Discussion
overweight, weight loss
The aim of our study was to determine the effectiveness of the 12-session, healthy lifestyle RUFIT-NZ program on weight loss, fitness, blood pressure, and lifestyle change at 12- and 52-weeks. Overall, our findings showed the program resulted in sustained changes in weight, waist circumference, physical fitness, self-reported physical activity, alcohol consumption, and HRQoL in overweight men. The RUFIT-NZ intervention, as assessed through cost per kg body weight loss and QALYs gained, was broadly comparable with other economic evaluations of weight loss interventions and was highly likely to be cost-effective at a willingness-to-pay threshold of $45,000 NZD per QALY [Strength and limitations: We conducted a pragmatic RCT based on extensive feasibility and pilot work [The major limitations of this trial were related to COVID-19 disruptions. A recent paper highlighted the effect of the COVID-19 pandemic and the need to acknowledge COVID–related changes to studies [The sustained weight loss (2.7 kg) at 52 weeks was slightly larger than observed in our RUFIT-NZ pilot study at 12-weeks [Given the considerable burden of overweight and obesity on Māori and Pasifika men, we aimed to recruit 50% Māori. While we did not reach this target, our study was successful in recruiting large numbers of both Māori and Pasifika men. Results from our present study highlight the potential for our RUFIT-NZ to be implemented at-scale to engage these populations and to support positive lifestyle changes in a culturally acceptable way. Findings from our pilot trial demonstrated NZ men found RUFIT-NZ was acceptable [