<scp>eH</scp>ealth interventions for the prevention and treatment of overweight and obesity in adults: a systematic review with meta‐analysis

Hutchesson, Melinda J.; Rollo, Megan E.; Krukowski, Rebecca A.; Ells, Louisa; Harvey, Jean; Morgan, Philip J.; Callister, Robin; Plotnikoff, Ronald C.; Collins, Clare E.

doi:10.1111/obr.12268

Cited by 354 publications

(379 citation statements)

References 105 publications

(329 reference statements)

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“…For example, Hutchesson et al (2015) found that eHealth weight-loss interventions could generate significantly greater weight loss than minimal interventions. This is encouraging but the 183 interventions considered in this review included a variety of delivery formats including self-directed interventions and those that involve regular online professional contact (e.g.…”

Section: Introductionmentioning

confidence: 99%

Self-directed interventions to promote weight loss: a systematic review and meta-analysis

Tang

Abraham

Greaves

et al. 2016

Health Psychology Review

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Downloaded by [2.124.227.49] at 11:47 19 April 2016 2 Many self-directed weight-loss interventions have been developed using a variety of delivery formats (e.g. internet, smartphone) and change techniques. Yet, little research has examined whether self-directed interventions can exclusively promote weight loss. MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Library were systematically reviewed for randomised controlled trials evaluating self-directed interventions in relation to weight loss outcomes in adults. Standard mean differences (SMD) and 95% confidence intervals (CI) were calculated using a random effects model. Twenty-seven trials incorporating 36 comparisons met our inclusion criteria. Participants using self-directed interventions lost significantly more weight (MD = -1.56 kg, CI -2.25, -0.86 ranging from 0.6 to 5.3 kg) compared to those in the minimal-intervention or no-treatment groups (3.1-month follow-up median). The majority of interventions were internet-based (18 evaluations) and these were effective at 3 months (MD = -1.74 kg, CI -2.65, -0.82 ranging from 0.6 to 4.8 kg) (SMD = -0.48, 95% CI -0.72, -0.24, I² = 82%; p < .0001; 16 evaluations) and 6 months follow-up (MD = -2.71 kg, CI -4.03, -1.39 ranging from 2.2 to 5.3 kg) (SMD = -0.59, 95% CI -0.99, -0.19, I² = 76%; p = .004; 4 evaluations). Self-directed weight-loss interventions can generate modest weight loss for up to 6 months but may need to be supplemented by other interventions to achieve sustained and clinically meaningful weight loss.

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Section: Introductionmentioning

confidence: 99%

Self-directed interventions to promote weight loss: a systematic review and meta-analysis

Tang

Abraham

Greaves

et al. 2016

Health Psychology Review

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“…With near-universal mobile phone ownership and three-quarters of the population now having daily access to the internet, eHealth and mHealth interventions are increasingly being used to promote lifestyle intervention. 230,231 The integration of such technological platforms into traditional behaviour change interventions may help to maximise engagement and better reflect changing societal norms around communication and feedback. Further research is therefore needed to investigate the efficacy of integrating mHealth and eHealth approaches with traditional interventions such as Let's Prevent.…”

Section: Research Recommendationsmentioning

confidence: 99%

A community-based primary prevention programme for type 2 diabetes mellitus integrating identification and lifestyle intervention for prevention: a cluster randomised controlled trial

