Weight loss in videoconference and in-person iDiet weight loss programs in worksites and community groups

Weight Loss Trajectories and Short-Term Prediction in an Online Weight Management Program

The extent to which early weight loss in behavioral weight control interventions predicts long-term success remains unclear. In this study, we developed an algorithm aimed at classifying weight change trajectories and examined its ability to predict long-term weight loss based on weight early change. We utilized data from 667 de-identified individuals who participated in a commercial weight loss program (Instinct Health Science), comprising 69,363 weight records. Sequential polynomial regression models were employed to classify participants into distinct weight trajectory patterns based on key model parameters. Next, we applied multinomial logistic models to evaluate if early weight loss in the first 14 days and prolonged duration of participation were significantly associated with long-term weight loss patterns. The mean percentage of weight loss was 7.9 ± 5.1% over 133 ± 69 days. Our analysis revealed four main weight loss trajectory patterns: a steady decrease over time (30.6%), a decrease to a plateau with subsequent decline (15.8%), a decrease to a plateau with subsequent increase (46.9%), and no substantial decrease (6.7%). Early weight change rate and total participating duration emerged as significant factors in differentiating long-term weight loss patterns. These findings contribute to support the provision of tailored advice in the early phase of behavioral interventions for weight loss.

Expert Opinion on the Utility of Telemedicine in Obesity Care: Recommendations on a Hybrid Multidisciplinary Integrated Care Follow-Up Algorithm

PURPOSE OF REVIEW

The proposed expert opinion was prepared by a panel of obesity and law specialists from Turkey to review the utility of telemedicine in obesity care and to provide a guidance document with recommendations on a hybrid multidisciplinary integrated care follow-up algorithm and the legislation governing telemedicine practice to assist obesity specialists in practicing the telemedicine.

RECENT FINDINGS

The efficacy and feasibility of telemedicine interventions in supporting obesity management programs even during pandemics confirm that obesity is a particularly well-suited field for telemedicine, emphasizing the strong likelihood of continued utilization of telemedicine in obesity management, beyond the pandemic period. Telemedicine has great potential to address several barriers to ongoing weight-management care, such as challenges of access to specialized care, cost, and time limitations as well as patient adherence to treatment. However, telemedicine practice should complement rather than replace the in-person visits which are unique in building rapport and offering social support. Accordingly, the participating experts recommend the use of a hybrid integrated care model in the management of obesity, with the use of telemedicine, as an adjunct to in-person visits, to enable the provision of suggested intensive obesity management via frequent visits by a multidisciplinary team of obesity specialists. Further research addressing the utility of telemedicine in terms of optimal modality and duration for successful long-term obesity management outcomes is necessary to develop specific guidelines on telemedicine practice. In addition, the legislation governing the norms and protocols on confidentiality, privacy, access, and liability needs to be improved.

Randomized controlled trial of a novel lifestyle intervention used with or without meal replacements in work sites

OBJECTIVE

Lifestyle interventions have had limited effectiveness in work sites when evaluated in randomized trials. This study assessed the effectiveness of a novel lifestyle intervention for weight loss (Healthy Weight for Living [HWL]) implemented with or without meal replacements (MR) in work sites. HWL used a new behavioral approach emphasizing reducing hunger and building healthy food preferences, and, unlike traditional lifestyle interventions, it did not require calorie counting.

METHODS

Twelve work sites were randomized to an 18-month intervention (n = 8; randomization within work sites to HWL, HWL + MR) or 6-month wait-listed control (n = 4). Participants were employees with overweight or obesity (N = 335; age = 48 [SD 10] years; BMI = 33 [6] kg/m2 ; 83% female). HWL was group-delivered in person or by videoconference. The primary outcome was 6-month weight change; secondary outcomes included weight and cardiometabolic risk factors measured at 6, 12, and 18 months in intervention groups.

RESULTS

Mean 6-month weight change was -8.8% (95% CI: -11.2% to -6.4%) for enrollees in HWL and -8.0% (-10.4% to -5.5%) for HWL + MR (p < 0.001 for both groups vs. controls), with no difference between interventions (p = 0.40). Clinically meaningful weight loss (≥5%) was maintained at 18 months in both groups (p < 0.001).

CONCLUSIONS

A new lifestyle intervention approach, deliverable by videoconference with or without MR, supported clinically impactful weight loss in employees.

A Pilot Study to Examine the Feasibility and Acceptability of a Virtual Adaptation of an In-Person Adolescent Diabetes Prevention Program

BACKGROUND

Rates of prediabetes and type 2 diabetes are alarmingly high among racial/ethnic minority youth. The current study examines the virtual adaptation of an in-person peer-led youth diabetes prevention program.

