West DS, Harvey JR, Krukowski RA, Prewitt TE, Priest J, Ashikaga T. Do individual, online motivational interviewing chat sessions enhance weight loss in a group-based, online weight control program? Obesity (Silver Spring). 2016;24(11):2334–2340. doi:10.1002/oby.21645

https://www.ncbi.nlm.nih.gov/pubmed/27616628

Type of article: Randomized Controlled Trial, 2016

Obesity (Silver Spring). 2016 Nov;24(11):2334-2340. doi: 10.1002/oby.21645. Epub 2016 Sep 12.

Do individual, online motivational interviewing chat sessions enhance weight loss in a group-based, online weight control program?

West DS1, Harvey JR2, Krukowski RA3, Prewitt TE4, Priest J5, Ashikaga T5.

Abstract

OBJECTIVE:

To examine whether the addition of online motivational interviewing (MI) chats to a Web-based, group behavioral obesity treatment program augments weight loss outcomes relative to the Web-based weight control program alone.

METHODS:

Healthy individuals (N = 398, 24% minority) with overweight/obesity were randomized to a 36-session group Internet behavioral weight control treatment (BT) or the same group Internet treatment plus six individual MI chat sessions (BT + MI). Both conditions received weekly synchronous online chat group sessions for 6 months followed by 12 monthly group chats. Participants in both groups received identical behavioral lessons and individualized therapist feedback on progress toward meeting exercise and calorie goals. BT + MI also received six individual MI sessions delivered by a separate MI counselor via Web chat. Weight loss was measured at 6 and 18 months.

RESULTS:

There were no significant differences in weight loss between BT (-5.5 ± 6.0 kg) and BT + MI (-5.1 ± 6.3 kg) at 6 months or at 18 months (-3.3 ± 7.1 kg vs. -3.5 ± 7.7 kg for BT and BT + MI, respectively). Attendance at group chats did not differ between groups, nor did self-monitoring patterns, suggesting comparable engagement in the weight control program in both conditions.

CONCLUSIONS:

Online MI chat sessions were not a viable strategy to enhance Web-based weight control treatment outcomes.

TRIAL REGISTRATION: ClinicalTrials.gov NCT01232699. © 2016 The Obesity Society.

PMID: 27616628 PMCID: PMC5093069 DOI: 10.1002/oby.21645

[Indexed for MEDLINE]

Teeriniemi A-, Salonurmi T, Jokelainen T, et al. A randomized clinical trial of the effectiveness of a web-based health behaviour change support system and group lifestyle counselling on body weight loss in overweight and obese subjects: 2-year outcomes. J Intern Med. 2018;284(5):534-545.

https://www.ncbi.nlm.nih.gov/pubmed/29974563

Type of article: Randomized Controlled Trial, 2018

J Intern Med. 2018 Nov;284(5):534-545. doi: 10.1111/joim.12802. Epub 2018 Jul 4.

A randomized clinical trial of the effectiveness of a Web-based health behaviour change support system and group lifestyle counselling on body weight loss in overweight and obese subjects: 2-year outcomes.

Teeriniemi AM1,2,3,4, Salonurmi T1,2,3, Jokelainen T5, Vähänikkilä H6, Alahäivälä T7, Karppinen P7, Enwald H3,8, Huotari ML3,8, Laitinen J9, Oinas-Kukkonen H7, Savolainen MJ1,2,3,5.

Abstract

BACKGROUND:

Weight loss can prevent and treat obesity-related diseases. However, lost weight is usually regained, returning to the initial or even higher levels in the long term. New counselling methods for maintaining lifestyle changes are urgently needed.

OBJECTIVES:

An information and communication technology-based health behaviour change support system (HBCSS) that utilizes persuasive design and methods of cognitive behavioural therapy (CBT) was developed with the aim of helping individuals to maintain body weight. The purpose of this study was to assess whether CBT-based group counselling combined with HBCSS or HBCSS alone helps to maintain improved lifestyle changes needed for weight loss compared to self-help guidance or usual care.

METHODS:

A randomized lifestyle intervention for overweight or obese persons (BMI 27-35 kg m-2 and age 20-60 years), recruited from the population registry in the city of Oulu, Finland, was conducted. This study comprised six randomly assigned study arms: CBT-based group counselling (eight sessions led by a nutritionist), self-help guidance-based group counselling (SHG; two sessions led by a nurse) and control, each with or without HCBSS, for 52 weeks. Subjects visited the study centre for anthropometric measurements, blood sample collection and to complete questionnaires at baseline, 12 and 24 months. The main outcome was weight change from baseline to 12 months and from baseline to 24 months.

