Effect of a Gender-Tailored eHealth Weight Loss Program on the Depressive Symptoms of Overweight and Obese Men: Pre-Post Study

Gender-sensitive community weight-loss programmes to address overweight and obesity in men: a scoping review

OBJECTIVES

To examine how gender-sensitive community weight-loss programmes have been used to address overweight and obesity in men and to identify what can be learnt from this rapidly evolving field.

DESIGN

Scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review checklist for reporting.

DATA SOURCES

A database search was conducted using EBSCOhost (Academic Search Complete, CINAHL Complete, Global Health, Health Source: Consumer Edition, Health Source: Nursing/Academic Edition and Medline Complete), Google, Google Scholar, Open Access Theses and Dissertations platform and Scopus.

ELIGIBILITY CRITERIA

All weight-loss programmes using a gender-sensitive approach to address men's overweight and obesity in community settings.

DATA EXTRACTION AND SYNTHESIS

Narrative synthesis was conducted based on the research questions and objectives. Primary outcomes include operationalisation, context and concept of the gender-sensitive approach. Information was reviewed and extracted to Microsoft Excel by two reviewers.

RESULTS

A total of 40 studies (28 quantitative, eight mixed methods and four qualitative) were identified from 4617 records. Gender-sensitive approaches were undertaken in a range of settings and contexts including professional sports clubs (n=21), non-professional sporting clubs (n=16), workplace-based (n=2) and commercial organisation-based (n=1). The most common analysis approaches were evaluating the effect of the programmes (n=31) where positive impact was predominantly shown (eg, up to 3.9 kg weight reduction at 3-month follow-up). Programmes (ie, Football Fans in Training) were short-term cost-effective (eg, the cost was £862-£2228 per 5% weight reduction at 12-month follow-up). Qualitative evidence highlights factors that influenced men's participation (eg, camaraderie) and identifies areas for improvement.

CONCLUSION

The findings demonstrate that gender-sensitive programmes for men's weight loss have been effectively applied using a range of different approaches and in a range of different contexts. Further evidence is needed to confirm the effectiveness of the programmes across diverse groups of men.

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.

Use of new technologies for the promotion of physical activity in patients with mental illness: A systematic review

BACKGROUND

Physical exercise is an underutilized tool for the management of mental disorders. New technologies have made a breakthrough in health care, and one of its possible applications (apps) could be that of customizing exercise programs for special populations, such as patients with mental disorders. However, the app of the so-called e-health to mental health care is still limited.

AIM

To know the efficacy of apps to promote physical activity in patients with mental disorders.

METHODS

We conducted a systematic review of the PubMed and Embase databases with the aim of exploring the use of new technologies for the enhancement of physical exercise in patients with a psychiatric illness. Following the selection process, 10 articles were included in the review.

RESULTS

The most commonly used devices in this type of intervention are wearable devices and web platforms. Good results in terms of effectiveness and acceptability were obtained in most of the studies.

CONCLUSION

Our findings suggest that the use of new technologies in mental health represents a feasible strategy with great potential in clinical practice.

Mechanisms of an eHealth program targeting depression in men with overweight or obesity: A randomised trial

BACKGROUND

The SHED-IT: Recharge study demonstrated that a gender-tailored eHealth program could improve the depressive symptoms of men with overweight or obesity and low mood. This study examined whether changes in key behaviours and cognitions acted as significant mediators of this treatment effect.

METHODS

The study was a randomised controlled trial (RCT) including 125 men with overweight or obesity (mean (SD) weight 103.8 (15.8) kg), and current depressive symptoms (Patient Health Questionnaire (PHQ-9) ≥ 5; mean (SD) 9.2 (4.1) units). Assessments were held at baseline, 3 months (post-intervention), and 6 months (follow-up). Depressive symptoms were assessed using the validated PHQ-9 and Masculine Depressive Risk Scale (MDRS-22). Behavioural and cognitive mediators were assessed with validated measures. Intention-to-treat mediation analyses were conducted using the PROCESS macro in SPSS.

