Evidence-Based Digital Tools for Weight Loss Maintenance: The NoHoW Project

Abstract

<b><i>Background:</i></b> Effective interventions and commercial programmes for weight loss (WL) are widely available, but most people regain weight. Few effective WL maintenance (WLM) solutions exist. The most promising evidence-based behaviour change techniques for WLM are self-monitoring, goal setting, action planning and control, building self-efficacy, and techniques that promote autonomous motivation (e.g., provide choice). Stress management and emotion regulation techniques show potential for prevention of relapse and weight regain. Digital technologies (including networked-wireless tracking technologies, online tools and smartphone apps, multimedia resources, and internet-based support) offer attractive tools for teaching and supporting long-term behaviour change techniques. However, many digital offerings for weight management tend not to include evidence-based content and the evidence base is still limited. <b><i>The Project:</i></b> First, the project examined why, when, and how many European citizens make WL and WLM attempts and how successful they are. Second, the project employed the most up-to-date behavioural science research to develop a digital toolkit for WLM based on 2 key conditions, i.e., self-management (self-regulation and motivation) of behaviour and self-management of emotional responses for WLM. Then, the NoHoW trial tested the efficacy of this digital toolkit in adults who achieved clinically significant (≥5%) WL in the previous 12 months (initial BMI ≥25). The primary outcome was change in weight (kg) at 12 months from baseline. Secondary outcomes included biological, psychological, and behavioural moderators and mediators of long-term energy balance (EB) behaviours, and user experience, acceptability, and cost-effectiveness. <b><i>Impact:</i></b> The project will directly feed results from studies on European consumer behaviour, design and evaluation of digital toolkits self-management of EB behaviours into development of new products and services for WLM and digital health. The project has developed a framework and digital architecture for interventions in the context of EB tracking and will generate results that will help inform the next generation of personalised interventions for effective self-management of weight and health.

Smartphone-supported behavioural weight loss treatment in adults with severe obesity: study protocol for an exploratory randomised controlled trial (SmartBWL)

“…36 37 However, evidence-based weight loss strategies were not used comprehensively, 30 which is, however, crucial for successful weight loss and maintenance. 38 Furthermore, only a few smartphone apps for supporting skills use in BWL treatment delivered personalised interventions, [39][40][41] a prerequisite to ensure acceptance and user-friendliness. 42 A promising way to deliver personalised interventions is the use of ecological momentary interventions (EMIs), commonly supplied through smartphone apps.…”

“…Most smartphone apps for weight loss provide self-monitoring tools (eg, for eating, physical activity and/or weight), as a greater use of self-monitoring skills has been linked to higher weight loss 36 37. However, evidence-based weight loss strategies were not used comprehensively,30 which is, however, crucial for successful weight loss and maintenance 38. Furthermore, only a few smartphone apps for supporting skills use in BWL treatment delivered personalised interventions,39–41 a prerequisite to ensure acceptance and user-friendliness 42…”

Nutrition Concepts for the Treatment of Obesity in Adults

“…Digital tools like online tools and applications (apps), tracking technologies, or even internet-based support have become attractive for teaching and supporting long-term behaviour change techniques [ 86 ]. Carter et al examined in a RCT the acceptability and feasibility of a self-monitoring weight management intervention provided by a smartphone app compared to a website and paper diary.…”

A literature review of evidence for primary prevention of overweight and obesity in healthy weight children and adolescents: A report produced by a working group of the Danish Council on Health and Disease Prevention

“…6,9 Accordingly, prevention of development of overweight in early childhood may imply a healthy weight development through adolescence into adulthood. The continuation of overweight and obesity into adulthood combined with low efficacy and sustainability of available long-term treatments of obesity (i.e., lifestyle interventions, 10 pharmacological treatment, 11 psychological interventions, 12 or invasive procedures such as bariatric surgery 13 ) emphasizes the need to prevent overweight and obesity early in life. 6 Moreover, children living with overweight or obesity are more likely to experience psychosocial and psychological comorbidities, such as loneliness, depression, anxiety, and low self-esteem.…”