The H2020 “NoHoW Project”: A Position Statement on Behavioural Approaches to Longer-Term Weight Management

There is substantial evidence documenting the effects of behavioural interventions on weight loss (WL). However, behavioural approaches to initial WL are followed by some degree of longer-term weight regain, and large trials focusing on evidence-based approaches to weight loss maintenance (WLM) have generally only demonstrated small beneficial effects. The current state-of-the-art in behavioural interventions for WL and WLM raises questions of (i) how we define the relationship between WL and WLM, (ii) how energy balance (EB) systems respond to WL and influence behaviours that primarily drive weight regain, (iii) how intervention content, mode of delivery and intensity should be targeted to keep weight off, (iv) which mechanisms of action in complex interventions may prevent weight regain and (v) how to design studies and interventions to maximise effective longer-term weight management. In considering these issues a writing team within the NoHoW Consortium was convened to elaborate a position statement, and behaviour change and obesity experts were invited to discuss these positions and to refine them. At present the evidence suggests that developing the skills to self-manage EB behaviours leads to more effective WLM. However, the effects of behaviour change interventions for WL and WLM are still relatively modest and our understanding of the factors that disrupt and undermine self-management of eating and physical activity is limited. These factors include physiological resistance to weight loss, gradual compensatory changes in eating and physical activity and reactive processes related to stress, emotions, rewards and desires that meet psychological needs. Better matching of evidence-based intervention content to quantitatively tracked EB behaviours and the specific needs of individuals may improve outcomes. Improving objective longitudinal tracking of energy intake and energy expenditure over time would provide a quantitative framework in which to understand the dynamics of behaviour change, mechanisms of action of behaviour change interventions and user engagement with intervention components to potentially improve weight management intervention design and evaluation.

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What goes on in digital behaviour change interventions for weight loss maintenance targeting physical activity: A Scoping Review (Preprint)

10.2196/preprints.28200 ◽

2021 ◽

Author(s):

Jorge Encantado ◽

António L. Palmeira ◽

Carolina Silva ◽

Falko F. Sniehotta ◽

R. James Stubbs ◽

...

Keyword(s):

Physical Activity ◽

Weight Loss ◽

Behaviour Change ◽

Mode Of Delivery ◽

Weight Loss Maintenance ◽

Mechanisms Of Action ◽

Behaviour Change Techniques ◽

Behavioural Interventions ◽

Behaviour Change Interventions ◽

Theoretical Approaches

BACKGROUND Behavioural interventions for weight loss maintenance have shown beneficial effects for weight loss maintenance. While the digital upgrade of behavioural interventions brings an enormous potential to tackle public health challenges, there is limited knowledge about the components of these interventions, i.e., its content, delivery and the theoretical approaches. OBJECTIVE To identify the core components of digital behaviour change interventions for weight loss maintenance targeting physical activity, in terms of: i) Behaviour Change Techniques; ii) Mechanisms of Action; iii) Modes of Delivery; iv) Dose; and v) Tailoring/Personalisation. In addition, the links between these components were investigated. METHODS A literature search was performed in 5 electronic databases: PubMed; Embase; CINHAL; PsycINFO, and Web of Science. Two reviewers independently screened the identified papers and extracted data related with the study characteristics and behaviour change techniques, mechanism of action, mode of delivery, dose, and tailoring, using standardized classifications whenever available (e.g., behaviour change techniques taxonomy). RESULTS Seventeen articles reporting eleven original studies were selected. Two studies were protocols, nine studies presented results for weight change and all but one showed no significant differences between the intervention and control groups. Eight studies (73%) provided adequate information on Behaviour Change Techniques. Five studies (45%) provided partial information about how the Behaviour Change Techniques were linked to mechanisms of action, and only one study (0.9%) described these links for all the techniques. Around half of the studies reported the modes through which behaviour change techniques were delivered. Descriptions of dose were present in most studies, but with minimal information. The use of tailoring or personalisation approaches was mentioned in eight studies (73%), but descriptions of what was tailored and how were minimal. CONCLUSIONS The compilation of information regarding intervention components was difficult due to the lack of information and systematisation in reporting across papers. This is particularly true for the reporting of the links between behaviour change techniques and the other core intervention components. This information is crucial to help us understand in the context of behaviour change interventions what works or does not work, how it works and why.

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What goes on in digital behaviour change interventions for weight loss maintenance targeting physical activity: A Scoping Review

10.31234/osf.io/4rjpa ◽

2021 ◽

Author(s):

Jorge Encantado ◽

António L Palmeira ◽

Carolina Silva ◽

Falko Sniehotta ◽

James Stubbs ◽

...