METHODS

The initial phase involved the study team adapting workshop sessions from an in-person to a virtual format (Zoom). We conducted a 2-h feasibility pilot in December 2020 and implemented the full 12 session pilot program from June to September 2021 with 14 prediabetic adolescents recruited from our hospital-based general pediatric clinic. Weekly sessions were led by trained peer educators and focused on promoting healthy eating and physical activity using behavioral techniques (e.g., goal setting, brainstorming, and problem solving).

RESULTS

The virtual adaptation of our program was shown to be feasible and acceptable among our pilot participants. We were able to deliver the same workshop content and behavioral skills development as the in-person workshop using a variety of Zoom features.

CONCLUSIONS

Our peer-led youth diabetes prevention program was successfully adapted and implemented in a virtual format and was well accepted by at-risk youth. Future research is needed to examine the impact of virtual youth lifestyle interventions on behavioral and clinical outcomes such as weight and diabetes risk.

Examining weekly facilitated group sessions and counselor‐crafted self‐monitoring feedback on treatment outcome in digital weight control: A pilot factorial study

Objective

Methods

Results

Conclusions

Weight Loss Strategies

Lifestyle interventions for weight loss combine support for changing diet and physical activity with weight management education and are considered the first line treatment for obesity. A variety of diet-focused interventions including time-restricted eating are also increasingly being promoted for weight management. This chapter reviews different types of interventions for weight management, their underlying health behavior change models, and effectiveness to date in randomized trials. The results justify increasing efforts to improve program effectiveness generally, and to personalize interventions to support long-term adherence. The high prevalence of obesity worldwide, combined with the known increase in risk of non-communicable diseases with duration of excess weight, provides a compelling justification for routine delivery of effective weight management interventions in the community and in clinical care.

Application of social cognitive theory in weight management: Time for a biological component?

Despite the utility of social cognitive theory for facilitating individual behavior changes needed for initial weight loss, this model has been less effective in facilitating adherence to recommended lifestyle changes required for sustainable weight-loss maintenance. One potential reason for the limited long-term effectiveness of lifestyle interventions guided by this model is that the model does not consider the important influence that biology can have on weight-relevant behaviors, during both weight loss and weight-loss maintenance, via sensations of hunger and satiety and changes in energy metabolism (expenditure and fat oxidation). We describe here a proposed revision to social cognitive theory that allows for biological factors to exist in reciprocal determinism with behavioral, environmental, and personal factors, with the goal of creating a theoretical basis for lifestyle interventions with greater personalization in order to facilitate better long-term adherence and improve weight-loss maintenance.

Randomized trial of a novel lifestyle intervention compared with the Diabetes Prevention Program for weight loss in adult dependents of military service members

BACKGROUND

Lifestyle interventions are the first-line treatment for obesity, but participant weight loss is typically low.

OBJECTIVES

We evaluated the efficacy of an alternative lifestyle intervention [Healthy Weight for Living (HWL)] compared with a modified Diabetes Prevention Program (m-DPP). HWL was based on a revised health behavior change model emphasizing hunger management and the development of healthy food preferences. m-DPP was a standard Diabetes Prevention Program implemented with counselor time matched to HWL. Participants were adult dependents of military personnel and had overweight or obesity.

METHODS

Participants were randomly assigned to HWL (n = 121) or m-DPP (n = 117), delivered primarily by group videoconference with additional midweek emails. The primary outcome was 12-mo weight change. Secondary outcomes included 6-mo changes in cardiometabolic risk factors and diet. Intention-to-treat (ITT) and complete case (CC) analyses were performed using linear mixed models.

RESULTS

Retention did not differ between groups (72% and 66% for HWL and m-DPP at 12 mo, respectively; P = 0.30). Mean ± SE adjusted 12-mo weight loss in the ITT cohort was 7.46 ± 0.85 kg for HWL and 7.32 ± 0.87 kg for m-DPP (P = 0.91); in the CC cohort, it was 7.83 ± 0.82 kg for HWL and 6.86 ± 0.88 kg for m-DPP (P = 0.43). Thirty-eight percent of HWL and 30% of m-DPP completers achieved ≥10% weight loss (P = 0.32). Improvements in systolic blood pressure, LDL cholesterol, triglycerides, fasting glucose, general health, sleep, and mood were similar across groups; improvements in diastolic blood pressure were greater in m-DPP. Adjusted group mean reductions in energy intake were not significantly different between groups, but HWL participants were more adherent to their dietary prescription for lower glycemic index and high fiber and protein (P = 0.05 to <0.001 for ITT).