RESULTS

Single mediation analyses demonstrated that the intervention effect on both PHQ-9 and MDRS-22 scores was significantly mediated by changes in MVPA, energy-dense nutrient-poor foods, cognitive flexibility, and behavioural activation. In addition, changes in sleep quality mediated improvements in MDRS-22 scores. No mediation effects were observed for light physical activity, sedentary behaviour, fruit and vegetable intake, risky alcohol consumption or mindfulness.

LIMITATIONS

The study was a secondary analysis with power to detect moderate-to-large mediation effects only.

CONCLUSION

To prevent or treat depression in men with overweight or obesity, early evidence suggests MVPA, sleep quality, energy-dense nutrient-poor food intake, cognitive flexibility, and behavioural activation are important intervention targets.

Behavioral and Cognitive Outcomes of an Online Weight Loss Program for Men With Low Mood: A Randomized Controlled Trial

BACKGROUND

Depression and obesity are major health concerns and commonly co-exist, but men rarely seek help for these conditions. SHED-IT: Recharge was a gender-tailored eHealth program for men that generated clinically meaningful improvements in weight and depressive symptoms.

PURPOSE

To evaluate behavioral and psychological outcomes from the SHED-IT: Recharge intervention designed for overweight/obese men with low mood.

METHODS

Overall, 125 men (18-70 years) with a BMI between 25 and 42 kg/m2 and depressive symptoms (PHQ-9 ≥ 5) were randomly allocated to SHED-IT: Recharge (n = 62) or wait-list control (n = 63) groups. The self-directed program targeted key health behaviors combined with online mental fitness modules based on cognitive behavioral therapy. Behavioral (e.g., physical activity) and psychological outcomes (e.g., cognitive flexibility) were assessed with validated measures at baseline, 3 months (post-test) and 6 months (follow-up). Intention-to-treat linear mixed models examined treatment effects, which were adjusted for covariates, and effect size estimated (Cohen's d).

RESULTS

At post-test, intervention men achieved small-to-medium improvements in several health behavior outcomes including moderate-to-vigorous physical activity, light physical activity, sedentary behavior, sleep, energy intake, portion size, and risky alcohol consumption (range, d = 0.3-0.5), when compared with the control group. Intervention effects were also observed for perceived physical self-worth, perceived physical strength, cognitive flexibility, and behavioral activation (range, d = 0.3-0.8). No effects were found for fruit and vegetable intake, or mindful attention. Most effects were maintained at follow-up.

CONCLUSIONS

This gender-tailored, eHealth program with integrated mental fitness support elicited meaningful improvements in health behaviors and psychological outcomes for men with low mood. Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN12619001209189).

An Evaluation of 5-Year Web Analytics for HeadsUpGuys: A Men's Depression E-Mental Health Resource

The present study reports an evaluation of web analytics, over a 5-year period, for HeadsUpGuys.org, an eHealth resource for men with depression. Google Analytics, Search Console, and Tag Manager were used to monitor user activity over the course of the website's first 5 years (June 15, 2015-June 15, 2020). Through this period, HeadsUpGuys had a total of 1,665,356 unique users, amounting to 1,948,481 sessions and 3,328,258 page views. Organic traffic accounted for the highest proportion (53.44%; n = 1,041,277) of website sessions. Four of the top 10 Google search queries that brought users to the website related to suicidality. Three countries (United States, United Kingdom, Canada) accounted for almost three-quarters (71.10%; n = 1,385,485) of the site's traffic. Nearly three-quarters (73.35%; n = 1,429,285) of sessions occurred on a mobile device. The goal conversion rate for the Self Check was 60.27%. The average time on page was 2 min 53 s, with a bounce rate of 65.92%, and an exit rate of 57.20%. The goal conversion rate for the Stress Test was 52.89%. The average time on page was 4 min 8 s, with a bounce rate of 72.40% and an exit rate of 48.88%. The conversion rate for the final goal was 11.53%, indicating that approximately one in 10 visitors to the site had a session of at least 3 min. The findings illustrate the potential of eHealth resources to support men's mental health and provide a real-world benchmark to help advance the men's eHealth field.

