Wednesday, 28 May 2014

NICE throwing away millions of our money

Firstly I am no expert in weight management but I can analyse evidence.  I just wanted to outline the foundations of sand upon which the recently released NICE guidance is based.  NICE has released guidance on the management of obesity and they have summarised the evidence here, or should I say lack of evidence.  Even NICE admits the evidence is poor:

"...the studies tended to be small and with methodological limitations, providing little information on intervention setting and evaluating a fairly restricted range of interventions. In most RCTs, the methods of randomisation, allocation to treatment group and blinding of outcome assessors were inadequate or not possible to assess due to poor reporting"

Then I started to have a look through the studies that NICE has cited.  A large systematic review has demonstrated that 'little evidence supports the efficacy of commercial and self help weight loss programmes'

The only study that has shown any benefit at all to a commercial weight loss programme has major major flaws.  This study lost almost a third of its patients to follow up, so it has no idea what happened to their weights and health.  The study also assumed that 'participants who made no follow-up visits were assumed to remain at baseline value', this is generous at best, and at worst it may well be the real reason for the trial showing a 3% weight reduction in the 71% of patients who did manage to complete their follow up.  The data also showed that maximal weight gain is achieved early on, with all patients tending to increase their weight beyond the 26 week time point. 

Essentially all the trial showed was that the more motivated people tended to keep a small amount of weight of a two years, and this was probably independent of the commercial weight loss programme, it could easily have been down to selection bias.  In fact if they had managed to follow up the 29% that were lost, it is arguable that they were the least motivated and would have probably gained significant amounts of weight by the 2 year time point.

I conclude that the NICE guidance is going to result in a huge waste of public money on commercial weight loss programmes that do nothing of any benefit to anyone but their own company bank balances.   NICE does not have the evidence to back up its guidance as I have outlined above.  In the absence of good evidence, we should not be gambling with millions of tax payer's pounds that could be more effectively spent elsewhere.  After all until the government addresses our obesity-prone environment with holistic policies in non-medical areas, then society will simply continue to get fatter and fatter, as NICE pisses our money into the wind.