BackgroundDiet is an important determinant of health, and food purchasing is a key antecedent to consumption.ObjectiveWe set out to evaluate the effectiveness of grocery store interventions to change food purchasing, and to examine whether effectiveness varied based on intervention components, setting, or socioeconomic status.DesignWe conducted a systematic review of randomized controlled trials (search performed June 2017). Studies must have: aimed to change food purchasing; been implemented in grocery stores (real or simulated); reported purchasing; and had a minimal control or compared interventions fulfilling our criteria. Searching, screening, bias assessment, and data extraction followed Cochrane methods. We grouped studies by intervention type (economic, environmental, swaps, and/or education), synthesized results narratively, and conducted an exploratory qualitative comparative analysis.ResultsWe included 35 studies representing 89 interventions, >20,000 participants, and >800 stores. Risk of bias was mixed. Economic interventions showed the most promise, with 8 of the 9 studies in real stores and all 6 in simulated environments detecting an effect on purchasing. Swap interventions appeared promising in the 2 studies based in real stores. Store environment interventions showed mixed effects. Education-only interventions appeared effective in simulated environments but not in real stores. Available data suggested that effects of economic interventions did not differ by socioeconomic status, whereas for other interventions impact was variable. In our qualitative comparative analysis, economic interventions (regardless of setting) and environmental and swap interventions in real stores were associated with statistically significant changes in purchasing in the desired direction for ≥1 of the foods targeted by the intervention, whereas education-only interventions in real stores were not.ConclusionsFindings suggest that interventions implemented in grocery stores—particularly ones that manipulate price, suggest swaps, and perhaps manipulate item availability—have an impact on purchasing and could play a role in public health strategies to improve health. Review protocol registered at https://www.crd.york.ac.uk/PROSPERO/ as CRD42017068809.

Introduction The participants' experience of low-energy total diet replacement (TDR) programmes delivered by lay counsellors in the community for the routine treatment of obesity is currently unclear. We interviewed a sample of twelve participants who took part in the Doctor Referral of Overweight People to Low-Energy total diet replacement Treatment (DROPLET) trial and were randomised to the TDR programme. Methods We purposively sampled twelve patients who took part in the DROPLET trial, and conducted in-depth telephone interviews, which were audio-recorded and transcribed verbatim. Interview questions focused on participants' experiences and perceptions of the TDR programme. We conducted a thematic analysis, actively developing themes from the data, and used the one sheet of paper (OSOP) technique to develop higher-level concepts. Results Nine key themes were identified; Reasons for taking part, Expectations, Support and guidance from the counsellor, Time to build a personal relationship, Following the TDR Programme, Adverse events, Outcomes from the TDR, Weight Loss Maintenance, Recommending TDR to others. The relationship between participants and the counsellor was central to many of the themes. Close relationships with counsellors facilitated TDR adherence through providing one-to-one support (including during difficult times), sharing expert knowledge, and building a close relationship. Adherence was also supported by the rapid weight loss that patients reported experiencing. Overall participants reported positive experiences of the TDR, and emphasised the positive impact on their wellbeing.

BackgroundSignificant weight loss takes several months to achieve, and behavioral support can enhance weight loss success. Weight loss apps could provide ongoing support and deliver innovative interventions, but to do so, developers must ensure user satisfaction.ObjectiveThe aim of this study was to conduct a review of Google Play Store apps to explore what users like and dislike about weight loss and weight-tracking apps and to examine qualitative feedback through analysis of user reviews.MethodsThe Google Play Store was searched and screened for weight loss apps using the search terms weight loss and weight track*, resulting in 179 mobile apps. A content analysis was conducted based on the Oxford Food and Activity Behaviors taxonomy. Correlational analyses were used to assess the association between complexity of mobile health (mHealth) apps and popularity indicators. The sample was then screened for popular apps that primarily focus on weight-tracking. For the resulting subset of 15 weight-tracking apps, 569 user reviews were sampled from the Google Play Store. Framework and thematic analysis of user reviews was conducted to assess which features users valued and how design influenced users’ responses.ResultsThe complexity (number of components) of weight loss apps was significantly positively correlated with the rating (r=.25; P=.001), number of reviews (r=.28; P<.001), and number of downloads (r=.48; P<.001) of the app. In contrast, in the qualitative analysis of weight-tracking apps, users expressed preference for simplicity and ease of use. In addition, we found that positive reinforcement through detailed feedback fostered users’ motivation for further weight loss. Smooth functioning and reliable data storage emerged as critical prerequisites for long-term app usage.ConclusionsUsers of weight-tracking apps valued simplicity, whereas users of comprehensive weight loss apps appreciated availability of more features, indicating that complexity demands are specific to different target populations. The provision of feedback on progress can motivate users to continue their weight loss attempts. Users value seamless functioning and reliable data storage.

