Development of a theory and evidence-based digital intervention tool for weight loss maintenance: the NoHoW Toolkit (Preprint)

2020 ◽  
Author(s):  
Marta Marques ◽  
Marcela Matos ◽  
Elina Mattila ◽  
Jorge Encantado ◽  
Cristiana Duarte ◽  
...  
Keyword(s):  
Weight Loss ◽  
Emotion Regulation ◽  
Weight Management ◽  
Behaviour Change ◽  
Systematic Approach ◽  
Self Regulation ◽  
Weight Loss Maintenance ◽  
User Testing ◽  
Web Based ◽  
Logic Models

BACKGROUND Many weight loss programs show short-term effectiveness, but subsequent weight loss maintenance is difficult to achieve. Digital technologies offer promising means to delivering behaviour change approaches at low cost and on a wide scale. The NoHoW project was a European Commission H2020-funded project aimed to develop, test, and evaluate a digital Toolkit designed to promote successful long-term weight management. The Toolkit was tested in an 18-month large-scale international 2 x 2 factorial (motivation and self-regulation versus emotion regulation) randomised controlled trial, conducted in overweight/obese adults who lost ≥5% of their body weight in the preceding twelve months before enrolment into the intervention. OBJECTIVE This paper describes the development of the NoHoW Toolkit focusing on the logic models, content and specifications, and results from user testing. METHODS The Toolkit was developed using a systematic approach including (1) development of the theory-based logic models, (2) selection of behaviour change techniques, (3) translation of these techniques into a digital web-based app (NoHoW Toolkit components), (4) technical development, (5) user evaluation and refinement of the Toolkit. RESULTS The Toolkit included a set of web-based tools and inputs from digital tracking devices (smart scales and activity trackers), with modules targeting weight, physical activity, and dietary behaviours. The final Toolkit was comprised of 34 sessions, distributed through 15 modules, providing active content over a 4-month period. The motivation and self-regulation arm consisted of 8 modules (17 sessions), the emotion regulation arm was presented with 7 modules (17 sessions), and the combined arm received the full Toolkit (15 modules, 34 sessions). The sessions included a range of implementations, such as videos, testimonies, and questionnaires. Further, the Toolkit contained 5 specific data tiles for monitoring weight, steps, healthy eating, mood and sleep. CONCLUSIONS A systematic approach to the development of digital solutions based on theory, evidence, and user testing, may significantly contribute to the advancement of the science of behaviour change and improve current solutions for sustained weight management. Testing the Toolkit using a 2x2 design provided a unique opportunity to examine the effect of motivation and self-regulation and emotion regulation separately, as well as the effect of their interaction in weight loss maintenance. CLINICALTRIAL ISRCTN88405328

scholarly journals NoHoW Toolkit Development

2020 ◽  
Author(s):  
Marta M Marques ◽  
Marcela Matos ◽  
Elina Mattila ◽  
Jorge Encantado ◽  
Cristiana Duarte ◽  
...  
Keyword(s):  
Weight Loss ◽  
Emotion Regulation ◽  
Weight Management ◽  
Behaviour Change ◽  
Systematic Approach ◽  
Self Regulation ◽  
Weight Loss Maintenance ◽  
Behaviour Change Techniques ◽  
Web Based ◽  
Logic Models

