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Beyond sanctions: a response to Sen et al.

Madigan et al. (unpublished results) responded to our evaluation of weight loss from three commercial providers, and proposed that it is more important to have a multiplicity of effective providers to broaden the reach and appeal of services rather than determining minor differences in effectiveness. They support the call for longer term follow-up but argue that research might be more usefully directed to increasing coverage and uptake by patients, rather than RCTs to characterize precise differences in effectiveness. We welcome Madigan et al.’s response and agree that research to determine longer term follow-up is a priority. Of the three areas where we called for research, the most important two are long-term weight loss and costeffectiveness. There may be value in providing a range of providers and this may be beneficial to accommodate preferences by socio-economic status, age or gender. However, commissioners of weight management services may have increased purchasing power when commissioning from one, rather than several, commercial providers. Therefore, research which provides differences in effectiveness, long-term weight loss and cost-effectiveness by providers would be beneficial to inform commissioners’ decisions.