Keyword(s):

Physical Activity ◽

Weight Loss ◽

Behaviour Change ◽

Partial Information ◽

Mode Of Delivery ◽

Weight Loss Maintenance ◽

Mechanisms Of Action ◽

Behaviour Change Techniques ◽

Behavioural Interventions ◽

Behaviour Change Interventions

Background: Behavioural interventions for weight loss maintenance have shown beneficial effects for weight loss maintenance. While the digital upgrade of behavioural interventions brings an enormous potential to tackle public health challenges, there is limited knowledge about the components of these interventions, i.e., its content, delivery and the theoretical approaches.Objective: To identify the core components of digital behaviour change interventions for weight loss maintenance targeting physical activity, in terms of: i) Behaviour Change Techniques; ii) Mechanisms of Action; iii) Modes of Delivery; iv) Dose; and v) Tailoring/Personalisation. In addition, the links between these components were investigated.Methods: A literature search was performed in 5 electronic databases: PubMed; Embase; CINHAL; PsycINFO, and Web of Science. Two reviewers independently screened the identified papers and extracted data related with the study characteristics and behaviour change techniques, mechanism of action, mode of delivery, dose, and tailoring, using standardized classifications whenever available (e.g., behaviour change techniques taxonomy). Results: Seventeen articles reporting eleven original studies were selected. Two studies were protocols, nine studies presented results for weight change and all but one showed no significant differences between the intervention and control groups. Eight studies (73%) provided adequate information on Behaviour Change Techniques. Five studies (45%) provided partial information about how the Behaviour Change Techniques were linked to mechanisms of action, and only one study (0.9%) described these links for all the techniques. Around half of the studies reported the modes through which behaviour change techniques were delivered. Descriptions of dose were present in most studies, but with minimal information. The use of tailoring or personalisation approaches was mentioned in eight studies (73%), but descriptions of what was tailored and how were minimal. Conclusions: The compilation of information regarding intervention components was difficult due to the lack of information and systematisation in reporting across papers. This is particularly true for the reporting of the links between behaviour change techniques and the other core intervention components. This information is crucial to help us understand in the context of behaviour change interventions what works or does not work, how it works and why.

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A Clinical Trial to Increase Self-Monitoring of Physical Activity and Eating Behaviors Among Adolescents: Protocol for the ImPACT Feasibility Study (Preprint)

10.2196/preprints.18098 ◽

2020 ◽

Author(s):

Justin B Moore ◽

Joshua R Dilley ◽

Camelia R Singletary ◽

Joseph A Skelton ◽

David P Miller Jr ◽

...

Keyword(s):

Physical Activity ◽

Clinical Trial ◽

Weight Loss ◽

Weight Management ◽

Management Program ◽

Evidence Based ◽

Weight Management Program ◽

Management Protocol ◽

Pediatric Weight Management ◽

The Impact

BACKGROUND Severe obesity among youths (BMI for age≥120th percentile) has been steadily increasing. The home environment and parental behavioral modeling are two of the strongest predictors of child weight loss during weight loss interventions, which highlights that a family-based treatment approach is warranted. This strategy has been successful in our existing evidence-based pediatric weight management program, Brenner Families in Training (Brenner FIT). However, this program relies on face-to-face encounters, which are limited by the time constraints of the families enrolled in treatment. OBJECTIVE This study aims to refine and test a tailored suite of mobile health (mHealth) components to augment an existing evidence-based pediatric weight management program. METHODS Study outcomes will include acceptability from a patient and clinical staff perspective, feasibility, and economic costs relative to the established weight management protocol alone (ie, Brenner FIT vs Brenner FIT + mHealth [Brenner mFIT]). The Brenner mFIT intervention will consist of 6 mHealth components designed to increase patient and caregiver exposure to Brenner FIT programmatic content including the following: (1) a mobile-enabled website, (2) dietary and physical activity tracking, (3) caregiver podcasts (n=12), (4) animated videos (n=6) for adolescent patients, (5) interactive messaging, and (6) in-person tailored clinical feedback provided based on a web-based dashboard. For the study, 80 youths with obesity (aged 13-18 years) and caregiver dyads will be randomized to Brenner FIT or Brenner mFIT. All participants will complete baseline measures before randomization and at 3- and 6-month follow-up points. RESULTS This study was approved by the Institutional Review Board in July 2019, funded in August 2019, and will commence enrollment in April 2020. The results of the study are expected to be published in the fall/winter of 2021. CONCLUSIONS The results of this study will be used to inform a large-scale implementation-effectiveness clinical trial. INTERNATIONAL REGISTERED REPORT PRR1-10.2196/18098