Background: Many weight loss programs show short-term effectiveness, but subsequent weight loss maintenance is difficult to achieve. Digital technologies offer promising means to delivering behaviour change approaches at low cost and on a wide scale. The NoHoW project was a European Commission H2020-funded project aimed to develop, test, and evaluate a digital Toolkit designed to promote successful long-term weight management. The Toolkit was tested in an 18-month large-scale international 2 x 2 factorial (motivation and self-regulation versus emotion regulation) randomised controlled trial, conducted in overweight/obese adults who lost ≥5% of their body weight in the preceding twelve months before enrolment into the intervention. Objective: This paper describes the development of the NoHoW Toolkit focusing on the logic models, content and specifications, and results from user testing.Methods: The Toolkit was developed using a systematic approach including (1) development of the theory-based logic models, (2) selection of behaviour change techniques, (3) translation of these techniques into a digital web-based app (NoHoW Toolkit components), (4) technical development, (5) user evaluation and refinement of the Toolkit.Results: The Toolkit included a set of web-based tools and inputs from digital tracking devices (smart scales and activity trackers), with modules targeting weight, physical activity, and dietary behaviours. The final Toolkit was comprised of 34 sessions, distributed through 15 modules, providing active content over a 4-month period. The motivation and self-regulation arm consisted of 8 modules (17 sessions), the emotion regulation arm was presented with 7 modules (17 sessions), and the combined arm received the full Toolkit (15 modules, 34 sessions). The sessions included a range of implementations, such as videos, testimonies, and questionnaires. Further, the Toolkit contained 5 specific data tiles for monitoring weight, steps, healthy eating, mood and sleep. Conclusions: A systematic approach to the development of digital solutions based on theory, evidence, and user testing, may significantly contribute to the advancement of the science of behaviour change and improve current solutions for sustained weight management. Testing the Toolkit using a 2x2 design provided a unique opportunity to examine the effect of motivation and self-regulation and emotion regulation separately, as well as the effect of their interaction in weight loss maintenance.

Development of a web-based, guided self-help, ACT-based intervention for weight loss maintenance: an evidence-, theory- and person-based approach. (Preprint)

2021 ◽  
Author(s):  
Rebecca Richards ◽  
Rebecca A Jones ◽  
Fiona Whittle ◽  
Carly A Hughes ◽  
Andrew J Hill ◽  
...  
Keyword(s):  
Weight Loss ◽  
Weight Management ◽  
Evidence Theory ◽  
Intervention Development ◽  
Weight Loss Maintenance ◽  
Theoretical Modelling ◽  
Healthcare Intervention ◽  
Web Based ◽  
Self Help

BACKGROUND The long-term impact and cost-effectiveness of weight management programmes depends on post-treatment weight maintenance. There is growing evidence that interventions based on third-wave cognitive behavioural therapy (3wCBT), specifically acceptance and commitment therapy (ACT), could improve long-term weight management however these interventions are typically delivered face-to-face by psychologists, which limits the scalability of this type of intervention. OBJECTIVE To use an evidence-, theory- and person-based approach to develop an ACT-based intervention for weight-loss maintenance that uses digital technology and non-specialist guidance to minimise resources needed for delivery at scale. METHODS Intervention development was guided by the Medical Research Council framework for the development of complex interventions in healthcare, Intervention Mapping Protocol, and the person-based approach for enhancing the acceptability and feasibility of interventions. Two phases of work were conducted: phase one consisted of collating and analysing existing and new primary evidence, and phase two consisted of theoretical modelling and intervention development. Phase one included a synthesis of existing evidence on weight-loss maintenance from previous research, a systematic review and network meta-analysis of 3wCBT interventions for weight management, a qualitative interview study of experiences of weight-loss maintenance, and the modelling of a justifiable cost for a weight-loss maintenance programme. Phase two included iterative development of guiding principles, a logic model and the intervention design and content. Target user and stakeholder panels were established to inform each phase of development and user-testing of successive iterations of the prototype intervention were conducted. RESULTS This process resulted in a guided self-help ACT-based intervention called SWiM (Supporting Weight Management). SWiM is a 4-month programme, consisting of weekly web-based sessions for 13 consecutive weeks, followed by a 4-week break for participants to reflect and practice their new skills, and a final session at week 17. Each session consists of psychoeducational content, reflective exercises, and behavioural experiments. SWiM includes specific sessions on key determinants of weight-loss maintenance, including developing skills to manage high-risk situations for lapses, creating new helpful habits, breaking old unhelpful habits, and learning to manage interpersonal relationships and their impact on weight-management. A trained, non-specialist coach provides guidance for participants through the programme with four scheduled 30-minute telephone calls and three further optional calls. CONCLUSIONS This comprehensive approach facilitated the development of an intervention that is based on scientific theory and evidence of how to support people with weight-loss maintenance, and is grounded in the experiences of the target users and the context in which it is intended to be delivered. The intervention will be refined based on findings of a planned pilot randomised controlled trial.

