Effectiveness of web-based interventions in achieving weight loss and weight loss maintenance in overweight and obese adults: a systematic review with meta-analysis

Efficacy of eHealth interventions to reduce depression symptoms in individuals with obesity: a systematic review of randomized controlled trials

Introduction

Obesity and depression are inter-related health concerns, demanding a high level of treatment and costs in the health care system. The development of eHealth interventions that simultaneously address obesity and mental health can be supportive in this regard. However, evidence of the efficacy of eHealth interventions in the treatment of depression symptoms in individuals with obesity is lacking. The aim of this systematic literature review is to evaluate the efficacy of existing eHealth interventions for individuals with obesity that target depression symptoms.

Methods

We systematically searched electronic databases (Cochrane Library, PubMed, Scopus) to identify studies published in English between January 2016 and January 2023, that focused on eHealth interventions, targeting depression symptoms in individuals with obesity people. Exclusion criteria were study objectives that (1) focused specifically on one or more metabolic comorbidities of individuals with obesity, e.g., hypertension, hyperlipidemia, diabetes; (2) focused specifically on eating disorders comorbidities e.g., binge eating disorder, and (3) focused specifically on patients before or after bariatric surgery.

Results

The database search identified 214 records. Six articles were included in this review. Sample sizes ranged from 70 to 1267 participants of ages 18-60 years. All included studies were randomized controlled trials. Two of the six included studies were web-based interventions guided either by medical doctors or psychologists. All interventions included video, printed materials, and interactive parts of which two studies integrated elements of Cognitive Behavioural Therapy and Social Cognitive Therapy. The findings showed that eHealth treatment services, supported and guided throughout the intervention had high acceptance and efficacy in the reduction of depression symptoms among individuals with obesity.

Conclusion

EHealth interventions that address and target both mental and physical health with interactive strategies calls for better efficacy in the reduction of depression symptoms. Future eHealth interventions that target depression symptoms in individuals with obesity should integrate digital strategies that address both mental and physical health through interactive modules.

An e-mental health intervention to reduce depression symptoms in individuals with obesity: study protocol for the randomized, controlled, two-armed, confirmatory LightMood trial

BACKGROUND

Patients with obesity often experience psychological distress, specifically depression symptoms. Due to various barriers, such as limitations of healthcare offers, digital interventions, for example medical apps, can provide a suitable approach to support affected people. In the envisaged prospective randomized controlled trial, we aim to examine the efficacy of the LightMood intervention. The LightMood intervention is a manualized and user-centered, digital intervention for patients with obesity, with a duration of 4 months, which contains elements of cognitive behavioral therapy and mindfulness-based and skills-based exercises. We expect the LightMood intervention to be superior to treatment as usual (TAU) in terms of reducing depression symptoms.

METHODS

The trial incorporates four distinct measurement time points: the baseline assessment, the post-treatment assessment, and 1- and 3-month follow-up assessments. Furthermore, we implemented in-treatment assessments for both groups. Participants will be randomized into two groups (LightMood intervention vs TAU). The aim is to include 128 participants (64 per group) in the study. Inclusion criteria are patients who are obese, at least 18 years old, with a private Internet access, and with adequate digital literacy and show depression symptoms (PHQ ≥ 10). Exclusion criteria are weekly outpatient individual psychotherapy, obesity surgery within the last year or planned within the next 7 months, no private Internet access, and the prescription of a new psychotropic drug within the last 2 weeks. The primary outcome is the post-assessment reduction in depression symptoms. Secondary outcomes will include the improvement in self-efficacy, quality of life, mindfulness, reduction in eating disorder symptoms, and body mass index (BMI). Furthermore, we expect a positive development of depression symptoms throughout the different time points (T1, T2, and T3) in patients with obesity.

DISCUSSION

LightMood is an evidence-based, efficient, low-threshold online intervention that aims to reduce depression symptoms in people with obesity. Online interventions could offer a promising alternative to conventional face-to-face therapy. The primary objective of the current study is to add essential insight into the feasibility, efficacy, effectiveness, and acceptance of e-mental health interventions for people with obesity and depression symptoms.

TRIAL REGISTRATION

German Clinical Trial Register (DRKS), DRKS00029219. Registered on May 19, 2023.

Effectiveness of Different Online Intervention Modalities for Middle-Aged Adults with Overweight and Obesity: A 20-Year Systematic Review and Meta-analysis

The main objectives of this systematic review and meta-analysis study include evaluating the methodological quality of existing randomized controlled trials (RCTs) for weight loss and features of online intervention [OI]s in each trial, examining the associations between the methodological quality, intervention features and the effectiveness of OIs, and comparing the effectiveness of OIs and other intervention modalities through systematic review and meta-analysis. Systematic searches were conducted using PubMed, Cochrane Library, CINAHL, and PsycINFO in the past two decades (2000 through 2019). Inclusion criteria includes Online intervention (intervention modality), middle-aged adults with overweight or obesity, at least six months or longer study period, an RCT, and 70% plus retention rate. Risk of Bias was assessed using Miller et al. in (Hester, Miller (eds) Handbook of alcoholism treatment approaches: Effective alternatives (3rd ed.). Allyn & Bacon, Boston, 2003)'s Methodological Quality Rating Scale (MQRS) and GRADE. MOOSE guidelines was referred for data synthesis. In total, 29 OIs were evaluated using 10 criteria for methodological quality and eight criteria for intervention features. Results revealed that the mean methodological quality score of the RCTs was 12.1 (out of 16), and the mean intervention features score was 6.6 (out of 8). RCTs with higher scores were more effective in weight loss than those with lower scores. Results of meta-regression showed that methodological quality was more important than intervention features to increase the effectiveness. Results of meta-analysis showed that OIs were significantly more effective than controls. Compared to OIs only, OIs with interactions with others and professionals were more effective. The study limitation includes assessing 'effectiveness' based on weight only due to lack of other indicators to compare between studies; some results are self-reported; and feedback from intervention participants were hard to review. Nevertheless, this study may contribute to improving the effectiveness of existing OIs for weight loss considering methodological quality and better intervention features.

Implementation of a Scalable Online Weight Management Programme in Clinical Settings: Protocol for the PROPS 2.0 Programme (Partnerships for Reducing Overweight and Obesity with Patient-Centered Strategies 2.0)

INTRODUCTION

There is an urgent need for scalable strategies for treating overweight and obesity in clinical settings. PROPS 2.0 (Partnerships for Reducing Overweight and Obesity with Patient-Centered Strategies 2.0) aims to adapt and implement the combined intervention from the PROPS Study at scale, in a diverse cross-section of patients and providers.

METHODS AND ANALYSIS

We are implementing PROPS 2.0 across a variety of clinics at Brigham and Women's Hospital, targeting enrolment of 5000 patients. Providers can refer patients or patients can self-refer. Eligible patients must be ≥20 years old and have a body mass index (BMI) of ≥30 kg/m2 or a BMI of 25-29.9 kg/m2 plus another cardiovascular risk factor or obesity-related condition. After enrolment, patients register for the RestoreHealth online programme/app (HealthFleet Inc.) and participate for 12 months. Patients can engage with the programme and receive personalized feedback from a coach. Patient navigators help to enrol patients, enter updates in the electronic health record, and refer patients to additional resources. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework is guiding the evaluation.

ETHICS AND DISSEMINATION

The Mass General Brigham Human Research Committee approved this protocol. An implementation guide will be created and disseminated, to help other sites adopt the intervention in the future.

TRIAL REGISTRATION NUMBER

NCT0555925.

Tailor Made: A Pilot Virtual Weight Loss Intervention Individually Tailored for African American Men

This study tests the acceptability and feasibility of the first virtual weight loss study individually tailored for middle-aged African American men. Tailor Made is a 3-month randomized controlled pilot of a weight loss intervention that included 58 overweight or obese African American men (mean age of 50.4; SD = 7.9). Control group participants received a Fitbit activity tracker and Bluetooth-enabled scale and copies of the self-led Tailor Made curriculum. Intervention group participants received the same Fitbit, Bluetooth-enabled scale, and curriculum and also participated in weekly, 45-minute virtual small group, professional-led education sessions using the Tailor Made curriculum and received three SMS text messages weekly: (a) a message individually tailored on African American Manhood that links men's values, goals, and motivation to health-promoting behavior; (b) a goal-tracking message to monitor physical activity, healthier eating, and lifestyle changes; and (c) a reminder 24 hours before their session. Participation rates in weekly small group sessions, randomization, and attendance at the assessments suggest that Tailor Made was feasible and acceptable. Only among intervention group participants, we found a small and significant decrease in BMI between baseline and final. In addition, active minutes of physical activity decreased for the control group while active minutes for the intervention group remained steady throughout the intervention. In sum, we demonstrated that a virtual, individually tailored weight loss intervention is feasible and acceptable to African American men. Participants valued the convenience of a virtual intervention, but there were a number of ways we may be able to enhance the potential benefits of this approach.

The (cost) effectiveness of a very low-energy diet intervention with the use of eHealth in patients with type 2 diabetes and obesity: study protocol for a randomised controlled non-inferiority trial (E-diet trial)

BACKGROUND

Despite preventive measures, the number of people with type 2 diabetes and obesity is increasing. Obesity increases morbidity and mortality in people with type 2 diabetes, making weight loss a cornerstone of treatment. We previously developed a very low energy diet (VLED) intervention that effectively reduced weight in people with type 2 diabetes in the long term. However, this intervention requires considerable time and manpower, which reduces the number of people who can benefit from it. eHealth offers more efficient solutions but has proven to be less effective than face-to-face interventions. Therefore, we want to investigate whether a blended version of our VLED intervention (in which face-to-face contact is partly replaced by an eHealth (mobile) application (E-VLED)) would be more cost-effective than the current face-to-face intervention.