Football and Ice Hockey Fans' Experience of a 12-Week Training and Weight-Loss Pilot Intervention (ViSiT) in Sweden-A Focus Group Study

Background: Excess weight is associated with an increased risk of poor health and premature mortality. This is more problematic for men than for women because men have a lower life expectancy and a higher prevalence of several lifestyle-related diseases. A concept whereby overweight male supporters of professional football clubs are recruited and offered a weight-loss intervention has been developed in Scotland. In the present study, we explore participants' experiences of a similar pilot intervention, called ViSiT, conducted with supporters in one ice hockey club and one football club in Sweden to assess the feasibility of using the intervention in a Swedish context.

Methods: In this user centered evaluation, focus groups were conducted with 12 men who had completed the 12-week ViSiT intervention. Participants discussed reasons for participating in and completing the intervention, effects of the intervention, advantages, and areas of improvement of the intervention, and thoughts on the club's involvement. The material was analyzed using thematic analysis according to Braun and Clarke.

Results: The analyses revealed four themes: reasons to participate, motivation and reinforcement, change of habit, and areas for improvement. The intervention was seen as an opportunity to change daily lifestyle behaviors. The group format, as well as the involvement of a prestigious sports club, was important for signing up to the intervention and for motivating continued involvement. The intervention had also resulted in increased knowledge on health and changed mindsets about being more attentive to regulating day-to-day behavior. Although the overall feedback on the intervention was positive, the participants suggested that possibilities to have more individual coaching should be added.

Conclusions: The ViSiT weight loss and lifestyle intervention may be feasible in a Swedish context to reach overweight men at risk of poor health. The ice hockey and football club supporters expressed similar experiences from participating in the intervention. ViSiT seem to have a potential to be adopted by many sports clubs for a widespread reach to a group normally considered reluctant to participate in lifestyle change programs.

The impact of adult behavioural weight management interventions on mental health: A systematic review and meta-analysis

There is good evidence that behavioural weight management interventions improve physical health; however, the impact on mental health remains unclear. We evaluated the impact of behavioural weight management interventions on mental health-related outcomes in adults with overweight or obesity at intervention-end and 12 months from baseline. Eligible studies were randomized controlled trials (RCTs) or cluster RCTs of adult behavioural weight loss interventions reporting affect, anxiety, binge eating, body image, depression, emotional eating, quality of life, self-esteem and stress. We searched seven databases from inception to 7 May 2019 and included 43 articles reporting 42 RCTs. Eighteen studies were deemed to be at high risk of bias. We conducted random-effects meta-analyses, stratified analyses and meta-regression using Stata. Interventions generated greater improvements than comparators for depression, mental health-related quality of life and self-efficacy at intervention-end and 12 months from baseline. There was no difference between groups for anxiety, overall quality of life, self-esteem or stress at intervention-end. There was insufficient evidence to assess the impact on anxiety, binge eating, body image, emotional eating, affect, life satisfaction, self-esteem or stress at intervention-end and/or 12 months from baseline. Although evidence suggests that interventions benefit some aspects of mental health, high-quality, transparently reported RCTs measuring a range of mental health outcomes over longer durations are required to strengthen the evidence base.

Promoting Men's Health With the "Don't Change Much" e-Program

Men's e-health promotion programs can offer end-user anonymity and autonomy that provide avenues for supporting positive health behavior change. The twofold purpose of the current study was to use a benchmark cohort as a reference group to: (1) describe associations between men's usage levels of the e-health program Don't Change Much (DCM) and their recent and intended health behavior changes, and (2) report an exploratory analysis of the moderating effects of demographic variables on the associations between DCM users and their recent and intended health behavior changes. Based on self-report, DCM users were classified into limited (n = 613, 34.7%), low (n = 826, 46.8%), and high (n = 327, 18.5%) exposure groups. Compared with the benchmark cohort, DCM high-exposure respondents had significantly increased odds for eight of the nine recent behavior changes, with the largest effect size observed for "Made an effort to sit less and walk more" (odds ratio [OR] 2.996, 95% CI [2.347, 3.826]). Eight of the nine intended health behavior changes in the DCM high-exposure group had significantly increased odds compared to the benchmark cohort, with "Reduce stress level" (OR 3.428, 95% CI [2.643, 4.447]) having the largest effect size. Significantly greater total numbers of recent (F(12, 2850) = 29.32; p = .001; R² = .086) and intended health behavior changes (F(12, 2850) = 34.59; p = .001; R² = 0.100) were observed among high exposure respondents while adjusting for demographics. Younger age, being employed, and household income <$120,000 had an enhancing moderator effect on DCM users' number of intended behavior changes.

