Setting goal and implementation intentions in consultations between practice nurses and patients with overweight or obesity in general practice

AbstractObjectivePatients with overweight or obesity increasingly attend general practice, which is an ideal setting for weight-loss counselling. The present study is the first to investigate the quality of weight-loss counselling provided by practice nurses in general practice to patients with overweight or obesity, in order to identify points for improvement.DesignAn observational checklist was developed to assess goal and implementation intentions and ‘missed opportunities for lifestyle counselling’. Comparisons were made with overall consultation goals set by practice nurses, as measured in a post-visit questionnaire.SettingDutch general practice.SubjectsOne hundred video-taped consultations (2010/2011) between practice nurses and patients with overweight or obesity.ResultsHalf of the consultations contained a goal intention, of which the majority aimed to change eating behaviour. Only part of these goal intentions could be considered implementation intentions. It appeared that actions (how elements) were not often included here. Lifestyle change was more often perceived as an overall consultation goal than weight change. Regarding patterns of overall consultation goals, the majority addressed only one lifestyle factor at a time. If practice nurses formulated weight change in their overall consultation goal, they also used goal or implementation intentions, especially for weight change. In a quarter of the consultations, practice nurses did not ask any further questions about weight, nutrition or physical activity to gain insight, which is an important ‘missed opportunity for lifestyle counselling’.ConclusionsMatching implementation intentions to the broader overall consultation goals of practice nurses would be meaningful, leading to desired goal-directed behaviours and subsequent goal attainment.

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Patterns of self-monitoring technology use and weight loss in people with overweight or obesity

Translational Behavioral Medicine ◽

10.1093/tbm/ibab015 ◽

2021 ◽

Author(s):

Michael C Robertson ◽

Margaret Raber ◽

Yue Liao ◽

Ivan Wu ◽

Nathan Parker ◽

...

Keyword(s):

Weight Loss ◽

Linear Regression ◽

Multiple Linear Regression ◽

Weight Change ◽

Technology Use ◽

Latent Profile Analysis ◽

Monitoring Technology ◽

Self Monitoring ◽

Monitoring Technologies ◽

Overweight Or Obesity

Abstract Mobile applications and paired devices allow individuals to self-monitor physical activity, dietary intake, and weight fluctuation concurrently. However, little is known regarding patterns of use of these self-monitoring technologies over time and their implications for weight loss. The objectives of this study were to identify distinct patterns of self-monitoring technology use and to investigate the associations between these patterns and weight change. We analyzed data from a 6-month weight loss intervention for school district employees with overweight or obesity (N = 225). We performed repeated measures latent profile analysis (RMLPA) to identify common patterns of self-monitoring technology use and used multiple linear regression to evaluate the relationship between self-monitoring technology use and weight change. RMLPA revealed four distinct profiles: minimal users (n = 65, 29% of sample), activity trackers (n = 124, 55%), dedicated all-around users (n = 25, 11%), and dedicated all-around users with exceptional food logging (n = 11, 5%). The dedicated all-around users with exceptional food logging lost the most weight (X2[1,225] = 5.27, p = .0217). Multiple linear regression revealed that, adjusting for covariates, only percentage of days of wireless weight scale use (B = −0.05, t(212) = −3.79, p < .001) was independently associated with weight loss. We identified distinct patterns in mHealth self-monitoring technology use for tracking weight loss behaviors. Self-monitoring of weight was most consistently linked to weight loss, while exceptional food logging characterized the group with the greatest weight loss. Weight loss interventions should promote self-monitoring of weight and consider encouraging food logging to individuals who have demonstrated consistent use of self-monitoring technologies.

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Efficacy and Safety of Once-Weekly Subcutaneous Semaglutide 2.4 MG in Adults With Overweight or Obesity (STEP 1)

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.018 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A10-A10

Author(s):

John P H Wilding ◽

Rachel L Batterham ◽

Salvatore Calanna ◽

Melanie Davies ◽

Luc F Van Gaal ◽

...