CONCLUSIONS

HWL and m-DPP showed equivalent and clinically impactful mean weight loss with cardiometabolic benefits. These results identify an alternative approach for behavioral treatment of overweight and obesity.This trial was registered at clinicaltrials.gov as NCT02348853.

A Review of Telemedicine Interventions for Weight Loss

Purpose of Review

Telemedicine has become popular as an alternative for in-person weight loss treatment during the COVID-19 pandemic. This review focuses on weight loss interventions utilizing real-time telemedicine.

Recent Findings

Telemedicine interventions are usually run as a weekly counseling and educational session or as a complement to a primarily Web-based intervention. A wide variety of healthcare professionals may provide the intervention. Common content includes portion control, increased physical activity, and relapse prevention. Self-monitoring is associated with intervention success. Modalities considered include online chats, text messages, phone calls, and videoconferences. Videoconferencing may be especially useful in capturing the interpersonal connection associated with in-person care but is understudied compared to other modalities. While many interventions show improvements in weight and weight-related outcomes, small sample sizes limit generalizability. Technology access and digital literacy are both necessary.

Summary

Telemedicine interventions can successfully help patients with obesity lose weight. Telemedicine interventions provide a safe, remote alternative and may expand treatment access to hard-to-reach populations. Further research is needed on telemedicine weight loss treatments for seniors, men, and ethnic minorities, as well as on the impact of long-term interventions.

Effectiveness of eHealth Nutritional Interventions for Middle-Aged and Older Adults: Systematic Review and Meta-analysis

BACKGROUND

The risk of development of chronic diseases related to poor nutrition increases with age. In the face of an aging population, it is important for health care sectors to find solutions in delivering health services efficiently and effectively to middle-aged and older adults.

OBJECTIVE

The aim of this systematic review and meta-analysis was to consolidate the literature that reported the effectiveness of eHealth apps in delivering nutritional interventions for middle-aged and older adults.

METHODS

A literature search from five databases (PubMed, CINAHL, Cochrane, Web of Science, and Global Health) from the past 5 years was performed. Studies were selected for inclusion that used eHealth to deliver nutritional interventions to adults aged 40 years and above, and reported health and behavioral outcomes. Two independent reviewers searched for research articles and assessed the eligibility of studies to be included in the review. A third reviewer resolved disagreements on study inclusion. We also assessed the quality of the included studies using the CONSORT 2010 checklist.

RESULTS

A total of 70 studies were included for analysis. The study quality ranged from 44% to 85%. The most commonly used eHealth intervention type was mobile apps (22/70, 31%). The majority of studies (62/70, 89%) provided multicomponent health interventions, which aimed to improve nutrition and other health behaviors (eg, exercise, smoking cessation, medication adherence). Meta-analysis results indicated high and significant heterogeneity; hence, conclusions based on these results should be considered with caution. Nonetheless, the results generally showed that eHealth interventions improved anthropometric and clinical outcomes, but not behavioral outcomes such as fruit and vegetable consumption.

CONCLUSIONS

The use of eHealth apps to deliver health interventions has been increasing in recent years, and these apps have the potential to deliver health services to a larger group of people. Our findings showed that the effectiveness of eHealth apps to deliver health interventions for middle-aged to older adults was supported by the improvement of anthropometric and clinical outcomes. Future work could aim to develop research frameworks in administering eHealth interventions to address heterogeneity in this field of research.

Physiology of Energy Intake in the Weight-Reduced State

Physiological adaptations to intentional weight loss can facilitate weight regain. This review summarizes emerging findings on hypothalamic and brainstem circuitry in the regulation of body weight and identifies promising areas for research to improve therapeutic interventions for sustainable weight loss. There is good evidence that body weight is actively regulated in a homeostatic fashion similar to other physiological parameters. However, the defended level of body weight is not fixed but rather depends on environmental conditions and genetic background in an allostatic fashion. In an environment with plenty of easily available energy-dense food and low levels of physical activity, prone individuals develop obesity. In a majority of individuals with obesity, body weight is strongly defended through counterregulatory mechanisms, such as hunger and hypometabolism, making weight loss challenging. Among the options for treatment or prevention of obesity, those directly changing the defended body weight would appear to be the most effective ones. There is strong evidence that the mediobasal hypothalamus is a master sensor of the metabolic state and an integrator of effector actions responsible for the defense of adequate body weight. However, other brain areas, such as the brainstem and limbic system, are also increasingly implicated in body weight defense mechanisms and may thus be additional targets for successful therapies.