Psych-APP-Therapie: Smartphonebasierte Interventionen in der Psychotherapie – Eine systematische Übersichtsarbeit

<b><i>Hintergrund:</i></b> Technologiebasierte Interventionen haben in der Psychotherapie an Bedeutung gewonnen. Ein versorgungsrelevanter Ansatz sind Mental Health Apps. Ziel dieser systematischen Übersichtsarbeit ist es (1) international eva­luierte Apps zu den Störungsbildern Depressionen, Angststörungen und Essstörungen zu identifizieren, (2) deren Verfügbarkeit in deutschen App-Stores sowie (3) in deutscher Sprache zu prüfen und (4) ihre Effektivitätsergebnisse aus randomisiert-kontrollierten (Pilot-)Studien (RCTs) darzustellen. <b><i>Methode:</i></b> Die Übersichtsarbeit wurde in Anlehnung an das PRISMA Statement durchgeführt und ausgewertet. Eine systematische Recherche (2007–2018) der Datenbanken PubMed, PsychINFO sowie PSYNDEX wurde durchgeführt. Zudem fand eine Beurteilung der methodischen Qualität sowie der Effektivitätsergebnisse der (Pilot-)RCTs statt. <b><i>Ergebnisse:</i></b> Es wurden 2’571 Abstracts identifiziert und 47 Publikationen eingeschlossen (<i>N</i> = 32 unterschiedliche Apps; <i>N</i> = 24 [Pilot-]RCTs). Die Qualität der (Pilot-)RCTs ist überwiegend als gut bis moderat einzustufen. Die Ergebnisse waren heterogen (keine bis große Effekte [Cohens <i>d</i>] zwischen den Gruppen: –0,01; KI [–0,36; 0,34] bis 1,49; KI [1,00; 1,99]). Vier Apps mit einer Evaluation durch (Pilot-)RCTs sind in den deutschen App-Stores verfügbar – eine in deutscher Sprache. <b><i>Schlussfolgerungen:</i></b> Es liegt international eine Vielzahl von ersten App-Evaluationen zu den Störungsbildern vor, die Verfügbarkeit ausreichend evalu­ierter deutschsprachiger Apps in den deutschen App-Stores ist aber extrem limitiert. Englischsprachige, bereits evalu­ierte Apps könnten in das Deutsche übersetzt und – genauso wie schon verfügbare, aber nicht evaluierte deutschsprachige Apps – in RCTs inkl. Katamnesedaten evaluiert werden. So könnten smartphonebasierte Interventionen im Rahmen des “Digitalen-Versorgungs-Gesetzes” als ergänzendes Element in der Psychotherapie an Bedeutung gewinnen.

Impact of male-only lifestyle interventions on men's mental health: A systematic review and meta-analysis

Despite rising mental health problems worldwide, engaging men to seek mental health support is challenging. Male-only lifestyle interventions have shown promise for improving men's physical health, but the overall impact of these programs on psychological outcomes is unclear. This review aimed to evaluate the impact of male-only lifestyle interventions on men's mental health and to identify if any study or intervention features were associated with effectiveness. A systematic literature search with no date restrictions was conducted across four databases and returned 15 946 citations. Nine studies were eligible for inclusion, representing 1427 participants. Risk of bias was generally low across studies, although none were specifically powered to detect changes in mental health. Overall, significant group-by-time effects were reported for 26% of mental health outcomes examined. In the fixed-effects meta-analyses, small-to-medium intervention effects were observed for mental health-related quality of life (SMD = 0.24), self-esteem (SMD = 0.51), and positive affect (SMD = 0.58). Insights into effective study or intervention features were limited because of the low number of heterogeneous studies. Although male-only lifestyle interventions have improved men's mental health in some circumstances, studies that are specifically powered to detect long-term changes are urgently required, particularly in groups with pre-existing mental health concerns.

