Development of a Web-Based, Guided Self-help, Acceptance and Commitment Therapy–Based Intervention for Weight Loss Maintenance: Evidence-, Theory-, and Person-Based Approach

Abstract

Background The long-term impact and cost-effectiveness of weight management programs depend on posttreatment weight maintenance. There is growing evidence that interventions based on third-wave cognitive behavioral therapy, particularly acceptance and commitment therapy (ACT), could improve long-term weight management; however, these interventions are typically delivered face-to-face by psychologists, which limits the scalability of these types of intervention. Objective The aim of this study is to use an evidence-, theory-, and person-based approach to develop an ACT-based intervention for weight loss maintenance that uses digital technology and nonspecialist guidance to minimize the resources needed for delivery at scale. Methods Intervention development was guided by the Medical Research Council framework for the development of complex interventions in health care, Intervention Mapping Protocol, and a person-based approach for enhancing the acceptability and feasibility of interventions. Work was conducted in two phases: phase 1 consisted of collating and analyzing existing and new primary evidence and phase 2 consisted of theoretical modeling and intervention development. Phase 1 included a synthesis of existing evidence on weight loss maintenance from previous research, a systematic review and network meta-analysis of third-wave cognitive behavioral therapy interventions for weight management, a qualitative interview study of experiences of weight loss maintenance, and the modeling of a justifiable cost for a weight loss maintenance program. Phase 2 included the iterative development of guiding principles, a logic model, and the intervention design and content. Target user and stakeholder panels were established to inform each phase of development, and user testing of successive iterations of the prototype intervention was conducted. Results This process resulted in a guided self-help ACT-based intervention called SWiM (Supporting Weight Management). SWiM is a 4-month program consisting of weekly web-based sessions for 13 consecutive weeks followed by a 4-week break for participants to reflect and practice their new skills and a final session at week 18. Each session consists of psychoeducational content, reflective exercises, and behavioral experiments. SWiM includes specific sessions on key determinants of weight loss maintenance, including developing skills to manage high-risk situations for lapses, creating new helpful habits, breaking old unhelpful habits, and learning to manage interpersonal relationships and their impact on weight management. A trained, nonspecialist coach provides guidance for the participants through the program with 4 scheduled 30-minute telephone calls and 3 further optional calls. Conclusions This comprehensive approach facilitated the development of an intervention that is based on scientific theory and evidence for supporting people with weight loss maintenance and is grounded in the experiences of the target users and the context in which it is intended to be delivered. The intervention will be refined based on the findings of a planned pilot randomized controlled trial.

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

“…In addition, the success or failure of digital interventions subsequently depends on whether individual end user needs are met [ 32 , 115 ]. The development of technology-supported programs for weight loss maintenance based on theory, evidence, and person-based approaches is gradually receiving increased attention [ 116 - 119 ]. The eCHANGE intervention’s value-based approach to eHealth development, in which PSD principles and BCTs identified to match end user values and needs [ 32 ] were gradually embedded into the digital technology through the design features, represents a major novelty.…”

UK dietitians' attitudes and experiences of formula very low‐ and low‐energy diets in clinical practice

“…Furthermore, it was acknowledged that clinical psychology was considered an essential part of the MDT to help support long‐term weight loss and adherence, despite there being limited access to psychology in current practice 15 . This suggestion is likely to be due to multiple factors including reflection of national guideline for specialist service provision, 15 also, evidence is emerging for the role of third‐wave cognitive therapies, e.g., acceptance and commitment therapy and their benefit for both weight loss and weight loss maintenance 16,17 . Dietitians also felt that a lack of effective infrastructure to help support service delivery, including facilities, administrative support and capacity, meaning that using VLED/LED was negatively impacted.…”

“… 15 This suggestion is likely to be due to multiple factors including reflection of national guideline for specialist service provision, 15 also, evidence is emerging for the role of third‐wave cognitive therapies, e.g., acceptance and commitment therapy and their benefit for both weight loss and weight loss maintenance. 16 , 17 Dietitians also felt that a lack of effective infrastructure to help support service delivery, including facilities, administrative support and capacity, meaning that using VLED/LED was negatively impacted. These points highlight the importance of ensuring that VLED/LED programmes have the access to the appropriate staffing and support services prior to commencing to ensure long‐term success which may present a challenge for NHS services to effectively incorporate VLED/LED programmes without additional funding.…”

Acceptability and feasibility of an acceptance and commitment therapy-based guided self-help intervention for weight loss maintenance in adults who have previously completed a behavioural weight loss programme: the SWiM feasibility study protocol

“…Between sessions, participants are asked to complete more reflective exercises and behavioural experiments (called ‘SWiM Practice’). Full details of intervention content have been published elsewhere 8…”