RESULTS:

Of the 1065 volunteers screened for the study, 532 subjects (51% men) met the inclusion criteria and were enrolled. The retention rate was 80% at 12 months and 70% at 24 months. CBT-based counselling with HBCSS produced the largest weight reduction without any significant weight gain during follow-up. The mean weight change in this arm was 4.1% [95% confidence interval (CI), -5.4 to -2.8, P < 0.001) at 12 months and 3.4% (95% CI, -4.8 to -2.0, P < 0.001) at 24 months. HBCSS even without any group counselling reduced the mean weight by 1.6% (95% CI, -2.9 to -0.3, P = 0.015) at 24 months.

CONCLUSION:

The combination of CBT-based group counselling and HBCSS-based weight management is feasible for overweight or obese individuals. Moreover, HBCSS alone could be disseminated to the population at large as an effective means of treating obesity.

PMID: 29974563 DOI: 10.1111/joim.12802

[Indexed for MEDLINE]

Hutchesson MJ, Tan CY, Morgan P, Callister R, Collins C. Enhancement of Self-Monitoring in a Web-Based Weight Loss Program by Extra Individualized Feedback and Reminders: Randomized Trial. J Med Internet Res. 2016;18(4):e82. Published 2016 Apr 12. doi:10.2196/jmir.4100 https://www.ncbi.nlm.nih.gov/pubmed/27072817

Type of article: Randomized Controlled Trial, 2016

J Med Internet Res. 2016 Apr 12;18(4):e82. doi: 10.2196/jmir.4100.

Enhancement of Self-Monitoring in a Web-Based Weight Loss Program by Extra Individualized Feedback and Reminders: Randomized Trial.

Hutchesson MJ1, Tan CY, Morgan P, Callister R, Collins C.

Abstract

BACKGROUND:

Self-monitoring is an essential behavioral strategy for effective weight loss programs. Traditionally, self-monitoring has been achieved using paper-based records. However, technology is now more frequently used to deliver treatment programs to overweight and obese adults. Information technologies, such as the Internet and mobile phones, allow innovative intervention features to be incorporated into treatment that may facilitate greater adherence to self-monitoring processes, provide motivation for behavior change, and ultimately lead to greater weight loss success.

OBJECTIVE:

The objective of our study was to determine whether the consistency of self-monitoring differed between participants randomly assigned to a basic or an enhanced 12-week commercial Web-based weight loss program.

METHODS:

We randomly assigned a sample of 301 adults (mean age 42.3 years; body mass index 31.3 kg/m2; female 176/301, 58.5%) to the basic or enhanced group. The basic program included tools for self-monitoring (online food and exercise diary, and a weekly weigh-in log) with some feedback and reminders to weigh in (by text or email). The enhanced program included the basic components, as well as extra individualized feedback on self-monitoring entries and reminders (by text, email, or telephone) to engage with self-monitoring tools. We evaluated the level of self-monitoring by examining the consistency of self-monitoring of food, exercise, and weight during the 12 weeks. Consistency was defined as the number of weeks during which participants completed a criterion number of entries (ie, ≥3 days of online food or exercise diary records per week and ≥1 weigh-in per week).

RESULTS:

The enhanced group’s consistency of use of self-monitoring tools was significantly greater than that of the basic group throughout the 12 weeks (median consistency for food 8 vs 3 weeks, respectively, P<.001; for exercise 2.5 vs 1 weeks, respectively, P=.003).

CONCLUSIONS:

Enhanced features, including additional individualized feedback and reminders, are effective in enhancing self-monitoring behaviors in a Web-based weight loss program.

CLINICALTRIAL:

Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12610000197033; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=335159 (Archived by WebCite at http://www.webcitation.org/6gCQdj21G).