scholarly journals The NoHoW protocol: a multicentre 2×2 factorial randomised controlled trial investigating an evidence-based digital toolkit for weight loss maintenance in European adults

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e029425 ◽  
Author(s):  
Sarah Ellen Scott ◽  
Cristiana Duarte ◽  
Jorge Encantado ◽  
Elizabeth H Evans ◽  
Marja Harjumaa ◽  
...  
Keyword(s):  
Weight Loss ◽  
Emotion Regulation ◽  
Randomised Controlled Trial ◽  
Clinical Investigation ◽  
Controlled Trial ◽  
Self Regulation ◽  
Weight Loss Maintenance ◽  
Glycated Haemoglobin ◽  
Evidence Based ◽  
Randomised Controlled

IntroductionObesity and associated diseases place a severe burden on healthcare systems. Behavioural interventions for weight loss (WL) are successful in the short term but often result in weight regain over time. Self-regulation of eating and activity behaviours may significantly enhance weight loss maintenance (WLM) and may be effectively augmented by contextual behavioural approaches to emotion regulation. The NoHoW trial tests the efficacy of a theoretically informed, evidence-based digital toolkit using a mobile-enabled website, activity trackers and Wi-Fi scales for WLM aiming to target (1) self-regulation and motivation, and (2) emotion regulation in adults who achieved clinically significant (≥5%) WL in the previous 12 months (initial body mass index (BMI) ≥25 kg/m2).Methods and analysisThe study is an 18-month, 3-centre, 2×2 factorial single-blind, randomised controlled trial, which recruited 1627 participants achieving ≥5% WL between March 2017 and March 2018. Participants are randomly allocated to one of four arms: (1) self-monitoring only (self-weighing and activity tracker), (2) self-regulation and motivation, (3) emotion regulation or (4) combined self-regulation, motivation and emotion regulation. Participants attend four clinical investigation days at 0, 6, 12 and 18 months and are instructed to use the digital toolkit for 18 weeks during the first 6 months and at their discretion for the remaining 12 months. The primary outcome is change in weight (kg) at 12 months from baseline. Secondary outcomes are body composition (eg, bioimpedance analysis), health biomarkers (glycated haemoglobin, lipids, blood pressure, hair cortisol), dietary intake, physical activity, sleep, motivational, self-regulatory, emotion regulatory moderators/mediators of WLM, engagement, user experience, acceptability and cost-effectiveness of the interventions.Ethics and disseminationEthical approval was granted by Institutional Ethics Committees at the Universities of Leeds (17–0082; 27 February 2017), Lisbon (17/2016; 20 February 2017) and Capital Region of Denmark (H-16030495, 8 March 2017). Results will be published in scientific journals.Trial registration numberISRCTN88405328.

scholarly journals “I’m Still on Track”: A Qualitative Exploration of Participant Experiences of a Weight Loss Maintenance Program

Healthcare ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 21
Author(s):  
Bronwyn McGill ◽  
Blythe J. O’Hara ◽  
Philayrath Phongsavan ◽  
Adrian Bauman ◽  
Luke Lawler ◽  
...  
Keyword(s):  
Weight Loss ◽  
Weight Management ◽  
Personal Responsibility ◽  
Self Regulation ◽  
Real Life ◽  
Weight Loss Maintenance ◽  
External Support ◽  
Structured Interviews ◽  
Positive Health ◽  
Maintenance Program

