An Experientially Derived Model of Flexible and Intentional Actions for Weight Loss Maintenance After Severe Obesity

Primary care-led weight-management intervention: qualitative insights into patient experiences at one-year follow up

INTRODUCTION

The global prevalence of overweight and obesity is continuously increasing. Long-term weight loss results remain disappointing. This study aims to identify factors and strategies for successful long-term weight loss in a primary care-led weight-loss intervention from the perspective of participants.

MATERIALS AND METHODS

This qualitative interview study is the first follow-up study in a 2-year study series of participants with overweight or obesity. Methods utilized are semi-structured interviews (n = 20) with quantitative self-description. The data were transcribed from audio-taped interviews and analysed thematically.

RESULTS

This study found that clear, continuously evolving self-monitoring strategies facilitated by strong routines and a long-term focus enhanced successful outcomes. Challenges faced included stress, disappointment and loss of routine along with external criticism and discouragement. Benefits experienced due to weight loss included improved health, self-esteem, communal support and encouragement, which continued to fuel motivation. Receiving continuous support and encouragement from healthcare practitioners was instrumental for long-term success.

CONCLUSION

This study highlighted the complex, multifaceted experiences patients encounter in the pursuit of trying to achieve long-term weight loss. Personalized treatment protocols taking into account the diverse requirements and circumstances of individuals have the potential to improve treatment outcomes. Continuous, professional support may enhance long-term outcomes.

Patient insights into the experience of trying to achieve weight-loss and future expectations upon commencement of a primary care-led weight management intervention: A qualitative, baseline exploration

Introduction

The long-term effects of interventions aiming to achieve substantial, sustainable weight loss maintenance have been disappointing. Most people regain their lost weight over time but some seem to be able to maintain their weight loss. We are following the experiences of patients over time prospectively. This study forms the baseline to provide insights into patient experiences prior to entering a primary care-led weight management intervention and their expectations going forward.

Materials and methods

We recruited 21 adult male and female patients of varying ethnicity with a BMI between 27.7kg/m2 and 48.4kg/m2 from a cohort of patients entering a primary care-led weight management intervention. Patients were offered video and audio interview options during the COVID-19 lockdown. In total, twenty chose the audio option, while one chose the video option. The interview format was semi-structured with room for individual exploration.

Discussion

We found that participants experienced feeling unable to control their weight and encountered a multitude of internal and external barriers to weight management. Some had supportive environments, while others experienced discouraging external influences. Though personal characteristics varied, motivations, goals and expected benefits were similar across this cohort. Most participants had previously experienced transient successful weight-loss attempts with varying approaches. COVID-19 was experienced as an opportunity or barrier for change.

Conclusion

This study illustrates the importance of gaining comprehensive insights into the diverse experiences patients encounter when trying to achieve weight loss. Personalized support taking into account individual experiences and circumstances may enhance long-term treatment outcomes. Future research into the complexities of weight management based on individual accounts can aid in the creation of improved treatment protocols.

What happens after a weight loss intervention? A qualitative study of drivers and challenges of maintaining time-restricted eating among people with overweight at high risk of type 2 diabetes

Time-restricted eating (TRE)¹ has been conceptualised as a strategy for achieving weight loss and improving metabolic health, but limited knowledge exists about how people can maintain TRE in daily life. This study examined how TRE was maintainable in daily life after a three-month intervention (the RESET study) in which participants were encouraged to consume all food and beverages except water within a 10-hour daily window. Specifically, we examined TRE maintenance patterns across participants, including drivers and challenges for maintenance success. A qualitative longitudinal study was conducted, and twenty participants with overweight at high risk of type 2 diabetes were interviewed using a semi-structured interview guide at the end of the intervention and after a three-month follow-up period. Data were analysed longitudinally in two steps inspired by a pattern-oriented longitudinal analysis approach. Seven participants maintained a strict 10-hour window, ten maintained an adjusted TRE regimen (e.g., taking days off), and three did not attempt maintenance. Maintenance drivers included consistent daily rhythms and regular meal patterns, subjective experiences (e.g., feeling healthier), making flexible adjustments to the TRE regimen, family support and avoiding feelings of guilt. Maintenance challenges included social evening events, inconsistent daily rhythms and eating patterns, preoccupation with losing weight, lack of family support and self-blame. TRE was manageable for most participants; however, personalised support for adjusting TRE to daily life is needed to ensure long-term maintenance. Future studies should explore the effectiveness of a personalised TRE concept to determine the usefulness of TRE in real-life settings.

