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Funder: nihr oxford biomedical research centre; funder-id: http://dx.doi.org/10.13039/501100013373, Funder: national institute for health research; funder-id: http://dx.doi.org/10.13039/501100000272, OBJECTIVES: The aim was to investigate the impact of a group-based weight management programme on symptoms of depression and anxiety compared with self-help in a randomised controlled trial (RCT). METHOD: People with overweight (Body Mass Index [BMI]���28kg/m2) were randomly allocated self-help (n = 211) or a group-based weight management programme for 12 weeks (n = 528) or 52 weeks (n = 528) between 18/10/2012 and 10/02/2014. Symptoms were assessed using the Hospital Anxiety and Depression Scale, at baseline, 3, 12 and 24 months. Linear regression modelling examined changes in Hospital Anxiety and Depression Scale between trial arms. RESULTS: At 3 months, there was a -0.6 point difference (95% confidence interval [CI], -1.1, -0.1) in depression score and -0.1 difference (95% CI, -0.7, 0.4) in anxiety score between group-based weight management programme and self-help. At subsequent time points there was no consistent evidence of a difference in depression or anxiety scores between trial arms. There was no evidence that depression or anxiety worsened at any time point. CONCLUSIONS: There was no evidence of harm to depression or anxiety symptoms as a result of attending a group-based weight loss programme. There was a transient reduction in symptoms of depression, but not anxiety, compared to self-help. This effect equates to less than 1 point out of 21 on the Hospital Anxiety and Depression Scale and is not clinically significant.

Background: Guidelines recommend clinicians identify individuals at high cardiometabolic risk and support weight loss in those with overweight or obesity. However, individual level data quantifying the benefits of weight change for individuals, to guide these discussions in primary care, is lacking. Aim: Examine how weight change affects cardiometabolic risk factors, to facilitate shared decision-making between patients and clinicians regarding weight loss. Design and setting: Observational analysis using data from two trials of referral of individuals with overweight or obesity in primary care to community weight loss groups. Method: Linear mixed effects regression modelling, examining the association between weight change and change in systolic and diastolic blood pressure (SBP, DBP), fasting glucose, HbA1c, and lipid profile across multiple timepoints (baseline to 24 months). Subgroup analyses examined changes in individuals with hypertension, diabetes and hyperlipidaemia. Results: 2041 participants had a mean(±SD) age of 50 ±13.5 years, baseline weight 90.6 ±14.8kg and Body Mass Index 32.7 ±4.1kg/m2. Mean(±SD) weight change was -4.3 ±6.0kg. All outcome measures showed statistically significant improvements. Each 1kg weight loss was associated with 0.4mmHg reduction in SBP and 0.3mmHg reduction in DBP, or 0.5mmHg and 0.4mmHg/kg respectively in people with hypertension. Each 1kg weight loss was associated with 0.2mol/mol reduction in HbA1c, or 0.6mmol/mol in people with diabetes. Effects on plasma lipids were negligible. Conclusion: Weight loss achieved through referral to community weight loss programmes, which are commonly accessible in primary care, can lead to clinically relevant reductions in blood pressure and glucose regulation, especially in those at highest risk., EM was funded by an NIHR In‐Practice Fellowship and is currently funded by a Wellcome Trust Doctoral Research Fellowship. PA and SAJ are National Institute for Health Research (NIHR) Senior Investigators and funded by NIHR Oxford Applied Research Centre. PA, SAJ, and JO are supported in part by the NIHR Oxford Biomedical Research Centre (BRC). ALA is supported by the Medical Research Council (grant MC_UU_12015/4). The WRAP trial was funded by the National Prevention Research Initiative through research grant MR/J000493/1. The cost of the Weight Watchers programme and the costs of blood sampling and analysis were funded by Weight Watchers International as part of an MRC Industrial Collaboration Award.