 2.4% body weight.
  • The number of men who had achieved at least 5% weight loss since the start of the trial was also similar between groups: 32.2% of the intervention group and 31.8% of the control group.
  • Both groups showed sustained improvements in self-reported physical activity and diet from 12 months to 3.5 years. Both groups showed improvement in levels of moderate physical activity and reduced intake of fatty and sugary food, red meat and alcohol. Neither showed a difference in intake of fruit and vegetables or vigorous physical activity.
  • The FFIT programme was estimated to cost on average £2,450 per participant including programme costs and self-reported use of healthcare resources. The programme was estimated to be cost-effective at £10,770 to £15,300 per quality-adjusted life year (QALY) gained at 3.5 years, and £1,790 to £2,200 per QALY over the course of the person’s lifetime.

What does current guidance say on this issue?

The NICE 2014 guideline on weight management recommends referring overweight and obese adults to a lifestyle weight management programme that address diet, activity and behaviour change. NICE suggests that programmes are tailored to support the needs of different groups, such as men.  

Programmes are advised to set weight loss goals for the end of the programme and for one year. However, they should also stress the importance of maintaining new dietary habits and physical activity levels in the long term to prevent weight regain and discuss strategies to overcome any difficulties in maintaining new behaviours.

What are the implications?

This study supports the value of multicomponent interventions that are tailored to the needs and preferences of specific groups. It adds to the evidence that these creative programmes can promote sustained weight loss in the longer term and give value for money.

As the authors state, the programme was ‘gender-sensitised’ to the male environment of football clubs. It would be helpful to look at how the approach and principles of behaviour change could be adapted for people who don’t have a keen interest in football.

Citation and Funding

Gray CM, Wyke S, Zhang R, et al. Long-term weight loss trajectories following participating in a randomized controlled trial of a weight management programme for men delivered through professional football clubs: a longitudinal cohort study and economic evaluation. Int J Behave Nutr Phys Act. 2018;15(1):60.

This study was funded by the National Institute for Health Research Public Health Research Programme (project number 13/99/32).

Why was this study needed?

Being overweight or obese is an ongoing public health concern. In 2016, obesity prevalence in the UK was similar in both genders (26% of men and 27% of women), but more men were overweight (40% compared with 30% of women). The peak prevalence of obesity is among middle-aged and older adults, 45-75 years in men and 45-84 in women.

Multicomponent interventions centred on physical activity, diet and behaviour change are known to achieve short-term weight loss. But there’s little evidence whether weight loss is maintained long-term, particularly for men, and often weight is gradually put back on.

In 2011, the Football Fans in Training (FFIT) trial recruited 747 overweight/obese men (BMI ≥28kg/m2) aged 35-65 years. They were allocated to a 12-week programme of coach-led physical activity and dietary education delivered at 13 Scottish football clubs or put on a waiting list to act as a control. At 12 months the intervention group achieved 4.94kg greater weight loss. This follow-up study looked at whether weight loss was maintained over a longer period. 

What did this study do?

This cohort involved 488 men (65%) from this trial who completed re-assessments at 3.5 years. This comprised 62% of the intervention group and 68% of the control group. Compared with participants, men who did not complete follow-up had slightly higher baseline weight, BMI, waist circumference and blood pressure, were slightly younger and less likely to be in paid employment.

The waitlist control group had the option of taking part in the FFIT programme after the initial 12 month trial period. Therefore there is no comparison group who received no intervention for this longer follow-up. Twelve-month outcomes for the waitlist group who completed the programme under non-randomised conditions were not available separately.

What did it find?

  • The original intervention group and the waitlist control group who received the intervention at 12 months both sustained weight loss out to 3.5 years. The intervention group lost 2.9kg (95% confidence interval [CI] 1.78 to 4.02) or 2.5% body weight by 3.5 years. The control group lost 2.7kg (95% CI 1.65 to 3.77) or 2.4% body weight.
  • The number of men who had achieved at least 5% weight loss since the start of the trial was also similar between groups: 32.2% of the intervention group and 31.8% of the control group.
  • Both groups showed sustained improvements in self-reported physical activity and diet from 12 months to 3.5 years. Both groups showed improvement in levels of moderate physical activity and reduced intake of fatty and sugary food, red meat and alcohol. Neither showed a difference in intake of fruit and vegetables or vigorous physical activity.
  • The FFIT programme was estimated to cost on average £2,450 per participant including programme costs and self-reported use of healthcare resources. The programme was estimated to be cost-effective at £10,770 to £15,300 per quality-adjusted life year (QALY) gained at 3.5 years, and £1,790 to £2,200 per QALY over the course of the person’s lifetime.

What does current guidance say on this issue?

The NICE 2014 guideline on weight management recommends referring overweight and obese adults to a lifestyle weight management programme that address diet, activity and behaviour change. NICE suggests that programmes are tailored to support the needs of different groups, such as men.  

