Examples of our research


Long term maintenance of weight loss with non-surgical interventions in obese adults: systematic review and meta-analyses of randomised controlled trials

Purpose: Obesity poses an unparalleled societal challenge, costing the UK £16 billion per year and affecting 1 in every 4 adults. The NHS and members of the public invest considerably in weight loss treatments to combat obesity, but most people who successfully lose weight quickly regain it.  The full health benefits of weight loss can only be realised if that loss is maintained.  Behavioural interventions to help obese individuals maintain their weight loss are needed.

In response to this need, our research team is conducting the UK’s first research programme to develop and evaluate a digital, evidence-based, behavioural weight loss maintenance (WLM) intervention for initially obese people who have lost weight. The intervention has been developed through user-centred design, is underpinned by our recent review of WLM interventions and delivers techniques shown to support people in maintaining healthy lifestyle behaviours.

The primary outcome variable is weight change at 12 months from baseline assessment. 

Core objectives include:

  • develop procedures and materials for an evidence-based, inexpensive, scalable behavioural weight maintenance intervention, mediated by internet-ready mobile phones and SIM-enabled weighing scales
  • test the acceptability and feasibility of the trial procedures through an internal pilot
  • estimate the cost-effectiveness of the intervention and the association between socioeconomic status and WLM.



We are in the process of recruiting 288 people living in North East England to this randomised controlled trial.  We are keen to hear from people who are interested in taking part. Visit our website for more details and to complete an application form.

To take part you must:

  • be 18 years or older
  • have had a body mass index of at least 30 kg/m2 in the last two years
  • currently weigh at least 5 percent below your highest weight in the last year
  • use an internet-ready mobile phone. 

Intervention details

Equal numbers of participants are randomly allocated to receive either the novel intervention or a quarterly newsletter (control condition).  Participants in both groups receive a set of SIM-enabled scales which automatically relay users’ weights to a central server, enabling the research team to track participants’ weights.  However, only intervention participants receive:

  • instructions to weigh themselves daily
  • access to their weight progress data (and graphs) via their mobile phones.

Following randomisation, intervention group participants receive a one-hour in-person support session with a psychologist, focused upon reviewing current diet and physical activity, setting goals and developing plans for WLM over the coming months.  Participants then receive tailored support to enact the desired behaviour maintenance and behaviour change via their mobile phone. This is achieved using:

  • automated and researcher-mediated SMS content (including embedded links) uniquely tailored to the participants weight, dietary and physical activity status and
  • a remotely administered mobile-phone platform which allows users to visually track their goal progress, set new dietary/physical activity goals and communicate with the research team if needed.

Findings: No findings available yet.

Project Award: £832,129

Funder: Medical Research Council - National Prevention Research Initiative (NPRI)

Project dates: September 2012 to August 2015

Practical implications:

Primary beneficiaries of this project are expected to include:

  • Initially obese individuals seeking to maintain weight loss.
    • If the intervention is successful in reducing regain, individuals can expect to benefit from improved health, fitness and general wellbeing, as well as reduced risks of chronic disease.
    • Key benefits of the intervention include its accessible, user-friendly, convenient and interactive format, specifically tailored to the individual’s requirements.
  • NHS and local authority weight management services, including commissioners and providers.
    • Cost effective WLM interventions are a vital complement to existing NHS and local authority weight loss services and would benefit all NHS services directly and indirectly by lessening the healthcare burden and costs of obesity-related disease and disability
    • The intervention reflects current NICE guidance on components of programmes to prevent weight regain
    • Once fully optimised, the intervention should provide to commissioners and providers an ‘off the shelf’ support solution for their out-going weight management clients, requiring minimal set-up and low running costs as a natural successor to current weight loss services.
  • Academic beneficiaries
    • This is the first UK based RCT of a WLM intervention, and also the first RCT conducted in Europe to recruit participants from the community, rather than inducing weight loss in an initial stage of the study. As such, it meets a significant research need.
    • Academic beneficiaries will include public health and obesity researchers with an interest in long term prevention and the relationship between obesity and morbidity, disability and mortality as well as epidemiologists with an interest in modelling long term effects of weight loss. This trial will also improve understanding of behavioural maintenance in the long term management of weight, addressing key gaps identified in the evidence base. 
    • Future research studies may benefit from the novel technologies involved (i.e. the mobile phone internet platform and the SIM-enabled scales), which enable remote weight monitoring and the automated provision of tailored feedback, providing an innovative research platform for behavioural, clinical and applied science.