Mapping Canadian Men's Recent and Intended Health Behavior Changes Through the Don't Change Much Electronic Health Program

Background

Although evaluation studies confirm the strong potential of men’s electronic health (eHealth) programs, there have been calls to more fully understand acceptability, engagement, and behavior change to guide future work. Relatedly, mapping of behavior changes using health promotion theories including the transtheoretical model (or stages of change) has been recommended to build a translatable empirical base to advance design and evaluation considerations for men’s eHealth programs.

Objective

This study aimed to use a benchmark sample as a reference group to map the recent and intended health behavior changes in Canadian men who use the Don’t Change Much (DCM) eHealth program. The hypothesis being tested was that increased exposure to DCM would be positively associated with men’s recent and intended health behavior changes.

Methods

DCM users (n=863) were sampled for demographic data and self-reported recent and intended health behavior changes. Respondents also reported their usage (frequency and duration) for each of the 3 DCM components (web, newsletter, and social media) and were allocated to limited exposure (257/863, 29.8%), low exposure (431/863, 49.9%), and high exposure (175/863, 20.3%) subgroups. A benchmark sample (n=2000), comprising respondents who had not accessed DCM provided a reference group. Bivariate analysis of recent and intended health behavior changes and DCM exposure levels were used to compute the strength of association between the independent variables (exposure levels) and the 10 categorical dependent variables (recent and intended health behavior changes). Binary logistic regression models were computed for each of the 10 recent and intended health behavior changes. Linear regression was used to model the association between the number of recent and intended changes and the level of exposure to DCM.

Results

Compared with the benchmark reference group, DCM high-exposure respondents had significantly increased odds for 9 of the 10 health behavior changes, with the largest effect size observed for Changed diet or Improved eating habits (odds ratio [OR] 5.628, 95% CI 3.932-8.055). High-exposure respondents also had significantly increased odds for 9 intended health changes, with the largest effect sizes observed for Reduce stress level (OR 4.282, 95% CI 3.086-5.941). Moderate effect size (goodness of fit) was observed for increased total number of recent (F_12,2850=25.52; P.001; adjusted R²=.093) and intended health behavior changes (F_12,2850=36.30; P.001; adjusted R²=.129) among high-exposure respondents.

Conclusions

DCM respondents contrasted the predominately precontemplative benchmark sample mapping across the contemplative, preparation, and action stages of the transtheoretical health behavior change model. Almost 10% of variation in the recent and 13% of variation in the intended health behavior changes can be explained by DCM exposure and demographic factors, indicating the acceptability of this men’s eHealth resource.

Impact of adult weight management interventions on mental health: a systematic review and meta-analysis protocol

INTRODUCTION

The effects of interventions targeting weight loss on physical health are well described, yet the evidence for mental health is less clear. It is essential to better understand the impact of weight management interventions on mental health to optimise care and minimise risk of harm. We will assess the effect of behavioural weight management interventions on mental health in adults with overweight and obesity.

METHODS AND ANALYSIS

The systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. We will include behavioural weight management interventions with a diet and/or physical activity component focusing on weight loss for adults with a body mass index ≥25 kg/m2. Randomised controlled trials (RCTs) and cluster RCTs will be the only eligible study designs. Outcomes of interest will be related to mental health. The following databases were searched from inception to 07 May 2019: MEDLINE, Embase, Cochrane database (CENTRAL), PsycINFO, ASSIA, AMED and CINAHL. The search strategy was based on four concepts: (1) adults, defined as ≥18 years, with overweight/obesity, defined as BMI ≥25kg/m², (2) weight management interventions, (3) mental health outcomes and (4) study design. The search was restricted to English-language published papers, with no other restrictions applied. Two stage screening for eligibility will be completed by two independent reviewers, with two independent reviewers completing data extraction and risk of bias assessment. Data permitting, a random-effects meta-analysis of outcomes, subgroup analyses and meta-regression will be conducted. If not appropriate, narrative synthesis and 'levels of evidence' assessment will be completed.

ETHICS AND DISSEMINATION

Ethical approval is not required as primary data will not be collected. The completed systematic review will be disseminated in a peer-reviewed journal, at conferences and contribute towards the lead author's PhD thesis.

PROSPERO REGISTRATION NUMBER

CRD42019131659.