METHODS

We will conduct a randomised, controlled trial with non-inferiority design in patients with type 2 diabetes and obesity (BMI > 30 kg/m2), aged 18-75 years. The control group will receive the usual care VLED intervention, while the intervention group will receive the E-VLED intervention for 1 year, where face-to-face contact will be partly replaced by an eHealth (mobile) application. The main study endpoint is the difference in weight (% change) between the control and intervention group after 1 year, plus the difference between the total costs (euro) of the treatment in the control and intervention groups. The secondary aims are to investigate the effectiveness of the E-VLED diet intervention regarding cardiovascular risk factors, quality of life, patient satisfaction, compliance, and to study whether there is a difference in effectiveness in pre-specified subgroups. General linear models for repeated measurements will be applied for the statistical analysis of the data.

DISCUSSION

We hypothesise that the E-VLED intervention will be equally effective compared to the usual care VLED but lower in costs due to less time invested by the dietician. This will enable to help more people with type 2 diabetes and obesity to effectively lose weight and improve their health-related quality of life.

TRIAL REGISTRATION

Netherlands Trial Register, NL7832, registered on 26 June 2019.

The effectiveness of different aerobic exercises to improve pain intensity and disability in chronic low back pain patients: a systematic review

Background: Physical activity, including aerobic exercise, is highly recommended for chronic low back pain (CLBP) patients to improve pain intensity and functional disability. Objectives: To assess the effectiveness of different aerobic exercises to reduce pain intensity and functional disability in patients with CLBP. Methods: A computer-aided search was performed to find Randomised Controlled Trials (RCTs) that evaluated the effectiveness of different aerobic exercises in CLBP. Articles published between January 2007 to December 2020 were included in the review. Quality assessment using the PEDro scale, extraction of relevant information, and evaluation of outcomes were done by two reviewers independently. Results: A total of 17 studies were included that involved 1146 participants. Outcomes suggested that aerobic exercise combined with other interventions was more effective than aerobic exercise alone. Aerobic exercise with higher frequency (≥ 5 days/week) and longer duration (≥ 12 weeks) were effective to gain clinically significant (≥ 30%) improvements. Environment and using pedometer did not seem to influence the outcomes. Conclusions: Pain intensity and functional disability in CLBP patients can be minimized by prescribing aerobic exercise. However, to get better improvements, aerobic exercise should be done in combination with other interventions and at optimum frequency and duration. Further studies should emphasize examining the optimal doses and duration of different aerobic exercises.

A Systematic Review of eHealth Interventions to Promote Physical Activity in Adults with Obesity or Overweight

Use of information and communication technology to improve health, known as eHealth, is an emerging concept in healthcare that may present opportunities to promote physical activity in adults with obesity. The purpose of this research was to systematically review eHealth intervention studies to promote physical activity in adults with obesity. Five electronic databases were used. Two authors screened articles, assessed risk of bias, and extracted data independently. A qualitative data synthesis for summarizing the findings was performed using harvest plots. In the search, 2276 articles were identified, and 18 studies met all inclusion criteria. Study quality ranged from poor to good. The included studies varied in intervention technology (e.g., web-based), physical activity assessment (e.g., device-based), and control group (e.g., wait-list). Behavioral change techniques used in the included studies were consistent with some techniques (e.g., self-monitoring) known as effective in face-to-face interventions, but more efficiently employed in eHealth using information and communication technology. Overall, this systematic review showed that a web-based or physical activity monitor-based eHealth intervention had the potential to effectively promote physical activity in adults with obesity. Some recommendations for future eHealth interventions to promote physical activity in adults with obesity were provided (e.g., use of theory, accelerometers).

Study protocol for an online lifestyle modification education course for people living with multiple sclerosis: the multiple sclerosis online course (MSOC)

BACKGROUND

People living with multiple sclerosis (plwMS) seek access to information on evidence-based lifestyle-related risk factors associated with multiple sclerosis (MS). As the internet has made delivery of lifestyle information increasingly accessible and cost-effective, we designed the Multiple Sclerosis Online Course (MSOC) to deliver a multimodal lifestyle modification program for plwMS. Two MS online courses were developed: the intervention course based on lifestyle recommendations of the Overcoming Multiple Sclerosis (OMS) program and the standard-care course representing standard lifestyle recommendations from other MS websites. We examined for feasibility in a pilot randomised controlled trial (RCT), where satisfactory completion and accessibility were achieved across both study arms. From this success, a protocol for a larger RCT was developed to examine the effectiveness of MSOC in improving health-related quality of life (HRQoL) and other health outcomes in plwMS.

METHODS/DESIGN

This single-blinded RCT will recruit n = 1,054 plwMS. Participants in the intervention arm will receive access to a MSOC with seven modules providing evidence-based information on the OMS program. Participants in the control group will receive access to a MSOC of identical format, with seven modules providing general MS-related information and lifestyle recommendations sourced from popular MS websites, e.g. MS societies. Participants will complete questionnaires at baseline and at 6, 12, and 30 months after course completion. The primary endpoint is HRQoL, as measured by MSQOL-54 (both physical and mental health domains) at 12 months following course completion. Secondary outcomes are changes to depression, anxiety, fatigue, disability, and self-efficacy as measured by Hospital Anxiety and Depression Scale, Patient-Determined Disease Steps and University of Washington Self-Efficacy Scale, respectively, assessed at each timepoint. Further assessments will include quantitative post-course evaluation, adoption and maintenance of behaviour change from follow-up survey data, and qualitative analysis of participants' outcomes and reasons for course completion or non-completion.

DISCUSSION

This RCT aims to determine whether an online intervention course delivering evidence-based lifestyle modification recommendations based on the Overcoming Multiple Sclerosis program to plwMS is more effective at improving HRQoL, and other health outcomes post-intervention, compared with an online standard-care course.

TRIAL REGISTRATION

This trial was registered prospectively with the Australian New Zealand Clinical Trials Registry, www.anzctr.org.au , identifier ACTRN12621001605886.

DATE OF REGISTRATION

25 November 2021.

Using patient-reported outcome measures to assess the effectiveness of social media networking programs for people living with overweight and obesity to adopt a healthier lifestyle

Introduction

Overweight, obesity, and their associated health complications have become a major public health issue. Online approaches have been rarely attempted to address the problem. The aim of this study was to evaluate the effectiveness of using social media networking for people living with overweight and obesity to adopt a healthier lifestyle with a three-month multidisciplinary healthcare program. Effectiveness was assessed through questionnaires on patient-related outcome measures (PROMs).

Materials and methods

Two non-profit associations designed the program delivered to people living with overweight and obesity in a closed group via Facebook, the popular social network. The three-month program had three main axes, namely nutrition, psychology, and physical activity. Anthropomorphic data and sociodemographic profiles were collected. Quality of life (QoL) was assessed at the beginning and at the end of the intervention using PROM questionnaires for six different domains, i.e., body image, eating behavior, physical, sexual, social, and psychological functioning.

Results

Six hundred and twenty persons participated in the program; 567 persons consented for the study, and 145 completed the questionnaires entirely. QoL was significantly improved in five out of six domains, i.e., body image, eating behavior, as well as physical, sexual, and psychological functioning. The improvement was valid regardless of age, gender, initial body mass index, person with or without children, educational level (primary versus secondary versus high school), and occupation (employment compared to unemployment or any kind of social assistance). In multivariate analysis, living as a couple was an independent factor correlated to a positive progression in four domains, i.e., body image, eating behavior, as well as physical, and psychological functioning.

Conclusion

This study showed that an online lifestyle intervention might be a promising way of improving the quality of life of people living with overweight or obesity.

Effectiveness of eHealth weight management interventions in overweight and obese adults from low socioeconomic groups: a systematic review

Background

Low socioeconomic status (SES) is associated with increased rates of overweight and obesity. Proponents of electronic health (eHealth) hypothesise that its inclusion in weight management interventions can improve efficacy by mitigating typical barriers associated with low SES.

Objectives

To establish the scope of eHealth weight management interventions for people with overweight and obesity from a low SES. Secondary objectives were to determine the efficacy of eHealth interventions in facilitating weight loss, physical activity and fitness improvements.

Methods

Four databases and grey literature were systematically searched to identify eligible studies published in English from inception to May 2021. Studies examining an eHealth intervention with low SES participants were included. Outcomes included temporal change in weight and BMI, anthropometry, physiological measures and physical activity levels. The number and heterogeneity of studies precluded any meta-analyses; thus, a narrative review was undertaken.

Results

Four experimental studies with low risk of bias were reviewed. There was variance in how SES was defined. Study aims and eHealth media also varied and included reducing/maintaining weight or increasing physical activity using interactive websites or voice responses, periodic communication and discourse via telephone, social media, text messaging or eNewsletters. Irrespectively, all studies reported short-term weight loss. eHealth interventions also increased short-term physical activity levels where it was assessed, but did not change anthropometry or physiological measures. None reported any effect on physical fitness.

Conclusions

This review revealed short-term effects of eHealth interventions on weight loss and increased physical activity levels for low SES participants. Evidence was limited to a small number of studies, with small to moderate sample sizes. Inter-study comparison is challenging because of considerable variability. Future work should prioritise how to utilise eHealth in the longer term either as a supportive public health measure or by determining its long-term efficacy in engendering volitional health behaviour changes.

Systematic review registration

PROSPERO CRD42021243973

Supplementary Information

The online version contains supplementary material available at 10.1186/s13643-023-02207-3.

Trend Impact Analysis (TIA) of community-based futures study for pediatric obesity in Iran

BACKGROUND

Childhood obesity has been regarded as one of the main healthcare challenges in the last century, leading to critical health problems and reduced life expectancy. Many factors can play a role in its development or prevention. Using the Trend Impact Analysis (TIA), this study aimed to conduct a community-based futures study for pediatric obesity in Iran.