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A Clinical Trial to Increase Self-Monitoring of Physical Activity and Eating Behaviors Among Adolescents: Protocol for the ImPACT Feasibility Study

JMIR Research Protocols ◽

10.2196/18098 ◽

2020 ◽

Vol 9 (6) ◽

pp. e18098

Author(s):

Justin B Moore ◽

Joshua R Dilley ◽

Camelia R Singletary ◽

Joseph A Skelton ◽

David P Miller Jr ◽

...

Keyword(s):

Physical Activity ◽

Clinical Trial ◽

Weight Loss ◽

Weight Management ◽

Management Program ◽

Evidence Based ◽

Weight Management Program ◽

Management Protocol ◽

Pediatric Weight Management ◽

The Impact

Background Severe obesity among youths (BMI for age≥120th percentile) has been steadily increasing. The home environment and parental behavioral modeling are two of the strongest predictors of child weight loss during weight loss interventions, which highlights that a family-based treatment approach is warranted. This strategy has been successful in our existing evidence-based pediatric weight management program, Brenner Families in Training (Brenner FIT). However, this program relies on face-to-face encounters, which are limited by the time constraints of the families enrolled in treatment. Objective This study aims to refine and test a tailored suite of mobile health (mHealth) components to augment an existing evidence-based pediatric weight management program. Methods Study outcomes will include acceptability from a patient and clinical staff perspective, feasibility, and economic costs relative to the established weight management protocol alone (ie, Brenner FIT vs Brenner FIT + mHealth [Brenner mFIT]). The Brenner mFIT intervention will consist of 6 mHealth components designed to increase patient and caregiver exposure to Brenner FIT programmatic content including the following: (1) a mobile-enabled website, (2) dietary and physical activity tracking, (3) caregiver podcasts (n=12), (4) animated videos (n=6) for adolescent patients, (5) interactive messaging, and (6) in-person tailored clinical feedback provided based on a web-based dashboard. For the study, 80 youths with obesity (aged 13-18 years) and caregiver dyads will be randomized to Brenner FIT or Brenner mFIT. All participants will complete baseline measures before randomization and at 3- and 6-month follow-up points. Results This study was approved by the Institutional Review Board in July 2019, funded in August 2019, and will commence enrollment in April 2020. The results of the study are expected to be published in the fall/winter of 2021. Conclusions The results of this study will be used to inform a large-scale implementation-effectiveness clinical trial. International Registered Report Identifier (IRRID) PRR1-10.2196/18098

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Optimisation of the ActWELL lifestyle intervention programme for women attending routine NHS breast screening clinics.

10.21203/rs.2.22591/v1 ◽

2020 ◽

Author(s):

Annie Anderson ◽

Angela M. Craigie ◽

Stephanie Gallant ◽

Chloe McAdam ◽

E. Jane Macaskill ◽

...

Keyword(s):

Breast Cancer ◽

Physical Activity ◽

Weight Loss ◽

Weight Management ◽

Behaviour Change ◽

Breast Screening ◽

Feasibility Trial ◽

Behaviour Change Techniques ◽

Peer Reviewers ◽

Post Menopausal

Abstract Background Around 30% of post-menopausal breast cancer is related to excess body fat, alcohol intake and low levels of physical activity. Current estimates suggest that there is a 12% increased risk in post-menopausal breast cancer for every 5kg/m 2 increase in Body Mass Index (BMI). Despite this evidence there are few lifestyle programmes directed towards breast cancer risk reduction. This paper describes the process of optimising of the ActWELL programme which aims to support weight management in women invited to attend routine NHS breast screening clinics. Methods A feasibility study of a prototype programme aiming to change lifestyle behaviours was successfully undertaken. The programme used educational approaches and behaviour change techniques delivered by lifestyle coaches using individual face to face meetings and telephone sessions. To optimise the intervention for a definitive randomised controlled trial of weight management, data from the feasibility trial, focus group discussions conducted with the target population, feedback from the trial public advisory group and comments from peer reviewers were obtained. Concepts from implementation research provided further guidance to assist in the refinement of the intervention which was then discussed and agreed by all investigators and the trial steering group. Results The results from the feasibility trial were considered appropriate for moving on to a full trial with 70% of participants finding the programme acceptable. The primary outcomes (weight loss and physical activity) provided an important focus for design input from the target group. The contributions highlighted the need to review programme duration, coach contact time, content and use of behaviour change techniques as well as communications generally (e.g. science and evidence, non-judgemental approaches and avoiding guilt). In addition, the need for emphasis on support rather than education became apparent. The recommendations from peer reviewers focussed on the magnitude of effort required to achieve the intended weight loss and weight loss maintenance. Implementation science supported the use of the capability/opportunity/motivation (COM- B)model in overall design. Conclusions The optimisation process has facilitated the development and evaluation of a programme which enables the delivery of a promising intervention to achieve weight management in post-menopausal women.