Keyword(s):

Risk Factors ◽

Weight Loss ◽

Body Weight ◽

Weight Management ◽

Treatment Adherence ◽

Weight Change ◽

Cardiometabolic Risk ◽

Body Weight Change ◽

Efficacy And Safety ◽

Overweight Or Obesity

Abstract Background: Despite the increasing global adverse health impact of obesity, there are few pharmacological options for effective weight management. STEP 1 investigated the efficacy and safety of the glucagon-like peptide-1 analogue, subcutaneous (s.c.) semaglutide, for weight management in adults with overweight or obesity. Methods: This randomized, double-blind, placebo-controlled, phase 3 trial was conducted at 129 sites across 16 countries (NCT03548935). Adults aged ≥18 years with either body mass index (BMI) ≥30 kg/m2 or BMI ≥27 kg/m2 with ≥1 weight-related comorbidity, without type 2 diabetes, were randomized 2:1 to 68 weeks’ treatment with once-weekly s.c. semaglutide 2.4 mg or placebo, both as adjunct to lifestyle intervention. The co-primary endpoints were percentage change in body weight and achievement of weight loss ≥5%. Cardiometabolic risk factors, patient-reported outcomes, and safety/tolerability were also assessed. Two estimands were defined: treatment policy (effect regardless of treatment adherence and use of rescue intervention) and trial product (effect assuming treatment adherence and without rescue intervention); results are presented for the treatment policy estimand, unless stated otherwise. P values for parameters marked with # were not controlled for multiplicity. Results: 1961 randomized participants (mean age 46 years, body weight 105.3 kg, BMI 37.9 kg/m2; 74.1% female) were included. Mean body weight change from baseline to week 68 was −14.9% in the semaglutide group vs −2.4% with placebo (estimated treatment difference [ETD]: −12.4%; 95% confidence interval (CI): −13.4, −11.5; p<0.0001). Similar results were obtained with the trial product estimand: mean body weight change# was -16.9% for semaglutide vs -2.4% for placebo (ETD: -14.4%; 95% CI: -15.3, -13.6; p<0.0001). Participants were more likely to achieve weight loss ≥5%, ≥10%, ≥15%, and ≥20%# with semaglutide vs placebo (86.4% vs 31.5%, 69.1% vs 12.0%, 50.5% vs 4.9%, and 32.0% vs 1.7%, respectively; p<0.0001 for all). Greater improvements were seen with semaglutide vs placebo in waist circumference, BMI#, systolic and diastolic# blood pressure, glycated hemoglobin#, fasting plasma glucose#, C-reactive protein#, fasting lipid profile#, and self-reported physical functioning (p<0.05 for all). No new safety signals with semaglutide were observed. The most frequent adverse events with semaglutide were gastrointestinal disorders (typically transient and mild-to-moderate). Conclusion: In adults with overweight or obesity, once-weekly s.c. semaglutide 2.4 mg plus lifestyle intervention induced a mean weight loss of approximately 15% by week 68. Clinically beneficial weight loss of ≥10% was achieved by over two-thirds of participants and ≥20% by one-third of participants, along with associated improvements in cardiometabolic risk factors and physical functioning.

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ImpulsePal: The systematic development of a smartphone app to manage food temptations using intervention mapping

Digital Health ◽

10.1177/20552076211057667 ◽

2021 ◽

Vol 7 ◽

pp. 205520762110576

Author(s):

Samantha B van Beurden ◽

Colin J Greaves ◽

Charles Abraham ◽

Natalia S Lawrence ◽

Jane R Smith

Keyword(s):

Weight Loss ◽

Implementation Intentions ◽

Intervention Mapping ◽

Eating Behaviour ◽

Study Patient ◽

Smartphone App ◽

Advisory Group ◽

Management Intervention ◽

Adoption And Implementation ◽

Context Specific

Background Impulsive processes driving eating behaviour can often undermine peoples’ attempts to change their behaviour, lose weight and maintain weight loss. Aim To develop an impulse management intervention to support weight loss in adults. Methods Intervention Mapping (IM) was used to systematically develop the “ImpulsePal” intervention. The development involved: (1) a needs assessment including a qualitative study, Patient and Public advisory group and expert group consultations, and a systematic review of impulse management techniques; (2) specification of performance objectives, determinants, and change objectives; (3) selection of intervention strategies (mapping of change techniques to the determinants of change); (4) creation of programme materials; (5) specification of adoption and implementation plans; (6) devising an evaluation plan. Results Application of the IM Protocol resulted in a smartphone app that could support reductions in unhealthy (energy dense) food consumption, overeating, and alcoholic and sugary drink consumption. ImpulsePal includes inhibition training, mindfulness techniques, implementation intentions (if-then planning), visuospatial loading, use of physical activity for craving management, and context-specific reminders. An “Emergency Button” was also included to provide access to in-the-moment support when temptation is strong. Conclusions ImpulsePal is a novel, theory- and evidence-informed, person-centred app that aims to support impulse management for healthier eating. Intervention Mapping facilitated the incorporation of app components that are practical operationalisations of change techniques targeting our specific change objectives and their associated theoretical determinants. Using IM enabled transparency and provided a clear framework for evaluation, and enhances replicability and the potential of the intervention to accomplish the desired outcome of facilitating weight loss through dietary change.