BackgroundThis review aimed to compare the relative effectiveness of different exercise-based cardiac rehabilitation (ExCR) delivery modes (centre-based, home-based, hybrid and technology-enabled ExCR) on key heart failure (HF) outcomes: exercise capacity, health-related quality of life (HRQoL), HF-related hospitalisation and HF-related mortality.Methods and resultsRandomised controlled trials (RCTs) published through 20 June 2021 were identified from six databases, and reference lists of included studies. Risk of bias and certainty of evidence were evaluated using the Cochrane tool and Grading of Recommendations Assessment, Development and Evaluation, respectively. Bayesian network meta-analysis was performed using R. Continuous and binary outcomes are reported as mean differences (MD) and ORs, respectively, with 95% credible intervals (95% CrI). One-hundred and thirty-nine RCTs (n=18 670) were included in the analysis. Network meta-analysis demonstrated improvements in VO2peak following centre-based (MD (95% CrI)=3.10 (2.56 to 3.65) mL/kg/min), home-based (MD=2.69 (1.67 to 3.70) mL/kg/min) and technology-enabled ExCR (MD=1.76 (0.27 to 3.26) mL/kg/min). Similarly, 6 min walk distance was improved following hybrid (MD=84.78 (31.64 to 138.32) m), centre-based (MD=50.35 (30.15 to 70.56) m) and home-based ExCR (MD=36.77 (12.47 to 61.29) m). Incremental shuttle walk distance did not improve following any ExCR delivery modes. Minnesota living with HF questionnaire improved after centre-based (MD=−10.38 (−14.15 to –6.46)) and home-based ExCR (MD=−8.80 (−13.62 to –4.07)). Kansas City Cardiomyopathy Questionnaire was improved following home-based ExCR (MD=20.61 (4.61 to 36.47)), and Short Form Survey 36 mental component after centre-based ExCR (MD=3.64 (0.30 to 6.14)). HF-related hospitalisation and mortality risks reduced only after centre-based ExCR (OR=0.41 (0.17 to 0.76) and OR=0.42 (0.16 to 0.90), respectively). Mean age of study participants was only associated with changes in VO2peak.ConclusionExCR programmes have broader benefits for people with HF and since different delivery modes were comparably effective for improving exercise capacity and HRQoL, the selection of delivery modes should be tailored to individuals’ preferences.

BackgroundReframing means changing the way that a person thinks or feels about a weight loss attempt or weight loss maintenance to enhance its experience or facilitate its success. Although participants have described this, it has not been explored in the academic literature. Here, we set out to systematically review qualitative studies to examine the ways in which people use and experience reframing in self‐directed weight loss.MethodsSeven electronic databases were searched to January 2017 for qualitative studies of adults with overweight or obesity attempting to lose weight or maintain weight loss through self‐directed behavior change. Studies must have contained some information pertinent to reframing. Thematic synthesis was used to identify descriptive and analytical themes from the available data.ResultsWe included 23 studies, representing 723 participants. No study focused specifically on reframing. Most studies involved people who had tried to lose weight previously. In the most common examples of reframing, participants spoke of construing previous weight management attempts as “dieting”, whereas in current attempts they used reframing to move away from this concept. Participants spoke of finding reframing helpful because it removed the sense of depriving themselves and instead allowed them to construe the food choices as healthful. Likewise, the language of dieting created a sense of temporary effort, while construing this as a way of life allowed continuation of conscious control over energy balance without the feeling of undue effort. In some cases, these changes were bolstered by change in self‐identity.ConclusionsSome people construe deliberate weight loss as a form of deprivation and cognitively reframe to avoid the negative emotions this creates and to prevent relapse. Reframing the dietary regimen as about healthy eating and a new way of life made weight control seem less burdensome for these participants and they felt able to maintain their efforts.