METHODS

We obtained the prevalence of overweight and obesity from the database of the Ministry of Health and Medical Education. Moreover, we reviewed 21 documents, texts, and comments from three key stakeholders in Iran and prepared a list of key experts, who were stakeholders in the field of obesity prevention of childhood in different organizations. Then, we collected the expert opinions by Delphi method. Data analysis was performed using the Excel and R software.

RESULTS

Fourteen experts participated in the first stage and nine experts in the second stage. We identified two positive drivers, including the prevalence of coronavirus disease 2019 (COVID-19) and the widespread expansion of online educational programs. Meanwhile, we identified five negative drivers as follows: (1) controlling and limiting obesogenic environments in the community, school, and family; (2) running annual compulsory anthropometry programs for students of all educational levels in health centers; (3) integrating nutrition education interventions in the curricula of all educational levels; (4) taxation of unhealthy and fast foods; and (5) preparing safe and appropriate sports environments for children and adolescents (on the streets, schools, parks, and sports clubs). Without considering the drivers, the prevalence of overweight and obesity is predicted to reach 29.10% in 2031. However, it is expected that the negative drivers can increase the prevalence trend from 23.40% in 2018 to 19.57% in 2031, the positive drivers to 32.61%, and the combination of all drivers to 23.07%.

CONCLUSION

It seems that measures such as the effective communication of policy makers, basic evaluation of the programs and policies related to the prevention of childhood obesity, and localization of the programs of international organizations for the prevention of obesity can greatly control the prevalence of childhood obesity.

Comparison of an online versus conventional multidisciplinary collaborative weight loss programme in type 2 diabetes mellitus: A randomized controlled trial

AIM

The aim of this study was to examine the effect of an online multidisciplinary weight loss management programme.

METHODS

Between July 2016 and July 2017 this randomized controlled trial recruited patients in Nanjing, China who were living with type 2 diabetes mellitus and who were obese or overweight and randomized them to online versus conventional groups. All participants were managed by a multidisciplinary team. The experimental group was managed using the Why Wait WeChat Platform for Weight Reduction Management.

RESULTS

There were 55 and 52 participants in the online and conventional groups, respectively. The decreases in fasting blood glucose (-4.26 vs. -2.99 mmol/L), 2-h postprandial blood glucose (-4.48 vs. -2.68 mmol/L) and glycated haemoglobin (-22.11 vs. -6.21 mmol/mol) were more pronounced in the online compared to conventional group (all P < 0.05). After the intervention, self-management ability parameters, including diet control, foot care and total score, were improved in the online group compared with the conventional group, as well as all indexes of quality of life (all P < 0.05).

CONCLUSION

The online multidisciplinary weight loss management programme improved blood glucose in obese or overweight patients living with type 2 diabetes mellitus. Self-management ability parameters (including diet control, foot care and total score) and quality of life were improved in the online group compared with the conventional group.

Effectiveness and Components of Web-Based Interventions on Weight Changes in Adults Who Were Overweight and Obese: A Systematic Review with Meta-Analyses

Overweight and obesity have reached epidemic proportions worldwide. The COVID-19 pandemic resulted in an increased need for remote implementation of weight-loss interventions; therefore, the effectiveness of web-based interventions needed to be assessed. This study aimed to examine the effectiveness of web-based interventions and their potency in facilitating weight changes in adults who were overweight or obese. We searched PubMed and Ichu-shi Web from the first year of inclusion in each database until the search date (30 September 2020). Among 1466 articles retrieved from the two databases and manual search, 97 were selected to undergo qualitative analysis and 51 articles were subjected to quantitative analysis. Qualitative analysis of 97 articles demonstrated that articles showing significant effectiveness mostly used the following components: social support, self-monitoring for behavior, self-monitoring for the outcome (weight), behavioral goal setting, information about health consequences, and outcome goal setting. Quantitative analysis of 51 articles showed a significant effectiveness of web-based intervention (standardized mean difference, -0.57; 95% confidence interval, -0.75 to -0.40). This study demonstrated the effectiveness of web-based interventions on weight change in adults with overweight and obesity. Subgroup meta-analyses identified personalized information provision and expert advice to be remarkably effective components.

Primary care patients' and providers' perspectives about an online weight management program integrated with population health management: Post-intervention qualitative results from the PROPS study

Objective

To assess patients' and providers' attitudes about the online weight management program and population health management approach in the PROPS Study, which examined the effectiveness of these strategies in primary care.

Methods

We conducted semi-structured interviews with 22 patients and nine providers. Using thematic analysis, we analyzed transcripts of the interviews to identify key themes.

Results

Most patients found the online program to be well-structured and easy to use, although a few noted that the information was overwhelming or could be more personalized. Patients mentioned that the support from the population health managers was critical for their success, and several reported that they would have liked more involvement from their primary care provider or a dietitian. Providers also were satisfied with the interventions, and several stated that the population health management support was helpful because it added accountability. Providers suggested that the interventions could be improved by tailoring the information and integrating the online program with the electronic health record.

Conclusion

Most patients and providers were satisfied with the interventions, with several recommendations for improvements.

Innovation

These findings give additional information about patients' and providers' experience with this innovative approach for managing overweight and obesity in primary care.

Primary and secondary cardiovascular disease prevention interventions targeting lifestyle risk factors in women: A systematic review and meta-analysis

BACKGROUND AND AIMS

Over seven million women die from cardiovascular disease (CVD) annually. While lifestyle modification is recommended for CVD prevention, there are no systematic reviews evaluating the effectiveness of interventions targeted to women. The primary aim of this systematic review is to determine the efficacy of primary and secondary CVD prevention interventions targeting lifestyle risk factors in women.

METHODS

Six electronic databases were searched up to January 2022. Eligible studies included randomized controlled trials of primary or secondary CVD prevention interventions targeting CVD lifestyle risk factors (diet, physical activity, sedentary behavior, smoking, alcohol, sleep, and weight management) in women (≥18 years) that reported CVD risk markers or lifestyle risk factors. Meta-analyses were conducted on CVD risk markers and body mass index (BMI), and the level of evidence was applied to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria and reported.

RESULTS

Thirty-five RCTs were included (24 primary and 11 secondary prevention). Meta-analyses demonstrated that lifestyle CVD prevention interventions achieved statistically significant reductions in BMI at ≤ 6 months (0.95 kg/m2, 95% CI = 0.54 to 1.35, p < 0.0001), 12 months (0.61 kg/m2, 95% CI = 0.07 to 1.16, p = 0.03) and >12 months (0.58 kg/m2, 95% CI = 0.01 to 1.16, p = 0.05), and systolic blood pressure (mmHg) at ≤ 6 months (3.51, p < 0.001).

CONCLUSIONS

Lifestyle interventions are important for the prevention of CVD in women, specifically to reduce systolic blood pressure in the short term (≤ 6 months) and BMI long term (>12 months).

SYSTEMATIC REVIEW REGISTRATION

https://osf.io/bkwqm, identifier: osf-registrations-bkwqm-v1.

A Tailored Gender-Sensitive mHealth Weight Loss Intervention (I-GENDO): Development and Process Evaluation

BACKGROUND

Given the increase in the prevalence of overweight and obesity worldwide, the number of digital weight loss interventions has also risen. However, these interventions often lack theoretical background and data on long-term effectiveness. The consideration of individual and gender differences in weight-related psychological parameters might enhance the efficacy and sustainability of mobile-based weight loss interventions.

OBJECTIVE

This paper presented an introduction to and the process evaluation of a 12-week gender-sensitive mobile health (mHealth) weight loss intervention (I-GENDO) combining computer-based and self-tailoring features.

METHODS

Between August 2020 and August 2021, individuals with overweight (BMI 25.0-29.9 kg/m²), those with obesity class I (BMI 30.0-34.9 kg/m²), and those with obesity class II (BMI 35.0-39.9 kg/m²) were recruited to the I-GENDO project, a multicenter study in Germany. The mHealth intervention aimed at targeting individual psychological factors associated with the development and persistence of overweight and obesity (eg, emotional eating) using computer-based tailoring. Moreover, the intervention took a gender-sensitive approach by implementing self-tailoring of gender-targeted module versions. The computer-based assignment of the main modules, self-selection of gender-targeted module versions, and use patterns were evaluated while considering gender. Moreover, gender differences in the usability assessment were analyzed.

RESULTS

Data from the intervention arm of the study were processed. A total of 116 individuals with overweight and obesity (77/116, 66.4% women; age mean 47.28, SD 11.66 years; BMI mean 33.58, SD 3.79 kg/m2) were included in the analyses. Overall, the compliance (90/109, 82.6%) and satisfaction with the app (mean 86% approval) were high and comparable with those of other mobile weight loss interventions. The usability of the intervention was rated with 71% (5.0/7.0 points) satisfaction. More women obtained the main module that focused on emotion regulation skills. Most men and women selected women-targeted versions of the main modules. Women used the app more frequently and longer than men. However, women and men did not differ in the progress of use patterns throughout the intervention.

CONCLUSIONS

We developed a tailored gender-sensitive mHealth weight loss intervention. The usability of and engagement with the intervention were satisfactory, and the overall satisfaction with the intervention was also high. Gender differences must be considered in the evaluation of the effectiveness and sustainability of the intervention.

Agreement Between Clinically Measured Weight and Self-reported Weight Among Patients With Type 2 Diabetes Through an mHealth Lifestyle Coaching Program in Denmark: Secondary Analysis of a Randomized Controlled Trial

Background

Digital health interventions are increasingly used to handle and promote positive health behaviors. Clinical measures are often used, and a certain precision is essential for digital health interventions to have an effect. Only few studies have compared clinically measured weights with self-reported weights. No study has examined the validity of self-reported weight from a mobile app used in a tailored weight loss intervention.