Combining Persuasive System Design Principles and Behavior Change Techniques in Digital Interventions Supporting Long-term Weight Loss Maintenance: Design and Development of eCHANGE (Preprint)

Background

Long-term weight maintenance after weight loss is challenging, and innovative solutions are required. Digital technologies can support behavior change and, therefore, have the potential to be an effective tool for weight loss maintenance. However, to create meaningful and effective digital behavior change interventions that support end user values and needs, a combination of persuasive system design (PSD) principles and behavior change techniques (BCTs) might be needed.

Objective

This study aimed to investigate how an evidence-informed digital behavior change intervention can be designed and developed by combining PSD principles and BCTs into design features to support end user values and needs for long-term weight loss maintenance.

Methods

This study presents a concept for how PSD principles and BCTs can be translated into design features by combining design thinking and Agile methods to develop and deliver an evidence-informed digital behavior change intervention aimed at supporting weight maintenance. Overall, 45 stakeholders participated in the systematic and iterative development process comprising co-design workshops, prototyping, Agile development, and usability testing. This included prospective end users (n=17, 38%; ie, people with obesity who had lost ≥8% of their weight), health care providers (n=9, 20%), healthy volunteers (n=4, 9%), a service designer (n=1, 2%), and stakeholders from the multidisciplinary research and development team (n=14, 31%; ie, software developers; digital designers; and eHealth, behavior change, and obesity experts). Stakeholder input on how to operationalize the design features and optimize the technology was examined through formative evaluation and qualitative analyses using rapid and in-depth analysis approaches.

Results

A total of 17 design features combining PSD principles and BCTs were identified as important to support end user values and needs based on stakeholder input during the design and development of eCHANGE, a digital intervention to support long-term weight loss maintenance. The design features were combined into 4 main intervention components: Week Plan, My Overview, Knowledge and Skills, and Virtual Coach and Smart Feedback System. To support a healthy lifestyle and continued behavior change to maintain weight, PSD principles such as tailoring, personalization, self-monitoring, reminders, rewards, rehearsal, praise, and suggestions were combined and implemented into the design features together with BCTs from the clusters of goals and planning, feedback and monitoring, social support, repetition and substitution, shaping knowledge, natural consequences, associations, antecedents, identity, and self-belief.

Conclusions

Combining and implementing PSD principles and BCTs in digital interventions aimed at supporting sustainable behavior change may contribute to the design of engaging and motivating interventions in line with end user values and needs. As such, the design and development of the eCHANGE intervention can provide valuable input for future design and tailoring of evidence-informed digital interventions, even beyond digital interventions in support of health behavior change and long-term weight loss maintenance.

Trial Registration

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

Perspectives into the experience of successful, substantial long-term weight-loss maintenance: a systematic review

Purpose: In light of the increasing prevalence of overweight and obesity, understanding the experiences, strategies and challenges encountered when trying to achieve substantial, sustainable weight loss is an important area to investigate. We systematically evaluated qualitative studies focusing on the accounts of individuals who have achieved sustained weight loss to create a comprehensive picture of the experience of sustainable weight loss.

Methods: Included studies were peer-reviewed studies that qualitatively assessed the views and experiences of adults who previously had or currently have overweight or obesity who successfully lost weight and who subsequently maintained or regained weight. The evidence was systematically synthesized, which enabled the formulation of clear themes and recommendations.

Results: The 15 chosen studies included the accounts of 294 individuals. We found that continuous monitoring and goal setting, driven by sustained motivation and encouraging experiences, while resisting ever present challenges and enduring discouraging experience encapsulates the experience of sustained, substantial weight loss.

Conclusions: This review aims to provide a comprehensive understanding of the experiences, strategies and challenges encountered when trying to achieve substantial, sustained weight loss. Additional research taking into account findings from this review and others of its kind will enhance the formulation of treatment protocols.