PMID: 27072817 PMCID: PMC4846785 DOI: 10.2196/jmir.4100

[Indexed for MEDLINE]

Friederichs SA, Oenema A, Bolman C, Lechner L. Long term effects of self-determination theory and motivational interviewing in a web-based physical activity intervention: randomized controlled trial. Int J Behav Nutr Phys Act. 2015;12:101. Published 2015 Aug 18. doi:10.1186/s12966-015-0262-9

https://www.ncbi.nlm.nih.gov/pubmed/26283094

Type of article: Randomized Controlled Trial, 2015

Int J Behav Nutr Phys Act. 2015 Aug 18;12:101. doi: 10.1186/s12966-015-0262-9.

Long term effects of self-determination theory and motivational interviewing in a web-based physical activity intervention: randomized controlled trial.

Friederichs SA1, Oenema A2, Bolman C3, Lechner L4.

Abstract

BACKGROUND:

Our main objective in the current study was to evaluate the long-term effectiveness (12 months from baseline) of I Move (a web-based computer tailored physical activity intervention, based on self-determination theory and motivational interviewing). To this end, we compared I Move to a web-based computer tailored physical activity intervention based on traditional health behavior theories (Active Plus), and to a no-intervention control group. As a secondary objective, the present study aimed to identify participant characteristics that moderate the long term effects of I Move and Active Plus.

METHODS:

A randomized controlled trial was conducted, comparing three research conditions: 1) the I Move condition, participants in this condition received I Move; 2) the Active Plus condition, participants in this condition received Active Plus; 3) the control condition; participants in this condition received no intervention and were placed on a waiting list. Main outcome measures were weekly minutes of moderate to vigorous physical activity and weekly days with minimal 30 min of physical activity. All measurements were taken by web-based questionnaires via the study website. Intervention effects were analyzed using multilevel linear regression analyses.

RESULTS:

At 12 months from baseline, I Move was found to be effective in increasing weekly minutes of moderate to vigorous physical activity (ES = .13), while Active Plus was not. In contrast, Active Plus was found to be effective in increasing weekly days with ≥ 30 min PA at 12 months (ES = .11), while I Move was not. No moderators of the effects of I Move were found.

CONCLUSIONS:

The results suggest that web-based computer tailored physical activity interventions might best include elements based on both self-determination theory/motivational interviewing and traditional health behavioral theories. To be more precise, it is arguable that the focus of the theoretical foundations, used in new web-based PA interventions should depend on the intended program outcome. In order to draw firm conclusions, however, more research on the effects of self-determination theory and motivational interviewing in web-based physical activity promotion is needed.

TRIAL REGISTRATION: Dutch Trial Register NTR4129.

PMID: 26283094 PMCID: PMC4538737 DOI: 10.1186/s12966-015-0262-9

[Indexed for MEDLINE]

Sherrington A, Newham JJ, Bell R, Adamson A, McColl E, Araujo-Soares V. Systematic review and meta-analysis of internet-delivered interventions providing personalized feedback for weight loss in overweight and obese adults. Obes Rev. 2016;17(6):541–551. doi:10.1111/obr.12396

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4999041/

Type of article: Systematic review and meta‐analysis, 2016

Obes Rev. 2016 Jun;17(6):541-51. doi: 10.1111/obr.12396. Epub 2016 Mar 7.

Systematic review and meta-analysis of internet-delivered interventions providing personalized feedback for weight loss in overweight and obese adults

Sherrington A1,2,3, Newham JJ1, Bell R1, Adamson A1,2,3, McColl E1,4, Araujo-Soares V1.

Abstract

BACKGROUND:

Obesity levels continue to rise annually. Face-to-face weight loss consultations have previously identified mixed effectiveness and face high demand with limited resources. Therefore, alternative interventions, such as internet-delivered interventions, warrant further investigation. The aim was to assess whether internet-delivered weight loss interventions providing personalized feedback were more effective for weight loss in overweight and obese adults in comparison with control groups receiving no personalized feedback.

METHOD:

Nine databases were searched, and 12 studies were identified that met all inclusion criteria.

RESULTS:

Meta-analysis, identified participants receiving personalized feedback via internet-delivered interventions, had 2.13 kg mean difference (SMD) greater weight loss (and BMI change, waist circumference change and 5% weight loss) in comparison with control groups providing no personalized feedback. This was also true for results at 3 and 6-month time points but not for studies where interventions lasted ≥12 months.

