Self-Directed Interventions to Promote Weight Loss: A Systematic Review of Reviews

Abstract

BackgroundA wide range of self-directed weight-loss interventions are available, providing users with a variety of tools delivered through various formats to regulate weight-related behavior patterns. However, it is unclear how effective self-directed interventions are and how they promote weight loss and weight maintenance.ObjectiveA systematic review of reviews was conducted to examine the effectiveness of such interventions and to identify intervention content associated with effectiveness.MethodsMEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Library for systematic reviews were searched from 2000-2012 for reviews of the effectiveness of self-directed interventions on weight loss and weight maintenance in adults. Two reviewers used predefined inclusion criteria to select relevant reviews and assess their quality using the Overview Quality Assessment Questionnaire (OQAQ). We extracted data on effectiveness and on relationships between intervention characteristics and effectiveness.ResultsTwenty reviews were included and quality assessed. Findings relevant to self-directed interventions, including interactive websites, smartphone applications, and text messaging (short message service, SMS) were summarized. Findings were mixed but promising. For example, one review of Internet-based interventions found that, when used in conjunction with standard weight loss programs, these interventions resulted in a significant average increase in weight loss of 1.5 kg over evaluation periods. Unfortunately, only 7 of 20 reviews were of high methodological quality according to OQAQ scores, and only 4 employed meta-analyses. Few reviews linked intervention content to effectiveness.ConclusionsCurrent evidence suggests that self-directed interventions can independently promote weight loss and can augment interventions involving personal contact. Particular change techniques and delivery modes including individualized feedback, email counseling, and online social support appear to enhance effectiveness. Further reviews of the content of self-directed weight-loss intervention studies are needed to clarify which change techniques delivered through which delivery formats optimize intervention effectiveness.

How can weight‐loss app designers' best engage and support users? A qualitative investigation

“…E-health interventions have been found to be effective in facilitating change across a range of health behaviours including weight loss and diabetes self-management (e.g. Gabriele et al, 2011;Munoz et al, 2006;Tang, Abraham, Greaves & Yates, 2014;Wieland et al, 2012).…”

Frequency of Counseling Sessions and Weight Loss Maintenance in a Commercial Lifestyle-Based Weight Management Program

“…It was predicted that teens would better sustain their health-and weight-related behavior changes with more frequent, ongoing technology-based support, but no significant differences were found in sustained behavior change between those who did and did not receive the supplemental contact at the end of 12 and 24 months. It was proposed that the infrequent in-person sessions might have been an inadequate level of support to be overcome by supplemental text-and phone-based contact Tang et al, 2014;, it was hypothesized that those participants who visited their counselors more often would demonstrate better rates of WLM.…”

“…Selfdirected programs are independently utilized by participants at their own discretion via a website or printed materials, typically without personalized contact with an interventionist (Tang et al, 2014;Thomas et al, 2010). In contrast, personalized programs provide individualized feedback and direct interaction between the participant and the interventionist, with contact methods ranging from in-person group or individual sessions to technology-based communication via phone, text-message, or email .…”

“…The same contact options used in weight loss programs have been explored in WLM, ranging from self-directed and/or strictly technology-based modalities to personalized contact by telephone or email and individual or group in-person sessions with a trained health professional. Contact frequency typically ranges from biweekly to quarterly, and duration of support may vary widely from less than 6 months to several years (Ashley et al, 2001;Tang et al, 2014). Most long term WLM programs follow participants for 12, 24, or 36 months after weight loss; few have traced maintenance patterns for at least 5 years Perri, 2014;Radcliff et al, 2012;Thomas et al, 2010;.…”

“…in-person, telephone, technology-based, mail) for WLM treatments remain under investigation Tang, Abraham, Greaves, & Yates, 2014;Thomas, Vydelingum, & Lawrence, 2010;. One feature such studies have in common, however, is that the frequency of contact with the participants is predetermined by the research design, offering little or no freedom for participants or investigators to alter the frequency or method of contact in response to changes in a participant's needs over time.…”