Socio-demographic predictors of uptake of a virtual group weight management program during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has had a significant adverse impact on the delivery of weight management programmes (WMPs), in order to ensure the safety of patients and healthcare professionals. Videoconferencing could provide safe remote access to group WMPs during the COVID-19 pandemic. The objectives of this study were to determine the uptake of a virtual group WMP and its predictors.

METHODS

All patients enrolled on a face-to-face group WMP, which constitutes part of a Tier 3 WMP delivered by the NHS, at the time of the COVID-19 pandemic lockdown were invited to transfer to a virtual format of the group WMP. Baseline data included weight, BMI, age, gender, ethnicity and Index of Multiple Deprivation (IMD) quintile score. The outcomes were accept/decline transfer to the virtual group WMP. Logistic regression was performed to assess for predictors of uptake.

RESULTS

The 315 participants were included, of which 72.1% (n = 227) accepted. After adjusting for gender, deprivation and BMI; older patients (OR 0.966, [95% CI 0.944, 0.989]; p = 0.003) and Black, Asian and Minority Ethnicity (BAME) patients (OR 0.460 [95% 0.248, 0.851]; p = 0.023) were less likely to accept the virtual group WMP.

CONCLUSION

Strategies aimed at improving uptake of group WMP among BAME and older adult groups are needed, particularly considering the increased risk of severe COVID-19 in these two groups, and the links between obesity and poor COVID-19 outcomes.

Development of a Videoconference-Adapted Version of the Community Diabetes Prevention Program, and Comparison of Weight Loss With In-Person Program Delivery

INTRODUCTION

Effective, standardized, and easily accessible weight management programs are urgently needed for military beneficiaries. Videoconference interventions have the potential for widespread scaling, and can provide both real time interaction and flexibility in delivery times regardless of location, but there is little information on their effectiveness and acceptability.

MATERIALS AND METHODS

This study as part of a larger weight loss trial describes the videoconference adaption of Group Lifestyle Balance (GLB) program, a community group-based Diabetes Prevention Program intervention, and provides a comparison of weight loss and meeting attendance between in-person and videoconference delivery modes over 12 weeks in adult family members of military service members. Forty-three participants were enrolled from two military installations and received either the videoconference-adapted or an in-person GLB program in a non-randomized trial design. Differences in program attendance and percent weight lost at 12 weeks were compared by independent samples t-tests and nonparametric methods. Group differences in the percentage of weight lost over the 12-week period were analyzed using a linear mixed model.

RESULTS

All GLB intervention components were successfully delivered by videoconference with minor adaptations for the different delivery mechanism. Participant retention was 70% and 96% in the in-person and videoconference groups, respectively (p = 0.04). Completing participants in both groups lost a significant percent body weight over the 12 week intervention (p < 0.001) and there was no difference in percent body weight after 12 weeks of intervention (6.2 ± 3.2% and 5.3 ± 3.4% for in-person and videoconference at 12 weeks, respectively; p = 0.60).

CONCLUSION

This study describes the first videoconference adaption of the GLB program for use in military families. Attrition was lower in the videoconference group, and there were a similar levels of weight loss in both groups regardless of delivery modality. Videoconference weight loss interventions are effective and feasible for scaling to support healthy weight management in military as well as civilian populations.

Feasibility and acceptability of a rural, pragmatic, telemedicine-delivered healthy lifestyle programme

BACKGROUND

The public health crisis of obesity leads to increasing morbidity that are even more profound in certain populations such as rural adults. Live, two-way video-conferencing is a modality that can potentially surmount geographic barriers and staffing shortages.

METHODS

Patients from the Dartmouth-Hitchcock Weight and Wellness Center were recruited into a pragmatic, single-arm, nonrandomized study of a remotely delivered 16-week evidence-based healthy lifestyle programme. Patients were provided hardware and appropriate software allowing for remote participation in all sessions, outside of the clinic setting. Our primary outcomes were feasibility and acceptability of the telemedicine intervention, as well as potential effectiveness on anthropometric and functional measures.

RESULTS

Of 62 participants approached, we enrolled 37, of which 27 completed at least 75% of the 16-week programme sessions (27% attrition). Mean age was 46.9 ± 11.6 years (88.9% female), with a mean body mass index of 41.3 ± 7.1 kg/m2 and mean waist circumference of 120.7 ± 16.8 cm. Mean patient participant satisfaction regarding the telemedicine approach was favourable (4.48 ± 0.58 on 1-5 Likert scale-low to high) and 67.6/75 on standardized questionnaire. Mean weight loss at 16 weeks was 2.22 ± 3.18 kg representing a 2.1% change (P < .001), with a loss in waist circumference of 3.4% (P = .001). Fat mass and visceral fat were significantly lower at 16 weeks (2.9% and 12.5%; both P < .05), with marginal improvement in appendicular skeletal muscle mass (1.7%). In the 30-second sit-to-stand test, a mean improvement of 2.46 stands (P = .005) was observed.