CONCLUSION:

This suggests that personalized feedback may be an important behaviour change technique (BCT) to incorporate within internet-delivered weight loss interventions. However, meta-analysis results revealed no differences between internet-delivered weight loss interventions with personalized feedback and control interventions ≥12 months. Further investigation into longer term internet-delivered interventions is required to examine how weight loss could be maintained. Future research examining which BCTs are most effective for internet-delivered weight loss interventions is suggested.

PMID: 26948257 PMCID: PMC4999041 DOI: 10.1111/obr.12396 [Indexed for MEDLINE]

Painter SL, Ahmed R, Kushner RF, et al. Expert Coaching in Weight Loss: Retrospective Analysis. J Med Internet Res. 2018;20(3):e92. Published 2018 Mar 13. doi:10.2196/jmir.9738

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871741/

Type of article: Retrospective Study, 2018

J Med Internet Res. 2018 Mar 13;20(3):e92. doi: 10.2196/jmir.9738.

Expert Coaching in Weight Loss: Retrospective Analysis.

Painter SL#1, Ahmed R#1, Kushner RF1, Hill JO1, Lindquist R1, Brunning S1, Margulies A1.

Abstract

BACKGROUND:

Providing coaches as part of a weight management program is a common practice to increase participant engagement and weight loss success. Understanding coach and participant interactions and how these interactions impact weight loss success needs to be further explored for coaching best practices.

OBJECTIVE:

The purpose of this study was to analyze the coach and participant interaction in a 6-month weight loss intervention administered by Retrofit, a personalized weight management and Web-based disease prevention solution. The study specifically examined the association between different methods of coach-participant interaction and weight loss and tried to understand the level of coaching impact on weight loss outcome.

METHODS:

A retrospective analysis was performed using 1432 participants enrolled from 2011 to 2016 in the Retrofit weight loss program. Participants were males and females aged 18 years or older with a baseline body mass index of ≥25 kg/m², who also provided at least one weight measurement beyond baseline. First, a detailed analysis of different coach-participant interaction was performed using both intent-to-treat and completer populations. Next, a multiple regression analysis was performed using all measures associated with coach-participant interactions involving expert coaching sessions, live weekly expert-led Web-based classes, and electronic messaging and feedback. Finally, 3 significant predictors (P<.001) were analyzed in depth to reveal the impact on weight loss outcome.

RESULTS:

Participants in the Retrofit weight loss program lost a mean 5.14% (SE 0.14) of their baseline weight, with 44% (SE 0.01) of participants losing at least 5% of their baseline weight. Multiple regression model (R2=.158, P<.001) identified the following top 3 measures as significant predictors of weight loss at 6 months: expert coaching session attendance (P<.001), live weekly Web-based class attendance (P<.001), and food log feedback days per week (P<.001). Attending 80% of expert coaching sessions, attending 60% of live weekly Web-based classes, and receiving a minimum of 1 food log feedback day per week were associated with clinically significant weight loss.

CONCLUSIONS:

Participant’s one-on-one expert coaching session attendance, live weekly expert-led interactive Web-based class attendance, and the number of food log feedback days per week from expert coach were significant predictors of weight loss in a 6-month intervention.

PMID: 29535082 PMCID: PMC5871741 DOI: 10.2196/jmir.9738

[Indexed for MEDLINE]

Group 1: n=199, 36 session of 18 months with online behavioral lifestyle program (BT)

Group 2: n=199, 36 session of 18 months with the same online group program plus six individual online motivational interviewing (MI) chat sessions (BT+MI).

– the online program focused on changing dietary and physical activity patterns by using self-management skills

– 1-hr online synchronous chat sessions with 12 to 19 participants were done by experienced behavioral weigh control counselors. The chat was done weekly for the first 6 months and monthly for the remaining 12 months giving a total of 36 chat sessions.

– Motivational interviewing (MI) chat session were a total of 6 individualized, private chat for about 30 minutes each, its content were tailored to each participant’s treatment commitment and weight changes. The first MI chat was done before the program started, the second chat was after week 5, and the next 5 chats were offered at 3 months intervals.

– Body weight changes: the study was designed to identify a 1.72kg group weight loss difference with SD of 5.2kg

-Sociodemographic characteristics – no significant differences

– Process data, which records participants attendance at online group chat, self-monitoring journal submissions, online adherence monitoring tools.

– A similar pattern was recorded at 18-months (3.5 kg for BT+MI vs 3.3 kg for BT).