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Development and feasibility study of an app (Ladle) for weight loss and behaviour change

PeerJ ◽

10.7717/peerj.6907 ◽

2019 ◽

Vol 7 ◽

pp. e6907

Author(s):

Jane Ogden ◽

Hazel Maxwell ◽

Adrian Wong

Keyword(s):

Weight Loss ◽

Weight Management ◽

Behaviour Change ◽

Health Care Professionals ◽

Preliminary Analysis ◽

Low Cost ◽

Completion Rate ◽

Evidence Based ◽

Face To Face ◽

Management Interventions

Background Weight management interventions involving behaviour change often utilise face to face interventions which include evidence based behaviour change strategies yet are costly and time intensive. In contrast, digital interventions cost less and have a wider reach yet tend to lack an evidence base and are less effective. Aims The present study therefore aimed to develop an evidence based behaviour change low cost app for weight management and to provide a preliminary analysis of its effectiveness. Methods The Ladle app was developed through evidence review and feedback from health care professionals and patients and consists of a 12 week course focusing on six habits and weight loss facilitated through 36 audio psychological lessons and 12 lessons specifically on the six habits. Each lesson was between 2–5 min (approx. 168 min of lessons). It was evaluated in terms of completion rate, weight loss, adoption of the six habits and participant feedback. Results The results showed a completion rate of 44%, that 52% of Completers showed weight loss of at least 5%, 79% showed weight loss of at least 3%, the median % weight lost was −5% and the median weight loss was −3.8 kg. Further, by the end of 12 weeks the majority (>80%) of participants had adopted four of the six habits for at least 5 days a week and nearly half (45%) had adopted the remaining two habits for at least 4 days out of 7. Feedback comments were mainly positive (n = 80) focusing mostly on the content of the lessons. Some comments were neutral (n = 56) and involved a statement of commitment or a description of a challenge and a minority were negative (n = 23) describing some technical issues which were addressed as the evaluation progressed. Conclusion The new Ladle app offers an evidenced based alternative to more intensive face to face interventions. On preliminary analysis it would seem to have lower completion rates than some more intensive interventions but comparable effectiveness for weight loss. It can also improve habits and is less time-intensive and costly to deliver. Participant feedback was generally positive.

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

Obesity Facts ◽

10.1159/000515663 ◽

2021 ◽

pp. 1-14

Author(s):

R. James Stubbs ◽

Cristiana Duarte ◽

António L. Palmeira ◽

Falko F. Sniehotta ◽

Graham Horgan ◽

...

Keyword(s):

Weight Loss ◽

Behaviour Change ◽

Digital Health ◽

Self Regulation ◽

Self Management ◽

Behaviour Change Techniques ◽

Evidence Based ◽

Behavioural Science ◽

Digital Architecture

Background: 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. The Project: 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. Impact: 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.

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Identifying and measuring the behavioural, dietary, and physical activity components of weight management consultations delivered by general practice nurses in routine care

BMC Family Practice ◽

10.1186/s12875-021-01403-1 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Heather Tong ◽

Elizabeth Morris ◽

Susan A. Jebb ◽

Dimitrios A. Koutoukidis

Keyword(s):

