Weight-loss interventions for improving emotional eating among adults with high body mass index: A systematic review with meta-analysis and meta-regression

Effectiveness of an Artificial Intelligence-Assisted App for Improving Eating Behaviors: Mixed Methods Evaluation

BACKGROUND

A plethora of weight management apps are available, but many individuals, especially those living with overweight and obesity, still struggle to achieve adequate weight loss. An emerging area in weight management is the support for one's self-regulation over momentary eating impulses.

OBJECTIVE

This study aims to examine the feasibility and effectiveness of a novel artificial intelligence-assisted weight management app in improving eating behaviors in a Southeast Asian cohort.

METHODS

A single-group pretest-posttest study was conducted. Participants completed the 1-week run-in period of a 12-week app-based weight management program called the Eating Trigger-Response Inhibition Program (eTRIP). This self-monitoring system was built upon 3 main components, namely, (1) chatbot-based check-ins on eating lapse triggers, (2) food-based computer vision image recognition (system built based on local food items), and (3) automated time-based nudges and meal stopwatch. At every mealtime, participants were prompted to take a picture of their food items, which were identified by a computer vision image recognition technology, thereby triggering a set of chatbot-initiated questions on eating triggers such as who the users were eating with. Paired 2-sided t tests were used to compare the differences in the psychobehavioral constructs before and after the 7-day program, including overeating habits, snacking habits, consideration of future consequences, self-regulation of eating behaviors, anxiety, depression, and physical activity. Qualitative feedback were analyzed by content analysis according to 4 steps, namely, decontextualization, recontextualization, categorization, and compilation.

RESULTS

The mean age, self-reported BMI, and waist circumference of the participants were 31.25 (SD 9.98) years, 28.86 (SD 7.02) kg/m2, and 92.60 (SD 18.24) cm, respectively. There were significant improvements in all the 7 psychobehavioral constructs, except for anxiety. After adjusting for multiple comparisons, statistically significant improvements were found for overeating habits (mean -0.32, SD 1.16; P<.001), snacking habits (mean -0.22, SD 1.12; P<.002), self-regulation of eating behavior (mean 0.08, SD 0.49; P=.007), depression (mean -0.12, SD 0.74; P=.007), and physical activity (mean 1288.60, SD 3055.20 metabolic equivalent task-min/day; P<.001). Forty-one participants reported skipping at least 1 meal (ie, breakfast, lunch, or dinner), summing to 578 (67.1%) of the 862 meals skipped. Of the 230 participants, 80 (34.8%) provided textual feedback that indicated satisfactory user experience with eTRIP. Four themes emerged, namely, (1) becoming more mindful of self-monitoring, (2) personalized reminders with prompts and chatbot, (3) food logging with image recognition, and (4) engaging with a simple, easy, and appealing user interface. The attrition rate was 8.4% (21/251).

CONCLUSIONS

eTRIP is a feasible and effective weight management program to be tested in a larger population for its effectiveness and sustainability as a personalized weight management program for people with overweight and obesity.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04833803; https://classic.clinicaltrials.gov/ct2/show/NCT04833803.

Associations Among Stress, Internalized Weight Stigma, Emotional Eating, and Body Composition in Active-Duty Service Members Enrolling in a Randomized Controlled Trial of a Weight Management Program

BACKGROUND

Obesity is a critical public health concern with particular relevance to US military personnel. Stress and internalized weight stigma ("stigma") may contribute to and maintain obesogenic processes and behaviors, including emotional eating. In this secondary cross-sectional analysis, we examined (1) associations among stress and stigma with emotional eating and body fat percentage (BF%), (2) whether stress explains the association between stigma and emotional eating, and (3) whether emotional eating explains associations between stress and stigma with BF%.

METHOD

Active-duty military service members (N = 178) completed BF% assessment and questionnaires assessing stress, stigma, and emotional eating.