– Adding MI chats to online program did not significantly boost weight loss

– the overall engagement in MI chat session was lower with online chat than face to face chat in previous studies

– Significantly more subjects from Vermont were randomized to the BT

– randomly assigned to 6 groups → 1) CBT-based group counselling,

2) CBT counselling with health behavior change support system (HBCSS),

3) group counselling (2 sessions) and self-help guidance (SHG counselling),

4) SHG counselling with HBCSS,

5) control (usual care like written information but no intervention),

6) HBCSS alone.

– n=85, 88, 87, 92, 89, 91= 532

– Study was completed in 2 years

– 8 CBT counseling of 90-min/session in groups of 8-9 participants

– 2 SHG counseling of 90-min/session face to face

– self-help guidance counselling

– web-based health behavior change

support system (HBCSS)

– success of weight loss

– blinding was not possible.

– commercial weight loss program with basic vs enhanced features for 12 weeks

– overweight and obese adults from New South Wales, Australia

– The basic program has tools for self-monitoring (online food and exercise diary, and a weekly weigh-in log) with some feedback and reminders to weigh in (by text or email).

– The enhanced program has

the basic components, and extra individualized feedback on self-monitoring entries and reminders (by text, email, or telephone) to engage with self-monitoring tools.

– study duration of 12 weeks.

– tools to enhance self monitoring

– Consistency of self-monitoring

– relationship between categories of self-monitoring consistency and weight loss

– the enhanced features had

the least impact on exercise entries

– the more use of self-monitoring tools, the greater weight loss

– evaluation of self-monitoring after 12 weeks was not done

– this study focused in only 1 behavioral strategy (self-monitoring) did not consider other tools like social support

1) the I Move condition, participants in this condition received I Move;

2) the Active Plus condition, participants in this condition

received Active Plus;

3) the control condition; participants in this condition received no intervention and were placed on a waiting list.

– outcome measured weekly

– All measurements were taken by web-based questionnaires via the study website.

– 12 months period

– the level of the physical activity

– based on motivational intervention to encourage more physical activity time

– using self-determination theory to encourage more physical activity time

– But Active Plus was found to be effective in increasing weekly days with ≥ 30 min physical activity at 12 months (ES = .11), while I Move was not. – No moderators of the effects of I Move were found.

– raffled prized to encourage completion of questionnaire can be a bias

– studies were from 2001 to 2012

– 7 studies were done in USA, 3 in Australia, 1 in the Netherlands, & 1 in UK

– The total number of participants was 3547

– all studies targeted changes to physical activity and diet

– the length of the study ranged from 3 to 24 months

– Internet weight loss interventions providing personalized feedback vs control groups receiving no personalized feedback

Feedback

– inability to isolate the influence of personalized feedback from other weight loss interventions.

– 3 studies provided monetary incentives, which may have biased the findings in terms of retention rates and thus outcome results

– 1432 participants enrolled from 2011 to 2016 in the Retrofit weight loss program.

– 1045 participants completed the study

– the program was designed with a 6-month weight loss phase with option to continue into maintenance program

– the program consisted of one-on-one expert coaching, with unlimited coach interactions through online messaging, lifestyle

patterns assessment, and personalized coaching content and plan. Expert coaches do weekly reviews of participants’ plan and self-monitoring data to offer personalized feedback.

Participants are encouraged to attend live weekly expert-led interactive online classes about exercise, nutrition, and mind-set. Digital tools, including a mobile app, Web-based dashboard, activity tracker, and Wi-Fi scale, are provided for tracking behaviors related to weight, food, mood, steps, and exercise.

– the program offered 7 one on one coaching sessions (via online video chat or mobile phone), and an initial 60 minutes session and 30 minutes follow up

– Participants were asked to weigh in, wear their activity tracker, log all food and drinks consumed, and communicate daily with their expert coach.

– weight changes at 6 months

– weight loss results at different levels of coach participant interaction

– weight loss changes compare to food log feedback per week

– greater weigh loss for those with a higher attendance with expert coaching session and other online classes.

– higher weight loss was noticed on those with higher interaction on the food log feedback

– predictors of weight loss were significant on attendance for the expert coach session, participation on the online classes and food log feedback days

– the study design does not provide any conclusions

based on the critical observations.

-Coach participant interaction was measured from a quantitative point of view.

– the study did not ask whether a participant

was actively using any other weight loss management program

outside of the Retrofit program