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How effective is weight loss in reducing cardiometabolic risk? An observational analysis of two randomised controlled trials of community weight loss programmes

British Journal of General Practice ◽

10.3399/bjgp20x714113 ◽

2020 ◽

pp. bjgp20X714113

Author(s):

Elizabeth Morris ◽

Susan Jebb ◽

Jason Lee Oke ◽

Alecia Nickless ◽

Amy Ahern ◽

...

Keyword(s):

Blood Pressure ◽

Primary Care ◽

Weight Loss ◽

Weight Change ◽

Cardiometabolic Risk ◽

Plasma Lipids ◽

Observational Analysis ◽

Individual Level ◽

Randomised Controlled ◽

Overweight Or Obesity

Abstract Background: Guidelines recommend clinicians identify individuals at high cardiometabolic risk and support weight loss in those with overweight or obesity. However, individual level data quantifying the benefits of weight change for individuals, to guide these discussions in primary care, is lacking. Aim: Examine how weight change affects cardiometabolic risk factors, to facilitate shared decision-making between patients and clinicians regarding weight loss. Design and setting: Observational analysis using data from two trials of referral of individuals with overweight or obesity in primary care to community weight loss groups. Method: Linear mixed effects regression modelling, examining the association between weight change and change in systolic and diastolic blood pressure (SBP,DBP), fasting glucose, HbA1c, and lipid profile across multiple timepoints (baseline to 24 months). Subgroup analyses examined changes in individuals with hypertension, diabetes and hyperlipidaemia. Results: 2041 participants had a mean(±SD) age of 50 ±13.5 years, baseline weight 90.6 ±14.8kg and Body Mass Index 32.7 ±4.1kg/m2. Mean(±SD) weight change was -4.3 ±6.0kg. All outcome measures showed statistically significant improvements. Each 1kg weight loss was associated with 0.4mmHg reduction in SBP and 0.3mmHg reduction in DBP, or 0.5mmHg and 0.4mmHg/kg respectively in people with hypertension. Each 1kg weight loss was associated with 0.2mol/mol reduction in HbA1c, or 0.6mmol/mol in people with diabetes. Effects on plasma lipids were negligible. Conclusion: Weight loss achieved through referral to community weight loss programmes, which are commonly accessible in primary care, can lead to clinically relevant reductions in blood pressure and glucose regulation, especially in those at highest risk.

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Does weight loss reduce the incidence of total knee and hip replacement for osteoarthritis?—A prospective cohort study among middle-aged and older adults with overweight or obesity

International Journal of Obesity ◽

10.1038/s41366-021-00832-3 ◽

2021 ◽

Author(s):

Xingzhong Jin ◽

Alice A. Gibson ◽

Joanne Gale ◽

Francisco Schneuer ◽

Ding Ding ◽

...

Keyword(s):

Older Adults ◽

Weight Loss ◽

Weight Gain ◽

Weight Change ◽

Hip Replacement ◽

Baseline Body Mass Index ◽

Middle Aged ◽

Increased Risk ◽

Total Knee ◽

Overweight Or Obesity

Abstract Objective This study aims to investigate the association between weight change and total knee or hip replacement (TKR or THR) for OA among middle-aged and older adults with overweight or obesity. Method Weight data were collected in 2006–2009 and in 2010 from the 45 and Up Study—a population-based cohort aged ≥45 years in New South Wales, Australia. Participants were included if they had a baseline body mass index (BMI) ≥ 25 kg/m2 and no history of TKR or THR. Weight change was categorised into four groups: >7.5% loss; >5–7.5% loss; stable (≤5% change) and >5% gain. Hospital admission data were linked to identify TKR and THR for OA, and multivariable Cox regression was used to assess risk of TKR and THR. Results Of 23,916 participants, 2139 lost >7.5% weight, 1655 lost 5–7.5% weight, and 4430 gained >5% weight. Over 5.2 years, 1009 (4.2%) underwent TKR and 483 (2.0%) THR. Compared to weight-stable, weight loss of >7.5% was associated with reduced risk of TKR after adjusting for age, sex, BMI, socioeconomic and lifestyle factors (hazard ratio 0.69, 95%CI 0.54–0.87), but had no association with THR. Weight loss of 5–7.5% was not associated with altered risk of either TKR or THR. Weight gain was associated with increased risk of THR after adjusting for confounders, but not TKR. Conclusion This study suggests that a weight loss target >7.5% is required to reduce the risk of TKR in adults with overweight or obesity. Weight gain should be avoided as it increases the risk of THR.