RESULTS

Structural equation modeling path analyses showed that stress and stigma were both significantly associated with emotional eating (b = 0.35, p < 0.001 and b = 0.23, p < 0.001, respectively) and with BF% (b = 0.38, p < 0.001 and b = 0.29, p < 0.001, respectively) such that individuals who reported higher stress and stigma tended to report more emotional eating and had higher BF%. Stress partially explained the association between internalized weight stigma and emotional eating, and emotional eating partially explained the relationship between stress and BF% but did not significantly mediate the association between stigma and BF%.

CONCLUSION

Greater stress and internalized weight stigma were associated with more emotional eating and higher BF%; however, emotional eating only partially explained the association between stress and BF%. Results highlight the importance of interventions targeting stress management skills, but additional research is needed to identify mechanisms that explain the association between stigma and BF%.

The moderating and mediating role of eating behaviour traits in acceptance and commitment therapy-based weight management interventions: protocol for an individual participant data meta-analysis

INTRODUCTION

Precision medicine approaches to obesity aim to maximise treatment effectiveness by matching weight management interventions (WMIs) to characteristics of individuals, such as eating behaviour traits (EBTs). Acceptance and commitment therapy (ACT)-based WMIs may address EBTs such as emotional and uncontrolled eating more effectively than standard interventions, and might be most effective in people with high levels of these traits. However, few studies have examined this directly. We will examine (a) whether ACT-based interventions are more effective for people with certain levels of EBTs (ie, moderation) and (b) whether ACT-based interventions operate through changes in EBTs (ie, mediation).

METHODS AND ANALYSIS

This individual participant data (IPD) meta-analysis will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Individual Participant Data guidance. We will include studies on ACT-based WMIs that assessed EBTs in people with a body mass index ≥25 kg/m2. We identified studies by screening studies included in a previous review of third wave cognitive behavioural interventions, and updating the search to 20 June 2022. We will request IPD from eligible published and unpublished studies. We will harmonise and re-analyse data using a two-stage random effects meta-analysis pooling within-trial interactions to investigate moderating effects and using a one-stage simultaneous equation model to examine mediating effects. We will assess the risk of bias in included studies using the Cochrane Risk of Bias tool 2 and the Risk of Bias in Non-randomised Studies of Interventions tool.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the Cambridge Psychology Research Ethics Committee (Application No: PRE.2023.121). Data sharing will follow data transfer agreements and coauthorship will be offered to investigators contributing data. Findings will be disseminated through peer-reviewed journals and conferences and will contribute to the lead author's PhD thesis.

PROSPERO REGISTRATION NUMBER

CRD42022359691.

Emotional eating among adults with healthy weight, overweight and obesity: a systematic review and meta-analysis

BACKGROUND

Emotional eating (EE) is a disordered eating behaviour which may lead to overeating. It is not clear whether EE presents to an equal degree among adults, regardless of their body mass index (BMI) status. The aim of this study was to assess whether there is a difference in degree of EE between adults with healthy weight, overweight and obesity.

METHODS

MEDLINE and APA PsycINFO databases were searched from inception up to January 2022 for studies that reported EE scores from validated questionnaires. The quality of all included studies was assessed using the AXIS tool. Meta-analysis used random effects and standardised mean difference (SMD). Heterogeneity was investigated using I2 statistics and sensitivity analyses.

RESULTS

A total of 11 studies with 7207 participants were included in the meta-analysis. Degree of EE was greater in adults with a BMI above the healthy range, compared to adults with a healthy BMI (SMD 0.31, 95% CI 0.17 to 0.45; I2  = 85%). However, subgroup analysis found that degree of EE was greater only in adults with obesity (SMD 0.61, 95% CI 0.41 to 0.81; I2  = 62%), and there was no difference in degree of EE between adults with overweight and those with a healthy BMI.

CONCLUSIONS

Degree of EE is greater among adults living with obesity, compared to adults with a healthy BMI, indicating a need for behavioural support to support EE among people living with obesity seeking weight management. Future research should examine the long-term effectiveness of interventions for EE.

