title: Successful weight management and health behaviour change using a health trainer model.
abstract: OBJECTIVE
  NHS Great Yarmouth and Waveney is an area of high deprivation and it is estimated that 49% of the adult population are overweight or obese. The health trainer model, which involves recruiting trainers from local communities, offers an innovative way of supporting individuals in managing their weight through one-to-one support. The aim of the current study was to evaluate the effectiveness of a health trainer-led intervention in terms of weight loss and behaviour change.
  
  
  METHODS
  Data were collected from all participants who visited a health trainer for the purpose of weight loss between February 2008 and March 2011. All participants were seen on a one-to-one basis, with the setting and length of the intervention varying according to individual requirements (median 21 weeks, IQR 12.4-29.6). Weight change was the primary outcome measure; secondary outcomes were blood pressure, fruit and vegetable intake and physical activity levels, measured using established health trainer data recording systems. Data on secondary outcomes were not available for all participants due to lack of compliance.
  
  
  RESULTS
  Using intention-to-treat analysis, average weight change was -2.5 kg (95% CI - 2.7 - -2.1, n = 541, p < .001) and weight gain was prevented in 90% of participants (n = 487). The number of participants classified as hypertensive reduced from 60% (n = 66) to 41% (n = 45) over the period of the intervention. In terms of behaviour change, fruit and vegetable intake increased significantly by 2.4 portions per day (95% CI 2.1-2.7, n = 248, p < .001) with 46% (n = 115) of participants increasing their intake to five portions per day. 68% of participants for whom data were available (n = 227) reported an increase in moderate physical activity, with time increasing by 59.3 minutes per week (95% CI 46.3-72.4, p < .001).
  
  
  CONCLUSIONS
  The health trainer service in Great Yarmouth and Waveney may be effective in helping participants to manage their weight and change their health-related behaviour. Although the degree of weight loss reported was moderate given the high levels of deprivation and the health needs of the local population, these were promising findings. To improve the current evidence base for the effectiveness of health trainer-led interventions, studies need to see if these findings are replicable in other population groups and in other settings.
authors.affiliation: Department of Nutrition, Norwich Medical School, University of East Anglia, Norwich UK.
authors.forename: Amy
authors.initials: A
authors.lastname: Jennings
authors.forename: Sarah
authors.initials: S
authors.lastname: Barnes
authors.forename: Uju
authors.initials: U
authors.lastname: Okereke
authors.forename: Ailsa
authors.initials: A
authors.lastname: Welch
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D001835:Body Weight; D003150:Community Health Workers / Q000458:organization & administration*; D004032:Diet; D015444:Exercise; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D012944:Social Support; D012959:Socioeconomic Factors; D015431:Weight Loss
keywords: behaviour change; diet and nutrition; health trainer; physical activity; weight management