Project outputs:


Press/other coverage:

View all the outputs from the Behaviour Change research programme

Contact information:

Principal Investigator: Prof Falko F. Sniehotta, Research Associate: Dr Elizabeth H. Evans, Research Assitant: Dominika Kwasnicka

Trial website: research.ncl.ac.uk/nulevel/

Study Twitter account: @nulevelstudy


Community pharmacy interventions for public health priorities: a systematic review of community pharmacy delivered smoking, alcohol and weight management interventions

Purpose: Obesity, smoking and excessive alcohol intakes are three of the most significant modifiable risk factors for morbidity and mortality in the UK.  Interventions led by community pharmacists, aimed at these three risk factors, have been identified by the government as public health priorities. In 2008, the Department of Health for England stated that ‘a sound evidence base that demonstrates how pharmacy delivers effective, high quality and value for money services is needed.’ This systematic review aims to respond to this requirement.

Community pharmacists can deliver health care advice at an opportunistic level and as part of focused services designed to reduce specific risks to health. Community pharmacies and their staff are easily accessible and can play a key role in public health initiatives and may have a positive impact on health equity. The rationale behind the important element of the interventions included in this review relates to access and acceptability of the interventions, particularly for those who live in areas of high deprivation and/or are members of sub-groups within the community who are less likely to access health services.

Design: We will conduct a comprehensive systematic review of the literature. We will search the databases MEDLINE, Embase, CINAHL, PsycINFO, Social Sciences Citation Index, ASSIA, IBSS, Sociological Abstracts, Scopus and NHS Economic Evaluation Database for studies that have evaluated interventions based in community pharmacies that aim to target weight management, smoking cessation and alcohol misuse. We will include all randomised controlled trials, non-randomised controlled trials, controlled before-after studies, interrupted time series and repeated measures studies. Data from included studies will be extracted by two independent reviewers and will include study details methods, results, intervention implementation/costs and methodological quality. Meta-analysis will be conducted if appropriate; if not, the synthesis will be restricted to a narrative overview of individual studies looking at the same question.

The review will examine studies that have explored the effectiveness of any intervention that aims to target weight management, smoking cessation or the misuse/excessive consumption of alcohol which were based in any community pharmacy, in any country. We will only include studies on smoking cessation and alcohol intake if they include a measurement of relevant behaviour as an outcome. For weight loss interventions, we will only include studies if they include a measurement of body weight or fatness (e.g. body-mass index, body fat) as an outcome.

Findings: The search for evidence is nearing completion; we currently have identified 27 relevant controlled studies for potential inclusion in the review. The data extraction of these studies is underway. Relatively few studies of alcohol intake interventions have been identified compared to smoking cessation and weight loss interventions.

Project Award: £143,147

Funder: National Institute for Health Research, Public Health Research (PHR) Programme

Project dates: From 1 March 2014 to 28 February 2015

Practical implications: The review aims to summarise the evidence base on the effectiveness of community pharmacy interventions on health and health behaviours in relation to weight management, smoking cessation and alcohol misuse. It will also explore if, and how, socio-economic status, gender, ethnicity and age moderate the effect of the interventions. The review will describe how the interventions have been organised, implemented and delivered, since context is an important factor governing the success of public health interventions. The findings from this review will have an impact on the commissioning of public health services in the UK which aim to promote healthy weight and smoking cessation and prevent excessive alcohol consumption.

The review is registered with PROSPERO and the protocol is published in Systematic Reviews. The findings from the systematic review will be published in an open access journal in 2015.

A programme of dissemination is planned for Autumn 2015. Key stakeholders include the Department of Health, Local Councils, the Royal Pharmaceutical Society, the Pharmaceutical Services Negotiating Committee, the Local Government Association, the Faculty of Public Health, NICE, Alcoholics Anonymous, Weight Concern, and Action for Smoking and Health.

Contact information: Tamara Brown, Post Doctoral Research Associate, Durham University.

View all the outputs from the Behaviour Change research programme