Socio-Demographic, Behavioral and Psychological Factors Associated with High BMI among Adults in a Southeast Asian Multi-Ethnic Society: A Structural Equation Model

While various influencing factors of overweight and obesity have been identified, the underlying mechanism remains unclear. We examined the relationships among sociodemographic, behavioral, and psychological factors on anthropometry in a multi-ethnic population with overweight and obesity. Participants (N = 251) were recruited from January to October 2022. Mean age and self-reported BMI were 31.7 ± 10.1 years and 29.2 ± 7.2 kg/m². Participants were mostly female (52.4%) and overweight (58.2%). Multivariate multiple regression was performed using maximum likelihood estimation. Body mass index was associated with waist circumference, age, sex, race, marital status, education level, residential region, overeating habit, immediate thinking, self-regulation, and physical activity, but not anxiety, depression, or the intention to change eating habits. Final model indicated good fit: χ² (30, N = 250) = 33.5, p = 0.32, CFI = 0.993, TLI = 0.988, RMSEA = 0.022, and SRMR = 0.041. Direct effects were found between BMI and overeating (β = 0.10, p = 0.004), race (β = -0.82, p < 0.001), marital status (β = -0.42, p = 0.001), and education level (β = -0.28, p = 0.019). Crisps (68.8%), cake (66.8%) and chocolate (65.6%) were identified as the most tempting foods. Immediate thinking indirectly increased overeating habits through poor self-regulation, although sociodemographic characteristics better predicted anthropometry than psycho-behavioral constructs.

Randomised controlled trial of breast cancer and multiple disease prevention weight loss programmes vs written advice amongst women attending a breast cancer family history clinic

BACKGROUND

Overweight and obesity are common amongst women attending breast cancer Family History, Risk and Prevention Clinics (FHRPCs). Overweight increases risk of breast cancer (BC) and conditions including¹ cardiovascular disease (CVD) and type-2 diabetes (T2D). Clinics provide written health behaviour advice with is likely to have minimal effects. We assessed efficacy of two remotely delivered weight loss programmes vs. written advice.

METHOD

210 women with overweight or obesity attending three UK FHRPCs were randomised to either a BC prevention programme (BCPP) framed to reduce risk of BC (n = 86), a multiple disease prevention programme (MDPP) framed to reduce risk of BC, CVD and T2D (n = 87), or written advice (n = 37). Change in weight and health behaviours were assessed at 12-months.

RESULTS

Weight loss at 12 months was -6.3% (-8.2, -4.5) in BCPP, -6.0% (-7.9, -4.2) in MDPP and -3.3% (-6.2, -0.5) in the written group (p = 0.451 across groups). The percentage losing ≥10% weight in these groups were respectively 34%, 23% and 14% (p = 0.038 across groups).

DISCUSSION

BCPP and MDPP programmes resulted in more women achieving ≥10% weight loss, but no evidence of additional benefits of MDPP. A multicentre RCT to test the BCPP across UK FHRPCs is warranted. Clinical Trial Registration ISRCTN16431108.

Emotional Eating Interventions for Adults Living with Overweight or Obesity: A Systematic Review and Meta-Analysis

BACKGROUND

Emotional eating (EE) may be defined as a tendency to eat in response to negative emotions and energy-dense and palatable foods, and is common amongst adults with overweight or obesity. There is limited evidence regarding the effectiveness of interventions that address EE.

OBJECTIVES

To synthesize evidence on the effectiveness of EE interventions for weight loss and EE in adults living with overweight or obesity.

METHODS

This is a systematic review and meta-analysis. Adhering to the PRISMA guidance, a comprehensive electronic search was completed up to February 2022. Random effects meta-analysis was carried out to determine the percentage change in weight and EE scores.

RESULTS

Thirty-four studies were included. The combined effect size for percentage weight change was -1.08% (95% CI: -1.66 to -0.49, I² = 64.65%, n = 37), once adjusted for publication bias. Similarly, the combined effect size for percentage change in EE was -2.37%, (95% CI: -3.76 to -0.99, I² = 87.77%, n = 46). Cognitive Behavioural Therapy showed the most promise for reducing weight and improving EE.

CONCLUSIONS

Interventions to address EE showed promise in reducing EE and promoted a small amount of weight loss in adults living with overweight or obesity.