Health Evidence hosted a 60 minute webinar examining the effectiveness of internet-delivered interventions providing personalized feedback for weight loss in overweight and obese adults. Click here for access to the audio recording for this webinar: https://youtu.be/AZXuc2XtCUs
Anna Haste, Research Associate at Newcastle University led the session and presented findings from her recent systematic review:
Sherrington, A, Newham, J, Bell, R, Adamson, A, McColl, E, & Araujo-Soares, V. (2016). Systematic review and meta-analysis of internet-delivered interventions providing personalized feedback for weight loss in overweight and obese adults. Obesity Reviews, 17(6), 541-551.
http://www.healthevidence.org/view-article.aspx?a=systematic-review-meta-analysis-internet-delivered-interventions-providing-29586
While prevalence of obesity is increasing, conventional weight loss interventions demonstrate barriers to implementation and mixed-results regarding effectiveness. This systematic review and meta-analysis examines the impact of internet-delivered interventions providing personalized feedback on weight loss in overweight and obese adults, in comparison to controls not receiving personalized feedback. Twelve randomized control trials, with a total of 3547 participants are included in this review. Evidence suggests internet-delivered interventions providing personalized feedback increase weight loss and 5% weight loss at 3 and 6 months, and decrease BMI and waist circumference at 3, 6 and ≥ 12 months. This webinar provided an overview of the effectiveness of internet-delivered interventions providing personalized feedback for weight loss in overweight and obese adults.
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3
4. What’s the evidence?
Sherrington, A., Newham, J., Bell, R., Adamson, A.,
McColl, E., & Araujo-Soares, V. (2016). Systematic
review and meta-analysis of internet-delivered
interventions providing personalized feedback for
weight loss in overweight and obese adults. Obesity
Reviews, 17(6), 541-551.
http://www.healthevidence.org/view-
article.aspx?a=systematic-review-meta-analysis-
internet-delivered-interventions-providing-29586
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7. Poll Question #1
How many people are watching
today’s session with you?
A. Just me
B. 2-3
C. 4-5
D. 6-10
E. >10
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11. A Model for Evidence-
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National Collaborating Centre for Methods and Tools. (revised 2012). A
Model for Evidence-Informed Decision-Making in Public Health (Fact
Sheet). [http://www.nccmt.ca/pubs/FactSheet_EIDM_EN_WEB.pdf]
12. Stages in the process of
Evidence-Informed Public Health
National Collaborating Centre for Methods and Tools. Evidence-Informed
Public Health. [http://www.nccmt.ca/eiph/index-eng.html]
15. How often do you use Systematic Reviews
to inform a program/services?
A. Always
B. Often
C. Sometimes
D. Never
E. I don’t know what a systematic review is
Poll Question #3
16. Internet interventions providing personalized
feedback are effective for weight loss in
overweight and obese adults
A. Strongly agree
B. Agree
C. Neutral
D. Disagree
E. Strongly disagree
Poll Question #4
20. Why is being obese a problem?
• Link between obesity and a number of serious
diseases and mental health problems:
• Cancer, hypertension, type 2 diabetes, high blood
pressure, depression, social stigmatisation,
premature death (World Health Organisation, 2014; Public Health England, 2014)
Higher BMI = Higher risk of disease
21. What is an internet-based
intervention?
• Software system, usually a website
• Participants required to log in to access
intervention
• Enables lifestyle information, modules or
assessments to be easily accessible
• Self-monitoring tools
• Systems may be interactive
• Personalised feedback – Automatic/Human
• Engagement with other users
22. Rationale for using an internet
intervention for weight loss
• Traditional primary care treatments (GP appointments, group
sessions) can be costly, have mixed effectiveness and experience
high attrition rates (Jolly et al., 2011)
• Acknowledged the need for intervention components to be
investigated (Neve et al., 2010)
• Personalised interventions have been shown to be more effective
(Kroeze et al., 2006; Neville et al., 2009)
• Internet weight loss studies have identified mixed findings (Morgan et al.,
2011; McConnon et al., 2007) but have the potential to reduce health
professional input and time per patient (Ramadas et al., 2011)
23. Research question
How effective is individualised internet
based feedback compared to those
receiving no feedback within weight
loss interventions for
overweight/obese adults?
24. Inclusion criteria
( P ): Adults aged > 18 years old with BMI > 25kg/ m2
( I ): Interventions targeting diet, physical activity or
both for weight loss. At least in part delivered
individually via internet.
( C ): Standard care or alternative interventions that do
not include individualised feedback via the internet
( O ): Weight loss, waist circumference, BMI change, 5%
weight loss
( S ): Randomised controlled trials
Prospero protocol:
http://www.crd.york.ac.uk/prospero/display_record.asp?ID=CRD42012002115
25. Feedback definition
Michie et al., 2011, pg. 9:
Provide feedback on performance –
“This involves providing the participant with data about
their own recorded behaviour or commenting on a
person’s behavioural performance (e.g. identifying a
discrepancy between behavioural performance and a set
goal or a discrepancy between one’s own performance in
relation to others).”