Qualitative evidence of participants’ experiences of real-life weight loss maintenance programs is important for ongoing participant engagement and can inform program improvements. The purpose of this study was to understand how participants account for their engagement with a weight loss maintenance program and the role of the program in their weight management. A qualitative study using semi-structured interviews with 17 participants of a weight loss maintenance program was conducted; common themes were identified using a thematic inductive approach. Many participant narratives incorporated recurrent descriptions of their program experiences as a weight management journey. Our analysis generated four themes: returning to real life as a threat, the personal responsibility imperative, the program supporting agency and the program supporting self-regulation. The program, which provides external support and strategies, overlapped with the context of returning to real life and the personal responsibility imperative. Participant accounts of their journey at this intersection include the program supporting both agency and self-regulation which influences ongoing weight management. The interplay between themes identified and the maintenance program services allows compatibility between participants’ sense of personal responsibility and the program components to help participants to ‘stay on track’ or ‘get back on track’. In providing sufficient structure, opportunities to revisit successful strategies, and accountability, participants are empowered to overcome real-life threats and make positive health choices.

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

Obesity Facts ◽  
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

<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.

scholarly journals Predictors of Weight Loss Maintenance following an Insurance-Sponsored Weight Management Program

2014 ◽  
Vol 2014 ◽  
pp. 1-12 ◽  
Author(s):  
Christiaan G. Abildso ◽  
Olivier Schmid ◽  
Megan Byrd ◽  
Sam Zizzi ◽  
Alessandro Quartiroli ◽  
...  
Keyword(s):  
Weight Loss ◽  
Weight Management ◽  
Weight Loss Maintenance ◽  
The United States ◽  
Management Program ◽  
Weight Management Program ◽  
Post Intervention ◽  
Physically Active ◽  
Intentional Weight Loss ◽  
Predictors Of Weight Loss

Intentional weight loss among overweight and obese adults (body mass index ≥ 25 kg/m2) is associated with numerous health benefits, but weight loss maintenance (WLM) following participation in weight management programming has proven to be elusive. Many individuals attempting to lose weight join formal programs, especially women, but these programs vary widely in focus, as do postprogram weight regain results. We surveyed 2,106 former participants in a community-based, insurance-sponsored weight management program in the United States to identify the pre, during, and post-intervention behavioral and psychosocial factors that lead to successful WLM. Of 835 survey respondents (39.6% response rate), 450 met criteria for inclusion in this study. Logistic regression analyses suggest that interventionists should assess and discuss weight loss and behavior change perceptions early in a program. However, in developing maintenance plans later in a program, attention should shift to behaviors, such as weekly weighing, limiting snacking in the evening, limiting portion sizes, and being physically active every day.

scholarly journals Long-Term Weight-Loss Maintenance by a Meal Replacement Based Weight Management Program in Primary Care

Obesity Facts ◽  
2017 ◽  
Vol 10 (2) ◽  
pp. 76-84 ◽  
Author(s):  
Renate Kruschitz ◽  
Sandra Wallner-Liebmann ◽  
Harald Lothaller ◽  
Maria Luger ◽  
Bernhard Ludvik
Keyword(s):  
Primary Care ◽  
Weight Loss ◽  
Weight Management ◽  
Weight Loss Maintenance ◽  
Management Program ◽  
Weight Management Program ◽  
Meal Replacement

Correlates of health-related quality of life, psychological well-being, and eating self-regulation after successful weight loss maintenance

2012 ◽  
Vol 36 (6) ◽  
pp. 601-610 ◽  
Author(s):  
Paulo N. Vieira ◽  
Marlene N. Silva ◽  
Jutta Mata ◽  
Sílvia R. Coutinho ◽  
Teresa C. Santos ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Weight Loss ◽  
Self Regulation ◽  
Weight Loss Maintenance ◽  
Well Being ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Successful Weight Loss
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