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Beyond the concept of 10,000 steps a day: association of physical activity level and variability with 6-month weight change in a real-life study among 26,935 users of connected devices (Preprint)

10.2196/preprints.25385 ◽

2020 ◽

Author(s):

Douae El Fatouhi ◽

Lidia Delrieu ◽

Catherine Goetzinger ◽

Laurent Malisoux ◽

Aurélie Affret ◽

...

Keyword(s):

Physical Activity ◽

Weight Loss ◽

Weight Change ◽

Real Life ◽

Activity Level ◽

Lifestyle Factor ◽

Daily Step ◽

Life Study ◽

Activity Trackers ◽

Wearable Activity Trackers

BACKGROUND Physical Activity (PA) is a modifiable lifestyle factor that can be targeted for increasing energy expenditure and promoting weight loss. However, results regarding the efficient PA amount for weight loss remain heterogeneous. Wearable activity trackers constitute a valuable opportunity to obtain objective measurements regarding PA and study large populations in real-life settings. OBJECTIVE We aimed to study the associations of 1) objectively-assessed PA characteristics (PA level and variability) and 2) their evolution with six-month weight change. METHODS We analyzed data from 26,935 Withings connected device users (wearable activity trackers and digital scales). We used the monthly mean of daily step values as a proxy for PA level and derived the monthly coefficient of variation (CV) of daily step values to estimate PA level variability. Associations between PA characteristics and six-month weight change were assessed using multivariable linear regression analyses controlled for age, sex, blood pressures, heart rate, and the predominant season. Restricted cubic spline regression was performed to better characterize the continuous shape of the associations between PA characteristics and weight change. Secondary analyses were performed by analyzing the six-month evolution of PA characteristics in relation with weight change. RESULTS Our results revealed that both a greater PA level and a lesser PA level variability were associated with weight loss. Compared with individuals who were initially in the sedentary category (<5,000 steps/day), low active (5,000–7,499), somewhat active (7,500–9,999), and active (≥10,000) individuals had a 0.21 kg, a 0.52 kg, and a 1.17 kg greater decrease in weight, respectively (95%CI: -0.36,-0.06; 95%CI: -0.70,-0.33; 95%CI: -1.42,-0.93). We also observed that each 1,000 steps/day increase in PA level over the six-month follow-up was associated with a 0.26 kg (95%CI: -0.29,-0.23) decrease in weight. No association was found between the six-month change in PA level variability and weight change. CONCLUSIONS Our results add to the current body of knowledge that health benefits can be observed below the 10,000 steps/day threshold and suggest that not only increasing mean PA level is important, but also that greater regularity of PA level, irrespectively of PA level, may play an important role for short-term weight loss.

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Efficacy and Safety of Semaglutide 2.4 MG Once-Weekly in Adults With Overweight or Obesity and Type 2 Diabetes (STEP 2)

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.019 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A10-A11

Author(s):

Melanie Davies ◽

Louise Færch ◽

Ole K Jeppesen ◽

Arash Pakseresht ◽

Sue D Pedersen ◽

...

Keyword(s):