Objective

The aim of this study was to analyze the agreement between clinically measured weight and self-reported weight collected from a mobile health lifestyle coaching program during a 12-month weight loss intervention for obese patients with and without type 2 diabetes. The secondary aim was to investigate the determinants for possible discrepancies between clinically measured and self-reported weights of these patients with different demographic and lifestyle characteristics and achievements of weight loss goals.

Methods

Weight registrations were collected from participants (N=104) in a Danish randomized controlled trial examining the effect of a digital lifestyle intervention on weight loss among obese patients with and without type 2 diabetes. Data were collected at baseline and after 6 and 12 months. Self-reported weight was measured at home and registered in the app.

Results

Self-reported body weight was lower than the weight measured in the clinic after 6 months by 1.03 kg (95% CI 1.01-1.05; P<.001) and after 12 months also by 1.03 kg (95% CI 0.99-1.04; P<.001). After 6 months, baseline weight and BMI were associated with a discrepancy of 0.03 kg (95% CI 0.01-0.04; P=.01) and 0.09 kg (95% CI 0.02-0.17; P=.02) per increment of 1 kg and 1 kg/m2, respectively, between clinically measured weight and self-reported weight. Weight change during the first 6 months was also associated with a difference of 0.1 kg (95% CI 0.04-0.01; P<.001) per kilogram of difference in weight between clinically measured weight and self-reported weight. Participants who did not achieve the 5% weight loss goal underestimated their weight by 0.79 kg (95% CI 0.34-1.23) at 6 months. After 12 months, only baseline weight was associated with a discrepancy of 0.03 kg (95% CI 0.01-0.05; P=.02) per increment of kilogram between clinically measured weight and self-reported weight. None of the other factors showed any significant discrepancy after 12 months.

Conclusions

Self-reported weight obtained from mobile health is a valid method for collecting anthropometric measurements.

Trial Registration

ClinicalTrials.gov NCT03788915; https://clinicaltrials.gov/ct2/show/NCT03788915

Systematic review of electronically delivered behavioral obesity prevention interventions targeting men

Globally, obesity persists at epidemic rates. Men are underrepresented within behavior-based obesity prevention research. As men prefer individualized, self-guided interventions, electronic delivery of treatment modalities has potential to reach this population. The purpose of this study was to systematically review primary, secondary, or tertiary behavioral obesity prevention interventions that used controlled designs; targeted men; and incorporated at least one electronically delivered treatment modality explicitly designed to elicit an intervention effect. Literature searches were delimited to peer-reviewed articles; published between 2000 and 2021; in the English language; and indexed in PsycINFO, CINHAL, MEDLINE, CENTRAL, and WOS electronic databases. Interventions satisfying inclusion criteria were critiqued for methodological quality using the Jadad Scale (0 = lowest quality; 10 = highest quality). Eleven studies satisfied the inclusion criteria (n = 1748; total participants) with five reporting group-by-time intervention effects on the primary variable targeted. Jadad scale quality assessment scores ranged from 5.00 to 9.00 with a mean of 7.72. Majority of the interventions applied a randomized control trial design (n = 10). Most interventions were theory based, with eight rooted in social cognitive theory. Behavior change strategies included self-monitoring (n = 10), personalized feedback (n = 8), health counseling (n = 8), and goal setting (n = 9). Community-level theories have the potential to guide future obesity prevention interventions targeting men.

A 2.5-Year Weight Management Program Using Noom Health: Protocol for a Randomized Controlled Trial

BACKGROUND

Overweight and obesity are serious public health concerns. As the prevalence of excess weight among individuals continues to increase, there is a parallel need for inexpensive, highly accessible, and evidence-based weight loss programs.

OBJECTIVE

This weight loss trial will aim to examine the efficacy of the Noom weight loss program in comparison to a digital control after a 6-month intervention phase and a 24-month maintenance phase, with assessments continuing for 2 years beyond the intervention (to 30 months-after the baseline). The secondary outcomes include quality of life, psychosocial functioning, sleep quality, physical activity, diet, and health status. This trial will also examine the severity of obesity-related functional impairment, weight loss history, and demographic moderators, along with adherence and self-efficacy as mediators of the outcome.

METHODS

A total of 600 participants were randomized in a parallel-group, controlled trial to either Noom Healthy Weight Program (intervention) or Noom Healthy Weight Control (control) for a 6-month intervention. Both intervention and control groups include diet and exercise recommendations, educational content, daily logging capabilities, and daily weigh-in entries. The Noom Healthy Weight Program also includes a coach support for weight loss. Remote follow-up assessments of eating, physical activity, psychosocial factors, app use data, and weight will be conducted at 1, 4, 6, 12, 18, 24, and 30 months after baseline. Weight is measured at each follow-up point during a Zoom call using the participants' scales.

RESULTS

Enrollment began in March 2021 and the 6-month intervention phase ended in March 2022. Data collection for the final assessment will be completed in March 2024.

CONCLUSIONS

This study tests commercially available digital lifestyle interventions for individuals with overweight and obesity seeking weight loss support. Data obtained from the study will evaluate whether the Noom Healthy Weight Control Program can help individuals overcome weight loss, achieve long-term maintenance, adhere to lifestyle changes, and feature use barriers that are present in other traditional weight loss treatments.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04797169; https://clinicaltrials.gov/ct2/show/NCT04797169.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/37541.

Effects of a 12-Week Web-Based Weight Loss Program for Adults With Overweight and Obesity on COVIDAge and Lifestyle-Related Cardiometabolic Risk Factors: A Randomized Controlled Trial

The coronavirus disease 2019 (COVID-19) pandemic has induced unhealthy lifestyles, particularly an increase in overweight and obesity, which have been shown to be associated with an increased risk of unfavorable COVID-19 outcomes. Web-based health programs could be a helpful measure, especially in times of severe restrictions. Therefore, the present study aimed to investigate the effects of regular attendance in a 12-week web-based weight loss program on COVIDAge, a new construct for risk assessment of COVID-19, and lifestyle-related cardiometabolic risk factors. N = 92 subjects with overweight and obesity (50.0 ± 10.8 years, 76.1% females, 30.5 ± 2.1 kg/m²) of this randomized controlled trial, which were assigned to an interactive (ONLINE: intervention group) or non-interactive (CON: control group) web-based weight loss program, were included in the data analysis. COVIDAge and cardiometabolic risk factors, including anthropometric outcomes, blood pressure, flow-mediated dilatation, and blood parameters, were assessed before and after the 12-week intervention phase. There was a significant group difference in the change of COVIDAge (ONLINE: −4.2%, CON: −1.3%, p = 0.037). The ONLINE group also showed significantly greater reductions in anthropometric outcomes and systolic blood pressure than the CON group (p < 0.05). To the authors' knowledge, this was the first study investigating the effects of regular attendance in a web-based health program on lifestyle-related risk factors for COVID-19. The results demonstrated that adults with overweight and obesity can improve their COVIDAge and specific cardiometabolic risk factors by using this interactive web-based weight loss program regularly. However, this needs to be confirmed by future studies. This study is registered at the German Clinical Trials Register (DRKS00020249, https://www.drks.de).

Weight Loss Trajectories in Healthy Weight Coaching: Cohort Study

Background

As global obesity prevalence continues to increase, there is a need for accessible and affordable weight management interventions, such as web-based programs.

Objective

This paper aims to assess the outcomes of healthy weight coaching (HWC), a web-based obesity management program integrated into standard Finnish clinical care.

Methods

HWC is an ongoing, structured digital 12-month program based on acceptance and commitment therapy. It includes weekly training sessions focused on lifestyle, general health, and psychological factors. Participants received remote one-on-one support from a personal coach. In this real-life, single-arm, prospective cohort study, we examined the total weight loss, weight loss profiles, and variables associated with weight loss success and program retention in 1189 adults (963 women) with a BMI >25 kg/m² among participants of the program between October 2016 and March 2019. Absolute (kg) and relative (%) weight loss from the baseline were the primary outcomes. We also examined the weight loss profiles, clustered based on the dynamic time-warping distance, and the possible variables associated with greater weight loss success and program retention. We compared different groups using the Mann-Whitney test or Kruskal-Wallis test for continuous variables and the chi-squared test for categorical variables. We analyzed changes in medication using the McNemar test.

Results

Among those having reached the 12-month time point (n=173), the mean weight loss was 4.6% (SE 0.5%), with 43% (n=75) achieving clinically relevant weight loss (≥5%). Baseline BMI ≥40 kg/m² was associated with a greater weight loss than a lower BMI (mean 6.6%, SE 0.9%, vs mean 3.2%, SE 0.6%; P=.02). In addition, more frequent weight reporting was associated with greater weight loss. No significant differences in weight loss were observed according to sex, age, baseline disease, or medication use. The total dropout rate was 29.1%. Dropouts were slightly younger than continuers (47.2, SE 0.6 years vs 49.2, SE 0.4 years; P=.01) and reported their weight less frequently (3.0, SE 0.1 entries per month vs 3.3, SE 0.1 entries per month; P<.001).

Conclusions

A comprehensive web-based program such as HWC is a potential addition to the repertoire of obesity management in a clinical setting. Heavier patients lost more weight, but weight loss success was otherwise independent of baseline characteristics.

A pilot randomized trial of simplified versus standard calorie dietary self-monitoring in a mobile weight loss intervention

OBJECTIVE

This study tested the efficacy of a lower-burden, simplified dietary self-monitoring approach compared with a standard calorie monitoring approach for self-monitoring adherence and weight loss in a mobile-delivered behavioral weight loss intervention.

METHODS

Participants (n = 72) with overweight or obesity who had children 2 to 12 years of age living in the home were randomly assigned to a group that used simplified dietary self-monitoring of high-calorie foods (Simplified) or a group that tracked calories (Standard). Both groups received a wireless scale, Fitbit trackers, and a 6-month intervention delivered via a smartphone application with lessons, text messages, and weekly personalized feedback messages.