Physical Activity ◽

Weight Loss ◽

Weight Management ◽

Care Group ◽

Dietary Recommendations ◽

Practice Nurses ◽

Audio Recordings ◽

Baseline Weight ◽

Physical Activity Recommendations ◽

Activity Recommendations

Abstract Background Many people with obesity receive weight loss consultations by general practice nurses (GPNs) in routine primary care. This exploratory study aimed to characterise the components of these consultations, including behaviour change techniques (BCTs), and dietary and physical activity recommendations. Methods We analysed audio recordings of weight management consultations conducted by 8 GPNs as part of the ‘usual care’ group in a randomised controlled trial (ISRCTN75092026). Consultations were coded against three taxonomies to classify BCTs, dietary recommendations, and physical activity recommendations. Associations between coded content and weight loss were assessed. Differences in the content of consultations where weight loss was < 5% or ≥ 5% from baseline weight at 6 months were explored. Results One hundred and fifty audio recordings were available from 53 out of 140 (38%) participants in the usual care group. Participants had on average 3 (SD = 1) recorded consultations over 3 months, lasting 14 (SD = 7) minutes each. Weight change at 3, 6, and 12 months was -3.6% (SD = 4.3), -5.5% (SD = 6.0) and -4.2% (SD = 6.5) for participants with audio recordings. GPNs used 3.9 (SD = 1.6) of 93 BCTs, 3.3 (SD = 2.7) of 30 dietary recommendations and 1.4 (SD = 1.2) of 10 physical activity recommendations per consultation. The most commonly employed BCTs were feedback on outcome of behaviour (80.0%), problem solving (38.0%), and social reward (34.3%). The most common dietary recommendations were about portion size (31.3%), nutrients (28.0%), and balanced diet (19.7%). The main physical activity recommendation was about walking (30.3%). There was no association between weight loss and the number of dietary recommendations, physical activity recommendations, or BCTs used per consultation, or per participant. Social reward was the only technique used significantly more in consultations of participants that lost ≥ 5% of their baseline weight at 6 months. Conclusions The study provides a new method that could be used to describe the content of weight management consultations. Specific dietary or physical activity recommendations and BCTs were used infrequently and inconsistently in this group of GPNs. Although replication is required in larger samples, this may point to a weakness in current practice.

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Are Men More Intuitive When It Comes to Eating and Physical Activity?

American Journal of Men s Health ◽

10.1177/1557988311428090 ◽

2011 ◽

Vol 6 (2) ◽

pp. 164-171 ◽

Cited By ~ 20

Author(s):

Julie Gast ◽

Hala Madanat ◽

Amy Campbell Nielson

Keyword(s):

Physical Activity ◽

Body Mass Index ◽

Weight Loss ◽

Intrinsic Motivation ◽

Weight Management ◽

Body Mass ◽

Demographic Variables ◽

Intuitive Eating ◽

Lower Body ◽

Behavioral Regulation

The purpose of this study was to determine where men fall on the motivation continuum based on intuitive eating status and if motivation for physical activity and intuitive eating are correlated. Results indicate that being an intuitive eater was associated with a lower body mass index. In terms of demographic variables, as age increased, intuitive eating status decreased and body mass index increased. Men scored high on the antidieting and self-care subscales of the Intuitive Eating Scale. Men who were classified as intuitive eaters scored higher on the external and introjected regulation of the Behavioral Regulation in Exercise Questionnaire but no significant differences were reported by eating status and the identified and intrinsic motivation subscales. Intuitive eating holds promise as a weight management and weight loss tool for men. Intuitive eating may also influence initial motivation for physical activity for men.

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Quantifying Canadians' use of the Internet as a source of information on behavioural risk factor modifications related to cancer prevention

Chronic Diseases and Injuries in Canada ◽

10.24095/hpcdp.33.3.02 ◽

2013 ◽

Vol 33 (3) ◽

pp. 123-128 ◽

Cited By ~ 3

Author(s):

CG Richardson ◽

LG Hamadani ◽

C Gotay

Keyword(s):

Physical Activity ◽

Weight Loss ◽

Cancer Prevention ◽

Behaviour Change ◽

Healthy Eating ◽

The Internet ◽

Quit Smoking ◽

Key Stakeholders ◽

Internet Searches ◽

Use Of The Internet

Introduction The purpose of this study was to quantify the frequency and timing of Canadians' Internet searches for information on modifying cancer prevention-related behavioural risk factors. Methods We used the Google AdWords Keyword tool to estimate the number of Internet searches in Canada from July 2010 to May 2011 for content associated with the keywords "physical activity / exercise", "healthy eating / weight loss" and "quit smoking". Results For ''physical activity / exercise,'' 663 related keywords resulted in 117 951 699 searches. For ''healthy eating / weight loss,'' 687 related search terms yielded 98 277 954 searches. ''Quit smoking'' was associated with 759 related keywords with 31 688 973 searches. All search patterns noticeably peaked in January 2011. Conclusion Many Canadians are actively searching for information on the Internet to support health behaviour change associated with cancer prevention, especially during the month of January. To take advantage of this opportunity, key stakeholders in cancer prevention need to identify knowledge translation priorities and work with health agencies to develop evidence-based strategies to support Internet-facilitated behaviour change.

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