Type 2 Diabetes ◽

Weight Loss ◽

Body Weight ◽

Weight Management ◽

Weight Change ◽

Body Weight Change ◽

Efficacy And Safety ◽

Treatment Policy ◽

Overweight Or Obesity

Abstract Background: In people with overweight/obesity and type 2 diabetes (T2D), achievement of weight loss can be a challenge. STEP 2 investigated the efficacy and safety of semaglutide 2.4 mg for weight management in adults with overweight/obesity and T2D. Methods: This randomized, double-blind, double-dummy, placebo-controlled, phase 3 trial was conducted at 149 sites across 12 countries (NCT03552757). Adults aged ≥18 years with body mass index (BMI) ≥27 kg/m2, T2D, HbA1c between 7–10% (53–86 mmol/mol), and receiving ≤3 oral glucose-lowering agents were randomized 1:1:1 to once-weekly subcutaneous (s.c.) semaglutide 2.4 mg or 1.0 mg, or placebo, as adjunct to a reduced-calorie diet and increased physical activity for 68 weeks. The co-primary endpoints were percentage change in body weight and proportion of participants achieving weight loss ≥5% for semaglutide 2.4 mg vs placebo. Cardiovascular risk factors, glycemia and safety/tolerability were also assessed. Two estimands were defined: treatment policy and trial product; results are presented for the treatment policy estimand, unless stated otherwise. Results: 1,210 participants (mean: age 55 years, body weight 99.8 kg, BMI 35.7 kg/m2, HbA1c 8.1%, diabetes duration 8.0 years; 50.9% female) were randomized. Mean body weight change from baseline to week 68 was −9.6% with semaglutide 2.4 mg vs −3.4% with placebo (estimated treatment difference [ETD]: −6.2%; 95% confidence interval [CI]: −7.3, −5.2; p<0.0001) and −7.0% for semaglutide 1.0 mg (ETD for semaglutide 2.4 mg vs 1.0 mg: −2.7%; 95% CI: −3.7, −1.6; p<0.0001). Similar results were obtained with the trial product estimand: mean body weight change −10.6% for semaglutide 2.4 mg vs −3.1% for placebo (ETD: −7.6%; 95% CI: −8.6, −6.6; p<0.0001) and 7.6% for semaglutide 1.0 mg (ETD vs semaglutide 2.4 mg: −3.1%; 95% CI: −4.1, −2.1; p<0.0001). Participants on semaglutide 2.4 mg were more likely to achieve weight loss ≥5%, ≥10%, ≥15% and ≥20% vs placebo (68.8% vs 28.5%, 45.6% vs 8.2%, 25.8% vs 3.2% and 13.1% vs 1.6%, respectively; p value for odds ratios <0.0001 for all). Mean change in HbA1c from baseline to week 68 was −1.6% for semaglutide 2.4 mg vs −0.4% for placebo (p<0.0001). Greater improvements with semaglutide 2.4 mg vs placebo were also seen in waist circumference, BMI, systolic blood pressure, fasting plasma glucose, C-reactive protein, and lipids (HDL, VLDL, free fatty acids, and triglycerides) (p<0.05 for all). The most frequent adverse events were gastrointestinal disorders (typically transient and mild-to-moderate), occurring in 57.5%, 63.5% and 34.3% of participants receiving semaglutide 1.0 mg, 2.4 mg and placebo, respectively. Conclusion: Semaglutide 2.4 mg, as adjunct to lifestyle intervention, was efficacious and well tolerated for weight management in adults with overweight or obesity and T2D, providing significantly greater weight loss vs placebo and semaglutide 1.0 mg at week 68.

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Attitude Matters! How Attitude towards Bariatric Surgery Influences the Effects of Behavioural Weight Loss Treatment

Obesity Facts ◽

10.1159/000517850 ◽

2021 ◽

pp. 1-12

Author(s):

Kerstin Bauer ◽

Sandra Schild ◽

Helene Sauer ◽

Martin Teufel ◽

Andreas Stengel ◽

...

Keyword(s):

Quality Of Life ◽

Bariatric Surgery ◽

Weight Loss ◽

Body Weight ◽

Weight Change ◽

Eating Behaviour ◽

Drop Out ◽

Body Weight Change ◽

University Hospitals

Introduction: Multidisciplinary obesity services at university hospitals usually treat patients with more complex and severe obesity. In addition, patients with Class 3 obesity, in particular, have different attitudes regarding the choices of therapy. Methods: This explorative study investigated the effect of patient attitudes towards bariatric surgery on body weight change (primary outcome) and psychological improvement (secondary outcomes: quality of life, depression, anxiety, and eating behaviour) in a 6-month moderate behavioural weight loss (BWL) programme in a university outpatient setting. Results: 297 patients with mostly Class 3 obesity participated in the programme. The patients did not yet have any indications for bariatric surgery. Of the participants, 37% had a positive attitude towards bariatric surgery (POS), whereas 38% had a negative attitude (NEG). The drop-out rate was 8%. NEG participants lost significantly more body weight than the POS participants (intention-to-treat population: 4.5 [SD: 6.3] kg versus 0.4 [SD: 5.8] kg; p < 0.001). In both subgroups, anxiety, depression, the mental score for quality of life, and eating behaviour improved. Conclusion: A BWL treatment in a clinical setting identified 2 distinct groups with different attitudes towards bariatric surgery that were associated with different body weight change outcomes. These groups may require differently targeted programmes to achieve the best body weight loss results.