RESULTS

Percentage weight loss at 6 months was 5.7% (95% CI: -8.3% to -3.2%) in the Standard group and 4.0% (95% CI: -5.7% to -2.3%) in the Simplified group, which was not significantly different. Similar proportions reached 5% weight loss at 6 months (43.2% in Standard and 42.9% in Simplified). There were no differences in number of dietary tracking days or change in average daily caloric intake between groups.

CONCLUSIONS

Two mobile-delivered weight loss interventions produced clinically meaningful levels of weight loss at 6 months, with no differences in dietary tracking adherence or dietary intake. The results suggest that simplified monitoring of high-calorie foods could be a promising alternative to calorie monitoring.

The active ingredients of physical activity and / or dietary workplace-based interventions to achieve weight loss in overweight and obese healthcare staff: a systematic review

This systematic review aims to synthesize the active ingredients, and identify a list of promising behaviour change techniques (BCTs), likely to be present within physical activity and / or dietary interventions in achieving weight loss in overweight and obese healthcare staff. Four electronic databases were searched in February 2021: PsychINFO, CINAHL, PubMed and MEDLINE (no start date-2021). Studies were eligible for inclusion if they: (1) described a quasi-experimental or cluster, cohort or randomised control trial; (2) implemented workplace-based physical activity and / or dietary interventions versus a less intensive intervention or usual care; (3) targeted predominantly (> 50% of participants) overweight or obese healthcare professionals; and (4) reported a weight loss related outcome and included data on that outcome at least 3 months after the intervention began. Three reviewers used the Behaviour Change Technique Taxonomy v1 to extract BCTs with the aim of identifying a list of "promising" BCTs, which were those that were present in interventions that reported a statistically significant difference in weight loss. Nine studies were included in the review. The majority (n = 7) reported a significant reduction in weight post-intervention. A combined physical activity and dietary intervention (n = 8) was the most common type of intervention. Twenty-five BCTs were identified as "promising". Instruction on how to perform the behaviour (n = 9), behaviour practice/rehearsal (n = 8) and self-monitoring of behaviour (n = 6) were the most promising BCTs. The contents of behaviour change interventions are complex and rely on accurate reporting of intervention components and BCTs to allow concrete and robust assumptions to be made regarding which factors are most effective at achieving a desired outcome. Fundamentally the lack of research exploring the effectiveness of physical activity and dietary interventions on weight loss in overweight and obese healthcare staff and the poor quality of existing research, warrant more investigation.

The effectiveness of e-health interventions for the treatment of overweight or obesity in children and adolescents: A systematic review and meta-analysis

The aim of this systematic review and meta-analysis was to examine the effectiveness of e-health interventions for the treatment of children and adolescents with overweight or obesity. Databases were searched up to November 2020. Studies were randomized controlled trials where interventions were delivered via e-health (e.g., computers, tablets, and smartphones, but not phone calls). Studies should target the treatment of overweight or obesity in children or their agent of changes and report body mass index (BMI) or BMI z-score. A meta-analysis using a random-effects model was conducted. Nineteen studies met the inclusion criteria, and 60% were of high quality. The narrative review revealed variation in behavior change strategies and modes of delivery. The pooled mean reduction in BMI or BMI z-score showed evidence for a nonzero effect (standardized mean difference = -0.31, 95% confidence interval -0.49 to -0.13), with moderately high heterogeneity between studies (I²  = 74%, p < 0.001). Subgroup analysis revealed high heterogeneity in studies with a high or unclear risk of bias. E-health interventions can be effective in treating children and adolescents with overweight and obesity and should be considered by practitioners and policymakers. However, an understanding of the most effective and acceptable intervention components, long-term benefits, and sustainability should be further studied.

Gamified Challenges in Online Weight-Loss Communities

Gamified challenges, one of the most popular features of online weight-loss communities, enable users to set weight-loss goals and compete with other challenge participants via leaderboards. Using the data from a leading online weight-loss community, we study the effect of gamified challenges on the weight-loss outcome. Our findings indicate that participation in gamified challenges has a positive and significant effect on weight loss. We found that, on average, the participants achieved a weight loss of 0.742 kg by participating in at least one challenge a month. We found that effective challenges do not include a numeric weight goal (e.g., lose 5 kg), focus on exercise-only behavioral goals, and have a large active group size. Further, the results show that the absence (presence) of a numeric weight goal benefits users in exercise (diet) challenges. Moreover, a small active group size can help (hurt) users in exercise (diet) challenges. Our results suggest that gamification elements that induce competition should be used with caution in goal-setting environments, especially when gamifying dietary goals. Online weight-loss communities can recommend a useful combination of numeric weight goals, behavioral goals, and an optimal number of participants in each challenge to induce an encouraging level of social comparison.

eHealth interventions targeting nutrition, physical activity, sedentary behavior, or obesity in adults: A scoping review of systematic reviews

A vast body of evidence regarding eHealth interventions for nutrition, physical activity, sedentary behavior, and obesity exists. This scoping review of systematic reviews aimed to evaluate the current level of evidence in this growing field. Seven electronic databases were searched for systematic reviews published until October 27, 2019. The systematic reviews must have included adult participants only and have evaluated eHealth behavioral interventions with the primary aim of changing nutrition, physical activity, and sedentary behavior or treating or preventing overweight and obesity. One hundred and six systematic reviews, published from 2006 to 2019, were included. Almost all (n = 98) reviews evaluated the efficacy of interventions. Over half (n = 61) included interventions focused on physical activity, followed by treatment of obesity (n = 28), nutrition (n = 22), prevention of obesity (n = 18), and sedentary behavior (n = 6). Many reviews (n = 46) evaluated one type of eHealth intervention only, while 60 included two or more types. Most reviews (n = 67) were rated as being of critically low methodological quality. This scoping review identified an increasing volume of systematic reviews evaluating eHealth interventions. It highlights several evidence gaps (e.g., evaluation of other outcomes, such as reach, engagement, or cost effectiveness), guiding future research efforts in this area.

Does self-monitoring diet and physical activity behaviors using digital technology support adults with obesity or overweight to lose weight? A systematic literature review with meta-analysis

Establish whether digital self-monitoring of diet and physical activity is effective at supporting weight loss, increasing physical activity and improving eating behavior in adults with obesity or overweight, and determine the intervention components that might explain variations in its effectiveness. A systematic search of MEDLINE, Embase, PsycINFO, Web of Science, Scopus, Cinahl, and CENTRAL identified 4068 studies, of which 12 randomized controlled trials were eligible and included in the review. A random-effect meta-analysis evaluated intervention effectiveness and subgroup analyses tested for effective intervention content. Twelve studies were included in the review and meta-analysis. Digital self-monitoring of both diet and physical activity had a statistically significant effect at supporting weight loss (mean difference [MD] = -2.87 [95% CI -3.78, -1.96], P < 0.001, I²  = 69%), improving moderate physical activity (standardized mean difference [SMD] = 0.44 [95% CI 0.26, 0.62], P < 0.001, I²  = 0%), and reducing calorie intake (MD = -181.71 [95% CI -304.72, -58.70], P < 0.01, I²  = 0%). Tailored interventions were significantly more effective than nontailored interventions (x²  = 12.92, P < 0.001). Digital self-monitoring of physical activity and diet is an effective intervention to support weight loss in adults with obesity or overweight. This effect is significantly associated with tailored advice. Future studies should use rigorous designs to explore intervention effectiveness to support weight loss as an adjunct to weight management services.

Feature Availability Comparison in Free and Paid Versions of Popular Smartphone Weight Management Applications

OBJECTIVE

Characterize capabilities of nutrition applications (apps) for weight management and associations between features, ratings, and app installations.

DESIGN

Calorie tracking apps with weight management as a primary outcome were selected from the Apple App Store and Google Play Store using keywords "diet" and "weight loss."

METHODS

Reviewers assessed free and upgraded versions of nutrition apps (n = 15) for features within 4 categories: (1) dietary intake, (2) anthropometrics, (3) physical activity, and (4) behavior change strategies.

OUTCOME MEASURES

Presence of specific app features, app ratings, and app installations.

ANALYSIS

Descriptive statistics of free and paid app versions. Spearman rank-order correlations were used to determine associations between feature inclusion, app ratings, and installations.

RESULTS

The apps had the greatest number of features in the dietary intake category. Additional dietary intake features were those most likely obtained through a subscription purchase. Behavior change content was absent from most apps. The macronutrient adjustment feature was strongly associated with average app ratings (r_s = 0.74; P < 0.002) and with subscription costs (r_s = 0.60; P < 0.019).

CONCLUSIONS AND IMPLICATIONS

This study found most nutrition apps possess an abundance of features dedicated to dietary intake, anthropometric, and physical activity tracking while also being notably devoid of behavior change content features.

Feasibility Study of a Newly Developed Technology-Mediated Lifestyle Intervention for Overweight and Obese Young Adults

Background: Poor eating habits and sedentary lifestyle are common among young adults and increase the risk for chronic diseases later in life. Due to the widespread use of information technology among young adults, the Rashakaty (Fitness for Me) study aimed to develop and test the feasibility of a technology-based nutrition education intervention. This would support overweight and obese university students to achieve weight loss, enhance nutrition knowledge, and increase physical activity levels. Methods: We enrolled 246 participants in a 16-week non-randomized feasibility study with two arms: Rashakaty-Basic and Rashakaty-Enhanced. The intervention was guided by social cognitive theory and was delivered via a website and mobile apps. Results: Among the 161 participants who completed the endline assessments, there was no significant difference in weight loss between the two arms. However, waist circumference decreased more (p = 0.003) in the Rashakaty -Enhanced group. Additionally, changes in knowledge related to sources of nutrients (p < 0.001) and diet–disease relationships (p = 0.006) were significantly higher among the Rashakaty-Enhanced group. Rashakaty-Enhanced participants reported increased number of days spent on moderate physical activity (p = 0.013) and minutes walked (p < 0.001). Moreover, they also reported higher scores in social support from friends to reduce fat intake (p = 0.006) and from family and friends to increase physical activity (p = 0.001). Conclusions: The results of this feasibility study can assist in the development and implementation of future technology–mediated health promotion programs in the UAE, especially for young adults.