26. Feedback examples
‘Weekly feedback was given from a pre-programmed
computer that instantaneously returned tailored
feedback on a Web page when the weight loss diary was
submitted.’ (Tate et al., 2006)
‘Each participant who provided diary entries received up to 7
individualized feedback documents via email over the 3
months from the research team. Each sheet gave feedback on
a week of diary entries and suggested personalized strategies
to address weight loss, reduce energy intake and increase
energy expenditure.’ (Morgan et al., 2011)
27. Search strategy
Databases:
Scopus, Web of Science, EMBASE, MEDLINE, PsycINFO,
ASSIA, IBSS and the Sociological Abstracts
Clinical Trial Registers
Hand searching relevant journals, conference publications
and theses databases.
28. Screening process
5861
Total articles identified
2251
Duplicates excluded
3610
Articles remaining
3472
Title and abstract exclusions
138
Articles remaining
23 additional found from
reference list search
124 Exclusions as did not
meet inclusion criteria:
•Participants (n=17)
•Design (n=77)
•Outcome (n=52)
•Intervention (n=52)
14 included articles = 12 separate studies
23 excluded as did not
meet inclusion criteria:
•Participants (n=6)
•Design (n=11)
•Outcome (n=12)
•Intervention (n=8)
30. Outcomes and timeframes
• Intention-to-treat (ITT) for all analyses
• Ordered by effect size
• Mean difference compared with continuous
outcome measures
• Risk ratio used for dichotomous variables
Control group Total 3 months 6 months 12 months
Minimal
intervention
(TAU or leaflet)
9 5 5 3
Website w/o
feedback
3 2 2 1
39. Summary of significant
results
Outcome End 3 months 6 months 12 months
Weight loss ~
Waist
circumference
BMI
5% weight loss ~
40. BCTs most commonly identified
• Provide feedback on performance
• Provide information on consequences
• Self-monitoring of behaviour/behaviour
outcome
• Social support/social change
• Goal setting (behaviour/outcome)
43. Future work
• Behaviour change techniques in relation
to effectiveness, engagement and
retention rates
• Variety of feedback types
(provided by a human or automatically)
• Internet feedback versus other modality
feedback
45. References
Jolly K., Lewis A, Beach J, et al. (2011). Comparison of range of commercial or primary care led weight reduction programmes with minimal intervention control for
weight loss in obesity: Lighten Up randomised controlled trial. BMJ 343.
Kroeze, W., Werkman, A., Brug, J. (2006) A systematic review of randomised trials on the effectivenss of computer-tailored education on physical activity and dietary
behaviors. Annals of Behavioural Medicine, 31 (3), 205-223.
McConnon, Á., Kirk, S. F. L., Cockroft, J. E., Harvey, E. L., Greenwood, D. C., Thomas, J. D., . . . Bojke, L. (2007). The Internet for weight control in an obese sample:
Results of a randomised controlled trial. BMC Health Services Research, 7.
Michie, S., Ashford, S., Sniehotta, F. F., Dombrowski, S. U., Bishop, A., & French, D. P. (2011). A refined taxonomy of behaviour change techniques to help people
change their physical activity and healthy eating behaviours: The CALO-RE taxonomy. Psychology and Health, 26(11), 1479-1498.
Morgan, P. J., Collins, C. E., Plotnikoff, R. C., Cook, A. T., Berthon, B., Mitchell, S., & Callister, R. (2011). Efficacy of a workplace-based weight loss program for
overweight male shift workers: The workplace POWER (preventing obesity without eating like a rabbit) randomized controlled trial. Preventive Medicine, 52(5), 317-
325.
Neve M, Morgan PJ, Jones PR, et al. (2010). Effectiveness of web-based interventions in achieving weight loss and weight loss maintenance in overweight and obese
adults: a systematic review with meta-analysis. Obes Rev, 11 (4), 306-321.
Neville, L. M., Milat, A. J., & O'Hara, B. (2009). Computer-tailored weight reduction interventions targeting adults: A narrative systematic review. Health Promotion
Journal of Australia, 20(1), 48-57.
Public Health England. (2014). Obesity and Health. from www.noo.org.uk/NOO_about_obesity/obesity_and_health
Ramadas, A., Quek, K. F., Chan, C. K. Y., & Oldenburg, B. (2011). Web-based interventions for the management of type 2 diabetes mellitus: A systematic review of
recent evidence. International Journal of Medical Informatics, 80(6), 389-405
Tate DF, Jackvony EH, Wing RR. A Randomized Trial Comparing Human e-Mail Counseling, Computer-Automated Tailored Counseling, and No Counseling in an
Internet Weight Loss Program. Arch Intern Med. 2006;166(15):1620-1625.
World Health Organisation. (2014). Obesity and Overweight Fact Sheet. From http://www.who.int/mediacentre/factsheets/fs311/en/.
47. Internet interventions providing personalized
feedback are effective for weight loss in
overweight and obese adults
A. Strongly agree
B. Agree
C. Neutral
D. Disagree
E. Strongly disagree
Poll Question #5
48. Poll Question #6
The information presented today was
helpful
A.Strongly agree
B.Agree
C.Neutral
D.Disagree
E.Strongly disagree
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50. Poll Question #7
What are your next steps? [Check all
that apply]
A. Access the full text systematic review
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review on www.healthevidence.org
C. Consider using the evidence
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