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Translating hunger training research to primary health: a qualitative study of nurse attitudes towards a novel weight management intervention

Journal of Primary Health Care ◽

10.1071/hc19052 ◽

2020 ◽

Vol 12 (1) ◽

pp. 79

Author(s):

Jennifer T. Gale ◽

Aimee L. Ward ◽

Willemijn E. de Bruin ◽

Rachael W. Taylor ◽

Michelle R. Jospe

Keyword(s):

Primary Care ◽

General Practice ◽

Weight Management ◽

Eating Behaviour ◽

Structured Interview ◽

Practice Nurses ◽

Management Intervention ◽

Stakeholder Perspectives ◽

The Impact ◽

Weight Management Intervention

ABSTRACT INTRODUCTIONPractice nurses in general practice are ideally placed to deliver weight management treatments. Teaching people to eat according to their appetite, based on measurements of blood glucose (‘hunger training’), is known to lead to weight loss and improved eating behaviour. To effectively translate this research to primary care requires understanding of key stakeholder perspectives. AIMThe aim of this study was to explore the perspectives of practice nurses on the suitability of using hunger training as a weight management intervention in general practice. METHODSTen nurses trialled hunger training for 1 week, followed by a semi-structured interview where they were asked about their experience; perceived patient interest; enablers and barriers; and suggested changes to hunger training. RESULTSAll nurses were positive about hunger training and wanted to use it with their patients. They thought it was a useful method for teaching patients about eating according to their appetite, and the impact of food choices on glucose. Motivation was seen to be both an important potential barrier and enabler for patients. Other anticipated patient enablers included the educational value of hunger training and ease of the programme. Other barriers included lack of time and cost of equipment and appointments. For most nurses, 1 week of following hunger training was sufficient training to deliver the intervention. Suggested refinements included adding nutrition advice to the booklet, incorporating other health goals and enabling social support. DISCUSSIONThese findings suggest that hunger training could be translated to primary care with minor modifications.

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ImpulsePal: Developing a Smartphone App to Manage Food Temptations using Intervention Mapping. (Preprint)

10.2196/preprints.11585 ◽

2018 ◽

Cited By ~ 1

Author(s):

Samantha Barbara van Beurden ◽

Colin James Greaves ◽

Natalia Sophie Lawrence ◽

Charles Abraham ◽

Jane Rebecca Smith

Keyword(s):

Weight Loss ◽

Implementation Intentions ◽

Intervention Mapping ◽

Eating Behaviour ◽

Smartphone App ◽

Management Technique ◽

Management Intervention ◽

Adoption And Implementation ◽

Novel Theory ◽

Context Specific

BACKGROUND Impulsive processes driving eating behaviour can often undermine peoples’ attempts to lose weight and maintain weight loss. OBJECTIVE To develop an impulse management intervention to support weight loss in adults. METHODS Intervention Mapping (IM) was used to systematically develop the “ImpulsePal” intervention. The development involved: 1) a needs assessment including a qualitative study, service user workshops, a systematic review of impulse modification techniques, and consultations with intervention design and delivery experts; 2) specification of performance objectives, determinants, and change objectives; 3) selection of intervention strategies (mapping of taxonomy-related change techniques to the determinants of change); 4) creation of programme materials; 5) specification of adoption and implementation plans; 6) devising an evaluation plan. RESULTS Application of the IM Protocol resulted in a smartphone app-based intervention aimed at reducing unhealthy snacking, overeating, and alcoholic and sugary drink consumption. The app includes inhibition training, mindfulness techniques, implementation intentions (if-then planning), visuospatial loading, use of physical activity as a craving-management technique, and context-specific reminders. An “Emergency Button” was also included to provide access to in-the-moment support when temptation is strong. CONCLUSIONS ImpulsePal is a novel, theory- and evidence-informed, person-centred app to improve impulse management and promote healthier eating. Intervention Mapping ensured that all app components are practical operationalisations of change techniques that target our specific change objectives and their associated theoretical determinants. Using this approach enhances transparency, provides a clear framework for analysis and increases replicability as well as the potential of the intervention to accomplish the desired outcome of supporting weight loss.

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