Weight Loss and Usage of an Online Commercial Weight Loss Program (the CSIRO Total Wellbeing Diet Online) Delivered in an Everyday Context: Five-Year Evaluation in a Community Cohort

BACKGROUND

Obesity is a global public health challenge, and there is a need for more evidence-based self-management programs that support longer-term, sustained weight loss.

OBJECTIVE

This study used data from the Commonwealth Scientific and Industrial Research Organisation (CSIRO) Total Wellbeing Diet Online program to determine the reach and weight loss results over its first 5 years.

METHODS

Participants were adults who joined the commercial weight loss program of their own volition between October 2014 and September 2019 (N=61,164). Information collected included year of birth, sex, height, weight, and usage data (eg, entries into the food diary, views of the menu, and program content). Weight loss and percentage of starting body weight lost were calculated. Members were divided into 2 groups for analysis: "stayers" were members who signed up for at least 12 weeks of the program and recorded a weight entry at baseline and at the end of the program, while "starters" began the program but did not record a weight after 12 weeks. Descriptive statistics and multiple linear regression were used to describe weight loss and determine the member and program characteristics associated with weight loss.

RESULTS

Data were available from 59,686 members for analysis. Members were predominately female (48,979/59,686, 82.06%) with an average age of 50 years (SD 12.6). The average starting weight was 90.2 kg (SD 19.7), and over half of all members (34,195/59,688, 57.29%) were classified as obese. At week 12, 94.56% (56,438/59,686) of the members had a paid program membership, which decreased to 41.48% (24,756/59,686) at 24 weeks. At week 12, 52.03% (29,115/55,958) of the remaining members were actively using the platform, and by week 24, 26.59% (14,880/55,958) were using the platform. The average weight loss for all members was 2.8 kg or 3.1% of their starting body weight. Stayers lost 4.9 kg (5.3% of starting body weight) compared to starters, who lost 1.6 kg (1.7% of starting body weight). Almost half (11,082/22,658, 48.91%) the members who stayed on the program lost 5% or more of their starting body weight, and 15.48% (3507/22,658) achieved a weight loss of 10% or more. Of the members who were classified as class 1 obese when they joined the program, 41.39% (3065/7405) who stayed on the program were no longer classified as obese at the end, and across all categories of obesity, 24% (3180/13,319) were no longer classified as obese at the end of the program. Based on multiple linear regression, platform usage was the strongest predictor of weight loss (β=.263; P<.001), with higher usage associated with greater weight loss.

CONCLUSIONS

This comprehensive evaluation of a commercial, online weight loss program showed that it was effective for weight loss, particularly for members who finished the program and were active in using the platform and tools provided. If the results demonstrated here can be achieved at an even greater scale, the potential social and economic benefits will be extremely significant.

The Behavioral Intervention with Technology for E-Weight Loss Study (BITES): Incorporating Energy Balance Models and the Bite Counter into an Online Behavioral Weight Loss Program

This study evaluated feasibility and acceptability of adding energy balance modeling displayed on weight graphs combined with a wrist-worn bite counting sensor against a traditional online behavioral weight loss program. Adults with a BMI of 27–45 kg/m2 (83.3% women) were randomized to receive a 12-week online behavioral weight loss program with 12 weeks of continued contact (n = 9; base program), the base program plus a graph of their actual and predicted weight change based on individualized physiological parameters (n = 7), or the base program, graph, and a Bite Counter device for monitoring and limiting eating (n = 8). Participants attended weekly clinic weigh-ins plus baseline, midway (12 weeks), and study culmination (24 weeks) assessments of feasibility, acceptability, weight, and behavioral outcomes. In terms of feasibility, participants completed online lessons (M = 7.04 of 12 possible lessons, SD = 4.02) and attended weigh-ins (M = 16.81 visits, SD = 7.24). Six-month retention appears highest among nomogram participants, and weigh-in attendance and lesson completion appear highest in Bite Counter participants. Acceptability was sufficient across groups. Bite Counter use (days with ≥ 2 eating episodes) was moderate (47.8%) and comparable to other studies. Participants lost 4.6% ± 4.5 of their initial body weight at 12 weeks and 4.5% ± 5.8 at 24 weeks. All conditions increased their total physical activity minutes and use of weight control strategies (behavioral outcomes). Although all groups lost weight and the study procedures were feasible, acceptability can be improved with advances in the technology. Participants were satisfied with the online program and nomograms, and future research on engagement, adherence, and integration with other owned devices is needed. ClinicalTrials.gov Identifier: NCT02857595

Obesity paradigm and web-based weight loss programs: an updated systematic review and meta-analysis of randomized controlled trials

BACKGROUNDS

Web-based therapeutic approaches are new and attractive tools for primary health care systems due to their time and cost-saving nature and their accessibility for different populations. The aim of the current systematic review and meta-analysis is to summarize the results of studies evaluating the effect of web-based interventional programs on weight loss among overweight and obese individuals.

METHODS

A literature review from 2000 to 2016 was conducted. Studies were included in the study if they had adult participants with body mass index (BMI) ≥ 25 kg/m², a web-user intervention arm, and a non-web user control arm, with the primary aim of weight loss. Weight change in the interventional group versus control group was pooled with the random-effect model. Data were extracted on sample characteristics, drop-outs, weight loss, intervention duration, and the amount of weight loss. The mean weighted difference and 95% confidence intervals (CI) were calculated.

RESULTS

Eight studies met the inclusion criteria and included in the final model. Overall, using the web-based interventions had a weak non-significant effect on weight loss in overweight and obese individuals (WMD 0.56 kg, CI - 3.474, 4.592; P = 0.786). The most important reason was the unadjusted baseline weight of experimental and control groups in included studies, although the stratified analysis showed that, low study quality score and not using feedback and goal-setting in the study were the main factors diminishing the effectiveness of web-based intervention treatment group.

CONCLUSION

The results of the current meta-analysis indicated no effectiveness of web-based interventional programs in the weight loss of overweight and obese individuals. Although the great between-study heterogeneity and a small number of included studies further highlight the need for additional researches in this field.

Protocol for a randomised trial evaluating a preconception-early childhood telephone-based intervention with tailored e-health resources for women and their partners to optimise growth and development among children in Canada: a Healthy Life Trajectory Initiative (HeLTI Canada)

INTRODUCTION

The 'Developmental Origins of Health and Disease' hypothesis suggests that a healthy trajectory of growth and development in pregnancy and early childhood is necessary for optimal health, development and lifetime well-being. The purpose of this paper is to present the protocol for a randomised controlled trial evaluating a preconception-early childhood telephone-based intervention with tailored e-health resources for women and their partners to optimise growth and development among children in Canada: a Healthy Life Trajectory Initiative (HeLTI Canada). The primary objective of HeLTI Canada is to determine whether a 4-phase 'preconception to early childhood' lifecourse intervention can reduce the rate of child overweight and obesity. Secondary objectives include improved child: (1) growth trajectories; (2) cardiometabolic risk factors; (3) health behaviours, including nutrition, physical activity, sedentary behaviour and sleep; and (4) development and school readiness at age 5 years.

METHOD AND ANALYSIS

A randomised controlled multicentre trial will be conducted in two of Canada's highly populous provinces-Alberta and Ontario-with 786 nulliparous (15%) and 4444 primiparous (85%) women, their partners and, when possible, the first 'sibling child.' The intervention is telephone-based collaborative care delivered by experienced public health nurses trained in healthy conversation skills that includes detailed risk assessments, individualised structured management plans, scheduled follow-up calls, and access to a web-based app with individualised, evidence-based resources. An 'index child' conceived after randomisation will be followed until age 5 years and assessed for the primary and secondary outcomes. Pregnancy, infancy (age 2 years) and parental outcomes across time will also be assessed.

ETHICS AND DISSEMINATION

The study has received approval from Clinical Trials Ontario (CTO 1776). The findings will be published in peer-reviewed journals and disseminated to policymakers at local, national and international agencies. Findings will also be shared with study participants and their communities.

TRIAL REGISTRATION NUMBER

ISRCTN13308752; Pre-results.

The epidemiology of diabetes in the Waikato region: an analysis of primary care data

INTRODUCTION Diabetes mellitus is common in primary care, yet little has been reported of its primary care prevalence or the clinical characteristics of patients with Type 2 diabetes mellitus (T2DM). AIM To determine the prevalence of diabetes mellitus and clinical characteristics of diabetes patients in primary care in the Waikato region. METHODS Primary care data were extracted from the electronic records of 15 general practices for patients aged >20 years with current diabetes mellitus at 20 June 2017. Diabetes mellitus was defined as having a glycated haemoglobin (HbA1c) of ≥50mmol/mol (6.7%) or having being dispensed two or more anti-diabetic medications in the previous 12 months. Additional data collected included patients' ethnicity, age, sex and years since diagnosis. RESULTS The overall prevalence of diabetes mellitus was 5.7% and was higher for Māori (8.6%), Asian (7.0%) and Pacific peoples (9.1%) than Europeans (5.0%; all P<0.001). For patients with T2DM for whom current diabetes annual review data were available (n=2227) the mean body mass index (BMI) was 32.8±0.2kg/m2, but BMI was higher in Māori, younger patients, females and patients diagnosed <2 years previously (all P<0.001). Similarly, HbA1c levels were highest in Māori and younger patients (both P<0.001), with 40% of patients overall having a HbA1c of ≤53mmol/mol (7.0%). Approximately 70% of all patients had at least one measure of hypertension (systolic ≥130 or diastolic ≥80mmHg), or dyslipidaemia. More than 85% of patients had completed a recent retinal screen and foot check. DISCUSSION We found that management of T2DM was suboptimal, with measures for many patients not meeting clinical targets. Support should be provided to improve weight and glycaemic management, particularly for Māori, females and younger patients.