Davies

Gray

Ahrabian

et al. 2017

Programme Grants Appl Res

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BackgroundPrevention of type 2 diabetes mellitus (T2DM) is a global priority; however, there is a lack of evidence investigating how to effectively translate prevention research into a primary care setting.Objectives(1) To develop and validate a risk score to identify individuals at high risk of T2DM in the UK; and (2) to establish whether or not a structured education programme targeting lifestyle and behaviour change was clinically effective and cost-effective at preventing progression to T2DM in people with prediabetes mellitus (PDM), identified through a risk score screening programme in primary care.DesignA targeted screening study followed by a cluster randomised controlled trial (RCT), with randomisation at practice level. Participants were followed up for 3 years.SettingA total of 44 general practices across Leicestershire, UK. The intervention took place in the community.ParticipantsA total of 17,972 individuals from 44 practices identified through the risk score as being at high risk of T2DM were invited for screening; of these, 3449 (19.2%) individuals attended. All received an oral glucose tolerance test. PDM was detected in 880 (25.5%) of those screened. Those with PDM were included in the trial; of these, 36% were female, the average age was 64 years and 16% were from an ethnic minority group.InterventionPractices were randomised to receive either standard care or the intervention. The intervention consisted of a 6-hour group structured education programme, with an annual refresher and regular telephone contact.Main outcome measuresThe primary outcome was progression to T2DM. The main secondary outcomes were changes in glycated haemoglobin concentrations, blood glucose levels, cardiovascular risk, the presence of metabolic syndrome, step count and the cost-effectiveness of the intervention.ResultsA total of 22.6% of the intervention group did not attend the education and 29.1% attended all sessions. A total of 131 participants developed T2DM (standard care,n = 67; intervention,n = 64). There was a 26% reduced risk of T2DM in the intervention arm compared with standard care, but this did not reach statistical significance (hazard ratio 0.74, 95% confidence interval 0.48 to 1.14;p = 0.18). There were statistically significant improvements in glycated haemoglobin concentrations, low-density lipoprotein cholesterol levels, psychosocial well-being, sedentary time and step count in the intervention group. The intervention was found to result in a net gain of 0.046 quality-adjusted life-years over 3 years at a cost of £168 per patient, with an incremental cost-effectiveness ratio of £3643 and a probability of 0.86 of being cost-effective at a willingness-to-pay threshold of £20,000.ConclusionsWe developed and validated a risk score for detecting those at high risk of undiagnosed PDM/T2DM. We screened > 3400 people using a two-stage screening programme. The RCT showed that a relatively low-resource pragmatic programme may lead to a reduction in T2DM and improved biomedical and psychosocial outcomes, and is cost-effective.LimitationsOnly 19% of those invited to screening attended, which may limit generalisability. The variation in cluster size in the RCT may have limited the power of the study.Future workFuture work should focus on increasing attendance to both screening and prevention programmes and offering the programme in different modalities, such as web-based modalities. A longer-term follow-up of the RCT participants would be valuable.Trial registrationCurrent Controlled Trials ISRCTN80605705.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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“…While important advances have been made and successes realized [6,7], there are numerous examples of carefully designed and wellimplemented interventions that had small effects or were ineffective [8][9][10][11][12][13][14]. Effective interventions have shown diminished effectiveness when disseminated perhaps due to their complex nature and intensive components [15].…”

Section: Introductionmentioning

confidence: 99%

Deconstructing interventions: approaches to studying behavior change techniques across obesity interventions

Tate

Lytle

Sherwood

et al. 2016

Behav. Med. Pract. Policy Res.

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Deconstructing interventions into the specific techniques that are used to change behavior represents a new frontier in behavioral intervention research. This paper considers opportunities and challenges in employing the Behavior Change Techniques Taxonomy (BCTTv1) developed by Michie and colleagues, to code the behavior change techniques (BCTs) across multiple interventions addressing obesity and capture dose received at the technique level. Numerous advantages were recognized for using a shared framework for intervention description. Coding interventions at levels of the social ecological framework beyond the individual level, separate coding for behavior change initiation vs. maintenance, fidelity of BCT delivery, accounting for BCTs mode of delivery, and tailoring BCTs, present both challenges and opportunities. Deconstructing interventions and identifying the dose required to positively impact health-related outcomes could enable important gains in intervention science.

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eHealth interventions for the prevention and treatment of overweight and obesity in adults: a systematic review with meta‐analysis

Cited by 354 publications

References 105 publications

Self-directed interventions to promote weight loss: a systematic review and meta-analysis

Self-directed interventions to promote weight loss: a systematic review and meta-analysis

A community-based primary prevention programme for type 2 diabetes mellitus integrating identification and lifestyle intervention for prevention: a cluster randomised controlled trial

Deconstructing interventions: approaches to studying behavior change techniques across obesity interventions

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