Programmes are advised to set weight loss goals for the end of the programme and for one year. However, they should also stress the importance of maintaining new dietary habits and physical activity levels in the long term to prevent weight regain and discuss strategies to overcome any difficulties in maintaining new behaviours.

What are the implications?

This study supports the value of multicomponent interventions that are tailored to the needs and preferences of specific groups. It adds to the evidence that these creative programmes can promote sustained weight loss in the longer term and give value for money.

As the authors state, the programme was ‘gender-sensitised’ to the male environment of football clubs. It would be helpful to look at how the approach and principles of behaviour change could be adapted for people who don’t have a keen interest in football.

Citation and Funding

Gray CM, Wyke S, Zhang R, et al. Long-term weight loss trajectories following participating in a randomized controlled trial of a weight management programme for men delivered through professional football clubs: a longitudinal cohort study and economic evaluation. Int J Behave Nutr Phys Act. 2018;15(1):60.

This study was funded by the National Institute for Health Research Public Health Research Programme (project number 13/99/32).

Long-term weight loss trajectories following participation in a randomised controlled trial of a weight management programme for men delivered through professional football clubs: a longitudinal cohort study and economic evaluation

Published on 28 June 2018

Gray CM, Wyke S, Zhang R, Anderson AS, Barry S, Boyer N, et al

International Journal of Behavioral Nutrition and Physical Activity , 2018

Background Obesity is a major public health concern requiring innovative interventions that support people to lose weight and keep it off long term. However, weight loss maintenance remains a challenge and is under-researched, particularly in men. The Football Fans in Training (FFIT) programme engages men in weight management through their interest in football, and encourages them to incorporate small, incremental physical activity and dietary changes into daily life to support long-term weight loss maintenance. In 2011/12, a randomised controlled trial (RCT) of FFIT demonstrated effectiveness and cost-effectiveness at 12 months. The current study aimed to investigate long-term maintenance of weight loss, behavioural outcomes and lifetime cost-effectiveness following FFIT. Methods A longitudinal cohort study comprised 3.5-year follow-up of the 747 FFIT RCT participants. Men aged 35–65 years, BMI ≥ 28 kg/m2 at RCT baseline who consented to long-term follow-up (n = 665) were invited to participate: those in the FFIT Follow Up Intervention group (FFIT-FU-I) undertook FFIT in 2011 during the RCT; the FFIT Follow Up Comparison group (FFIT-FU-C) undertook FFIT in 2012 under routine (non-research) conditions. The primary outcome was objectively-measured weight loss (from baseline) at 3.5 years. Secondary outcomes included changes in self-reported physical activity and diet at 3.5 years. Cost-effectiveness was estimated at 3.5 years and over participants’ lifetime. Results Of 665 men invited, 488 (73%; 65% of the 747 RCT participants) attended 3.5-year measurements. The FFIT-FU-I group sustained a mean weight loss of 2.90 kg (95% CI 1.78, 4.02; p < 0.001) 3.5 years after starting FFIT; 32.2% (75/233) weighed ≥5% less than baseline. The FFIT-FU-C group had lost 2.71 kg (1.65, 3.77; p < 0.001) at the 3.5-year measurements (2.5 years after starting FFIT); 31.8% (81/255) weighed ≥5% less than baseline. There were significant sustained improvements in self-reported physical activity and diet in both groups. The estimated incremental cost-effectiveness of FFIT was £10,700–£15,300 per QALY gained at 3.5 years, and £1790–£2200 over participants’ lifetime. Conclusions Participation in FFIT under research and routine conditions leads to long-term weight loss and improvements in physical activity and diet. Investment in FFIT is likely to be cost-effective as part of obesity management strategies in countries where football is popular.

Expert commentary

What made this football-based weight loss initiative so successful? We do not know, but a major factor could be that having the common bond of the football club increased motivation, and the organisational structure of the club would have contributed. There were 13 clubs involved, so findings do not necessarily relate to results on the pitch.

As the authors point out, there is a weakness in the case for economic evaluation, in the lack of a 'no intervention;' group. However, the reported effect is a strong one and would benefit those associated with other large sports clubs.

Julian Ashton, Interim Editorial Staff for the Journal of Public Mental Health; NIHR Research Design Service South West

The commentator declares no conflicting interests.

Expert commentary

Obesity is a public health priority, and there is a lack of evidence for interventions that have sustained impact over time.

The intervention studied is easily replicable, and the findings are relevant to all areas of the UK. Many public health teams are already using football to increase physical activity. A key finding is that the intervention delivered sustained weight loss over 3.5 years, a long-term finding that indicates a potential for sustained behaviour change.

A secondary outcome showed an increase in levels of physical activity over the same timescale, but this was based on self-reported levels of activity.

Paul Southon, Membership of the Faculty of Public Health; Director, Southon Associates Ltd

The commentator declares no conflicting interests.