Identifying Persuasive Design Principles and Behavior Change Techniques Supporting End User Values and Needs in eHealth Interventions for Long-Term Weight Loss Maintenance: Qualitative Study

BACKGROUND

An increasing number of eHealth interventions aim to support healthy behaviors that facilitate weight loss. However, there is limited evidence of the effectiveness of the interventions and little focus on weight loss maintenance. Knowledge about end user values and needs is essential to create meaningful and effective eHealth interventions, and to identify persuasive system design (PSD) principles and behavior change techniques (BCTs) that may contribute to the behavior change required for successful long-term weight loss maintenance.

OBJECTIVE

This study aimed to provide insight into the design of eHealth interventions supporting behavior change for long-term weight maintenance. The study sought to identify the values and needs of people with obesity aiming to maintain weight after weight loss, and to identify PSD principles, BCTs, and design requirements that potentially enable an eHealth intervention to meet end user values and needs.

METHODS

This study presents the concept of integrating PSD principles and BCTs into the design process of eHealth interventions to meet user values and needs. In this study, individual interviews and focus groups were conducted with people with obesity (n=23) and other key stakeholders (n=27) to explore end user values and needs related to weight loss maintenance. Design thinking methods were applied during the focus group sessions to identify design elements and to explore how eHealth solutions can support the needs to achieve sustainable weight loss maintenance. The PSD model and behavior change taxonomy by Michie were used to identify PSD principles and BCT clusters to meet end user values and needs.

RESULTS

A total of 8 key end user values were identified, reflecting user needs for weight loss maintenance support: self-management, personalized care, autonomy, feel supported, positive self-image, motivation, happiness, and health. Goals and planning, feedback and monitoring, repetition and substitution, shaping knowledge, social support, identity, and self-belief were some of the BCT clusters identified to address these concepts, together with PSD principles such as personalization, tailoring, self-monitoring, praise, and suggestions.

CONCLUSIONS

The process of translating end user values and needs into design elements or features of eHealth technologies is an important part of the design process. To our knowledge, this is the first study to explore how PSD principles and BCTs can be integrated when designing eHealth self-management interventions for long-term weight loss maintenance. End users and other key stakeholders highlighted important factors to be considered in the design of eHealth interventions supporting sustained behavior change. The PSD principles and BCTs identified provide insights and suggestions about design elements and features to include for supporting weight loss maintenance. The findings indicate that a combination of BCTs and PSD principles may be needed in evidence-based eHealth interventions to stimulate motivation and adherence to support healthy behaviors and sustained weight loss maintenance.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04537988; https://clinicaltrials.gov/ct2/show/NCT04537988.

Effect of an Online Weight Management Program Integrated With Population Health Management on Weight Change: A Randomized Clinical Trial

IMPORTANCE

Online programs may help with weight loss but have not been widely implemented in routine primary care.

OBJECTIVE

To compare the effectiveness of a combined intervention, including an online weight management program plus population health management, with the online program only and with usual care.

DESIGN, SETTING, AND PARTICIPANTS

Cluster randomized trial with enrollment from July 19, 2016, through August 10, 2017, at 15 primary care practices in the US. Eligible participants had a scheduled primary care visit and were aged 20 to 70 years, had a body mass index between 27 and less than 40, and had a diagnosis of hypertension or type 2 diabetes. Follow-up ended on May 8, 2019.

INTERVENTIONS

Participants in the usual care group (n = 326) were mailed general information about weight management. Participants in the online program only group (n = 216) and the combined intervention group (n = 298) were registered for the online program. The participants in the combined intervention group also received weight-related population health management, which included additional support from nonclinical staff who monitored their progress in the online program and conducted periodic outreach.

MAIN OUTCOMES AND MEASURES

The primary outcome was weight change at 12 months based on measured weights recorded in the electronic health record. Weight change at 18 months was a secondary outcome.

RESULTS

Among the 840 participants who enrolled (mean age, 59.3 years [SD, 8.6 years]; 60% female; 76.8% White), 732 (87.1%) had a recorded weight at 12 months and the missing weights for the remaining participants were imputed. There was a significant difference in weight change at 12 months by group with a mean weight change of -1.2 kg (95% CI, -2.1 to -0.3 kg) in the usual care group, -1.9 kg (95% CI, -2.6 to -1.1 kg) in the online program only group, and -3.1 kg (95% CI, -3.7 to -2.5 kg) in the combined intervention group (P < .001). The difference in weight change between the combined intervention group and the usual care group was -1.9 kg (97.5% CI, -2.9 to -0.9 kg; P < .001) and the difference between the combined intervention group and the online program only group was -1.2 kg (95% CI, -2.2 to -0.3 kg; P = .01). At 18 months, the mean weight change was -1.9 kg (95% CI, -2.8 to -1.0 kg) in the usual care group, -1.1 kg (95% CI, -2.0 to -0.3 kg) in the online program only group, and -2.8 kg (95% CI, -3.5 to -2.0 kg) in the combined intervention group (P < .001).

CONCLUSIONS AND RELEVANCE

Among primary care patients with overweight or obesity and hypertension or type 2 diabetes, combining population health management with an online program resulted in a small but statistically significant greater weight loss at 12 months compared with usual care or the online program only. Further research is needed to understand the generalizability, scalability, and durability of these findings.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02656693.

Effect of alternate-day fasting on obesity and cardiometabolic risk: A systematic review and meta-analysis

BACKGROUND & AIMS

Alternate-day fasting (ADF) is related to weight reduction, lowered risks of weight regain, and relative lean body mass preservation compared to continuous energy restriction. This meta-analysis aimed to assess the effects of ADF on obesity-related factors and cardiometabolic risk factors in adults.

METHODS

Using PubMed, EMBASE, and Cochrane online databases, an electronic search was performed. Randomized controlled trials were investigated to evaluate ADF effects on body mass index (BMI), body weight (BW), waist circumference, body fat mass (FM), lean body mass, and cardiometabolic risk factors in adults aged ≥18 years. By utilizing a random-effects model, meta-analyses to assess weighted mean difference (WMD) with 95% confidence intervals (CIs) were performed for eight randomized controlled trials (total participants = 728).

RESULTS

We observed significant effects of ADF for BMI (WMD -0.73 kg/m², 95% CI -1.13 to -0.34), FM (WMD -1.27 kg, 95% CI -2.09 to -0.46), and total cholesterol (WMD -8.14 mg/dL, 95% CI -14.59 to -1.69). Subgroup analyses indicated that significant intervention effects were observed for BMI, BW, FM, and total cholesterol when compared to the control, the participants were overweight, and the study duration was <6 months. ADF is effective in reducing waist circumference in adults aged ≥40 years with obesity. However, there was no difference between ADF and continuous energy restriction, time-restricted feeding, or control with regard to lean body mass.

CONCLUSIONS

Current evidence suggests that ADF effectively lowers BMI, BW, FM, and total cholesterol in adults with overweight within 6 months compared to the control.

Efficacy of a WeChat based intervention to adherence to secondary prevention in patients undergoing coronary artery bypass graft in China: A randomized controlled trial

INTRODUCTION

We assessed whether the social media-based (WeChat) intervention integrated with follow-up care could improve adherence to drugs, lifestyle changes and clinical risk markers in patients undergoing coronary artery bypass graft (CABG) in China.

METHODS

We randomized patients at hospital discharge following CABG to intervention group or control care in China. The intervention is a structured programme of cardiac health education, medication reminders and cardiologist-based follow-up service using WeChat platform. The control group maintains a routine practice pattern. The primary outcome is adherence to cardioprotective medications measured for 12 months after discharge. We also evaluated the lifestyle modifications and clinical risk markers at 12 months.

RESULTS

A total of 164 participants completed the trial for analysis. The intervention group had significantly greater adherence to statins use 98.6% vs. 75.0% (p < 0.01), beta-blockers 93.4% vs. 69.3% (p < 0.01) and aspirin 98.8% vs. 87.8% (p < 0.001). The intervention group had significantly greater adherence to regular physical activity (64.2% vs. 48.2%; p < 0.039). Furthermore, intervention versus standard group at 12 months had significantly lower mean systolic blood pressure and low-density lipoprotein cholesterol (p < 0.05).

DISCUSSION

A WeChat-based intervention strategy in post-CABG patients improved adherence to medications, including statin, aspirin and beta-blockers, and regular physical activity and resulted in an improvement in systolic blood pressure and low-density lipoprotein cholesterol level.

Usability and experience testing to refine an online intervention to prevent weight gain in new kidney transplant recipients

OBJECTIVES

Weight gain in the first year following kidney transplantation increases the risk of adverse health outcomes. Currently, there is no recognized intervention available to prevent weight gain after kidney transplantation. An online kidney transplant-specific resource, entitled Exercise in Renal Transplant Online (ExeRTiOn), has been co-created by a multi-professional team, including patients, to assist with weight prevention. This study aimed to evaluate patient and health care professional usability and experience of the ExeRTiOn online resource.

DESIGN

Qualitative study utilizing 'Think-Aloud' and semi-structured interviews.

METHODS

Participants (n = 17) were purposively sampled to include new kidney transplant recipients (n = 11) and transplant health care professionals (n = 6). Kidney transplant recipient participants were from a spread of physical activity levels based on scores from the General Practice Physical Activity Questionnaire (GPPAQ). 'Think-Aloud' interviews assessed the usability of ExeRTiOn. Semi-structured interviews explored participants' experience of ExeRTiOn, weight gain, and physical activity. The data set were analysed thematically. Participant characteristics, including login data and self-reported body weight, were collected.