CONCLUSION

A telemedicine-delivered, intensive weight loss intervention is feasible, acceptable, and potentially effective in rural adults seeking weight loss.

Enhancing group-based internet obesity treatment: A pilot RCT comparing video and text-based chat

OBJECTIVE

Internet delivery of behavioural weight control interventions offers potential for broad geographic reach and accessibility, but weight losses online fall short of those produced with the same programme delivered in-person. This pilot study examined feasibility and preliminary efficacy of a video-based platform for delivering weekly chat as part of a 6-month, 24-session online group behavioural weight control programme compared with the established text-based format, which has produced the best online weight losses to date.

METHOD

Women with obesity (N = 32) were randomized to either (a) weekly video group chat sessions and provided with a cellular-enabled scale (Video) or (b) Text-based weekly chat sessions and given a digital scale (Text) and followed for 6 months to determine weight loss and treatment engagement.

RESULTS

Women randomized to the ideo condition lost more weight than those in the Text condition (-5.0 ± 6.0% vs. -3.0 ± 4.1%, respectively) at 6 months, although the difference was not statistically significant. However, women in the Video condition had significantly greater treatment engagement, with greater self-monitoring and website utilization than those in the Text condition.

CONCLUSIONS

Videoconference delivery of group-based online weight control accompanied by a cellular-connected scale may promote greater treatment engagement and weight loss than text-based chat. A larger, adequately powered study is warranted to determine which elements drive these enhanced treatment outcomes.

Outcomes of an RCT of videoconference vs. in-person or in-clinic nutrition and exercise in midlife adults with obesity

OBJECTIVE

New communication technologies have shown some promise in lifestyle weight loss interventions but may be most effective when leveraging face-to-face communications. The study reported here sought to test whether weight loss programme attendance and outcomes are greater when offered in-person at community sites or remotely via videoconference vs. in Federally Qualified Health Centers (FQHCs). In a three-arm randomized trial among 150 FQHC adults, intervention delivery in community-sites or via videoconference was tested against a clinic-based lifestyle intervention (enhanced usual care [EUC]).

METHODS

Twice weekly, a nutrition topic was reviewed, and exercise sessions were held in a 20-week programme delivered either in community settings or via videoconference. The primary outcome was the proportion of participants losing more than 2 kg at 6 (end of treatment) and 12 months in intent-to-treat analyses.

RESULTS

Mean (SD) age was 53 years, 82% were women, 65% were African-American, 50% reported $18,000 or less household income and 49% tested low in health literacy, and mean (SD) body mass index was 39 kg m-2. The proportion losing more than 2 kg of weight in the community site, videoconference and EUC groups was 33%, 34% and 24%, respectively, at 6 months and 29%, 34% and 29% at 12 months. No differences reached significance. Attendance was poor in all groups; 45% of community site, 58% of videoconference and 16% of EUC participants attended at least one session.

CONCLUSION

Videoconference and community-based delivery were as effective as an FQHC-based weight loss programme.

The efficacy of a telemedicine-based weight loss program with video conference health coaching support

Introduction

Clinically significant weight loss is defined as a ≥5% of initial body weight loss within a 6-month period. The purpose of this study was to assess body weight change from a 12-week telehealth-based weight loss program that integrated health coaching via video conferencing.

Methods

A total of 25 obese participants (12 males, 13 females) were recruited for this fully online 12-week weight loss program. Participants were randomly assigned to either an intervention group or control group ( n = 13 intervention, body mass index (BMI) = 34.7 ± 4.5 kg/m2; n = 12 control, BMI = 34.4 ± 4.43 kg/m2). All participants were given access to a secure platform for data tracking and video conferencing with the research team. The intervention group met with the medical doctor once per month and with a registered dietitian, weekly. Control participants met with the research team at baseline and at 12 weeks. Independent samples t-tests and Chi-square tests were used via SPSS version 24 with significance set to p < 0.05.

Results

There was a significant difference between the intervention and control groups for body weight loss (7.3 ± 5.2 versus 1.2 ± 3.9 kg, respectively, p < 0.05) as well as for percent body weight loss (7.16 ± 4.4 versus 1.5 ± 4.1%, respectively, p < 0.05). Clinically significant weight loss was achieved in 9 out of 13 (69.2%) in the intervention group versus 1 out of 12 (8%) in the control group.

Discussion

Mobile phone-based health coaching may promote weight loss. Weekly video conferencing with education may be an applicable tool for inducing significant body weight loss in obese individuals.