RESULTS

Data analyses identified valued intervention content and usability aspects which were summarized by two themes. The first theme 'You need to know how to manage yourself' included subthemes: (1) the resource filled a guidance gap, (2) expert patient content resonated, and (3) the importance of goal setting and monitoring progress. The second theme 'room for improvement' included subthemes: (2) web support and (2) content and operational change suggestions.

CONCLUSIONS

Results have allowed for identification of potential areas for resource refinement. This has facilitated iterative enhancement of ExeRTiOn in preparation for a randomized controlled feasibility trial.

A Factorial Experiment to Optimize Remotely Delivered Behavioral Treatment for Obesity: Results of the Opt-IN Study

OBJECTIVE

Intensive behavioral obesity treatments face scalability challenges, but evidence is lacking about which treatment components could be cut back without reducing weight loss. The Optimization of Remotely Delivered Intensive Lifestyle Treatment for Obesity (Opt-IN) study applied the Multiphase Optimization Strategy to develop an entirely remotely delivered, technology-supported weight-loss package to maximize the amount of weight loss attainable for ≤$500.

METHODS

Six-month weight loss was examined among adults (N = 562) with BMI ≥ 25 who were randomly assigned to conditions in a factorial experiment crossing five dichotomous treatment components set to either low/high (12 vs. 24 coaching calls) or off/on (primary care provider reports, text messaging, meal replacements, and buddy training).

RESULTS

About 84.3% of participants completed the final assessment. The treatment package yielding maximum weight loss for ≤$500 included 12 coaching calls, buddy training, and primary care provider progress reports; produced average weight loss of 6.1 kg, with 57.1% losing ≥5% and 51.8% losing ≥7%; and cost $427 per person. The most expensive candidate-treatment component (24 vs. 12 coaching calls) was screened out of the optimized treatment package because it did not increase weight loss.

CONCLUSIONS

Systematically testing each treatment component's effect on weight loss made it possible to eliminate more expensive but less impactful components, yielding an optimized, resource-efficient obesity treatment for evaluation in a randomized controlled trial.

Web-Based Interventions for Dietary Behavior in Adults With Type 2 Diabetes: Systematic Review of Randomized Controlled Trials

Background

Type 2 diabetes mellitus (T2DM) is among the most prevalent noncommunicable health conditions worldwide, affecting over 500 million people globally. Diet is a key aspect of T2DM management with dietary modification shown to elicit clinically meaningful outcomes such as improved glycemic control, and reductions in weight and cardiovascular disease risk factors. Web-based interventions provide a potentially convenient and accessible method for delivering dietary education, but its effects on dietary behavior in people with T2DM are unknown.

Objective

The objective of this review was to determine the effectiveness of web-based interventions on dietary behavior change and glycemic control in people with T2DM.

Methods

Per PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, systematic literature searches were performed using Medline, Embase, The Cochrane Library, and CINAHL to retrieve papers from January 2013 to May 2019. Randomized controlled trials of web-based interventions in adults with T2DM with reported dietary assessment were included. Population and intervention characteristics, dietary guidelines and assessments, and significant clinical outcomes were extracted. Differences between groups and within groups were assessed for dietary behavior and clinical outcomes.

Results

There were 714 records screened, and five studies comprising 1056 adults were included. Studies measured dietary changes by assessing overall diet quality, changes in specific dietary components, or dietary knowledge scores. Significant improvements in dietary behavior were reported in four out of the five studies, representing healthier food choices, improvements in eating habits, reductions in carbohydrates, added sugar, sodium, saturated fat and overall fat intake, and/or increases in dietary knowledge. Three studies found significant mean reductions for hemoglobin A1c ranging from –0.3% to –0.8%, and/or weight ranging from –2.3 kg to –12.7 kg, fasting blood glucose (–1 mmol/L), waist circumference (–1 cm), and triglycerides (–60.1 mg/dL). These studies provided varied dietary recommendations from standard dietary guidelines, national health program guidelines, and a very low carbohydrate ketogenic diet.

Conclusions

This review provided evidence that web-based interventions may be an effective way to support dietary behavior change in people with T2DM, potentially leading to changes in glycemic control and other clinical outcomes. However, the evidence should be viewed as preliminary as there were only five studies included with considerable heterogeneity in terms of the diets recommended, the dietary assessment measures used, the complexity of the interventions, and the modes and methods of delivery.

Developing evidence-based behavioural strategies to overcome physiological resistance to weight loss in the general population

Physiological and behavioural systems are tolerant of excess energy intake and responsive to energy deficits. Weight loss (WL) changes body structure, physiological function and energy balance (EB) behaviours, which resist further WL and promote subsequent weight regain. Measuring and understanding the response of EB systems to energy deficits is important for developing evidence-based behaviour change interventions for longer-term weight management. Currently, behaviour change approaches for longer-term WL show modest effect sizes. Self-regulation of EB behaviours (e.g. goal setting, action plans, self-monitoring, relapse prevention plans) and aspects of motivation are important for WL maintenance. Stress management, emotion regulation and food hedonics may also be important for relapse prevention, but the evidence is less concrete. Although much is known about the effects of WL on physiological and psychological function, little is known about the way these dynamic changes affect human EB behaviours. Key areas of future importance include (i) improved methods for detailed tracking of energy expenditure, balance and by subtraction intake, using digital technologies, (ii) how WL impacts body structure, function and subsequent EB behaviours, (iii) how behaviour change approaches can overcome physiological resistance to WL and (iv) who is likely to maintain WL or relapse. Modelling physiological and psychological moderators and mediators of EB-related behaviours is central to understanding and improving longer-term weight and health outcomes in the general population.

Artificial Intelligence (AI) and Cardiovascular Diseases: An Unexpected Alliance

Cardiovascular disease (CVD), despite the significant advances in the diagnosis and treatments, still represents the leading cause of morbidity and mortality worldwide. In order to improve and optimize CVD outcomes, artificial intelligence techniques have the potential to radically change the way we practice cardiology, especially in imaging, offering us novel tools to interpret data and make clinical decisions. AI techniques such as machine learning and deep learning can also improve medical knowledge due to the increase of the volume and complexity of the data, unlocking clinically relevant information. Likewise, the use of emerging communication and information technologies is becoming pivotal to create a pervasive healthcare service through which elderly and chronic disease patients can receive medical care at their home, reducing hospitalizations and improving quality of life. The aim of this review is to describe the contemporary state of artificial intelligence and digital health applied to cardiovascular medicine as well as to provide physicians with their potential not only in cardiac imaging but most of all in clinical practice.

Technical Metrics Used to Evaluate Health Care Chatbots: Scoping Review

BACKGROUND

Dialog agents (chatbots) have a long history of application in health care, where they have been used for tasks such as supporting patient self-management and providing counseling. Their use is expected to grow with increasing demands on health systems and improving artificial intelligence (AI) capability. Approaches to the evaluation of health care chatbots, however, appear to be diverse and haphazard, resulting in a potential barrier to the advancement of the field.

OBJECTIVE

This study aims to identify the technical (nonclinical) metrics used by previous studies to evaluate health care chatbots.

METHODS

Studies were identified by searching 7 bibliographic databases (eg, MEDLINE and PsycINFO) in addition to conducting backward and forward reference list checking of the included studies and relevant reviews. The studies were independently selected by two reviewers who then extracted data from the included studies. Extracted data were synthesized narratively by grouping the identified metrics into categories based on the aspect of chatbots that the metrics evaluated.

RESULTS

Of the 1498 citations retrieved, 65 studies were included in this review. Chatbots were evaluated using 27 technical metrics, which were related to chatbots as a whole (eg, usability, classifier performance, speed), response generation (eg, comprehensibility, realism, repetitiveness), response understanding (eg, chatbot understanding as assessed by users, word error rate, concept error rate), and esthetics (eg, appearance of the virtual agent, background color, and content).

CONCLUSIONS

The technical metrics of health chatbot studies were diverse, with survey designs and global usability metrics dominating. The lack of standardization and paucity of objective measures make it difficult to compare the performance of health chatbots and could inhibit advancement of the field. We suggest that researchers more frequently include metrics computed from conversation logs. In addition, we recommend the development of a framework of technical metrics with recommendations for specific circumstances for their inclusion in chatbot studies.

Integrating an online weight management program with population health management in primary care: Design, methods, and baseline data from the PROPS randomized controlled trial (Partnerships for Reducing Overweight and Obesity with Patient-centered Strategies)

BACKGROUND

Scalable, low-cost weight management strategies are needed in primary care. We conducted a pragmatic, cluster-randomized controlled trial to examine the effectiveness of an online weight management program integrated with population health management support.

METHODS

We adapted an online weight management program and integrated it with population health management support in 15 primary care practices (24 clinics). We randomized the 24 clinics to usual care (UC), online program alone (OP), or combined intervention (CI). Eligible participants had to be ages 20 to 70 and have a recent primary care visit, body mass index (BMI) ≥ 27 and < 40 kg/m², and a diagnosis of hypertension or type 2 diabetes. Participants attended routine visits and completed surveys over 18 months. The primary outcome is absolute weight change at 12 months (± 90 days) after enrollment, calculated from weights measured at primary care visits and recorded in the electronic health record.

RESULTS

We enrolled 840 participants between July 2016 and August 2017 (326 UC, 216 OP, and 298 CI.) At enrollment, participants' mean age was 59.3 years, their mean weight was 203.1 pounds, and their mean BMI was 32.5 kg/m²; 60% of participants were female, 76.8% were white, 96.4% had hypertension, and 24.4% had type 2 diabetes.

CONCLUSION

It is feasible to adapt an online weight management program and integrate it with population health management support in primary care. The results of this trial will provide valuable information about the effectiveness of these strategies in primary care settings. ClinicalTrials.govregistration number:NCT02656693.