SummaryBackgroundObesity levels continue to rise annually. Face‐to‐face weight loss consultations have previously identified mixed effectiveness and face high demand with limited resources. Therefore, alternative interventions, such as internet‐delivered interventions, warrant further investigation. The aim was to assess whether internet‐delivered weight loss interventions providing personalized feedback were more effective for weight loss in overweight and obese adults in comparison with control groups receiving no personalized feedback.MethodNine databases were searched, and 12 studies were identified that met all inclusion criteria.ResultsMeta‐analysis, identified participants receiving personalized feedback via internet‐delivered interventions, had 2.13 kg mean difference (SMD) greater weight loss (and BMI change, waist circumference change and 5% weight loss) in comparison with control groups providing no personalized feedback. This was also true for results at 3 and 6‐month time points but not for studies where interventions lasted ≥12 months.ConclusionThis suggests that personalized feedback may be an important behaviour change technique (BCT) to incorporate within internet‐delivered weight loss interventions. However, meta‐analysis results revealed no differences between internet‐delivered weight loss interventions with personalized feedback and control interventions ≥12 months. Further investigation into longer term internet‐delivered interventions is required to examine how weight loss could be maintained. Future research examining which BCTs are most effective for internet‐delivered weight loss interventions is suggested.
Obesity levels are rising annually and the trend is set to continue unless reversal techniques are implemented. Evidence suggests that traditional primary care treatments can be costly, ineffective and experience high attrition rates (1) . Therefore research is needed into alternative approaches in relation to weight/obesity management. Previous systematic reviews examining internet based weight loss interventions have found it difficult to determine effectiveness due to heterogeneity in the studies. As a consequence it remains unclear which components of individualised interventions are key to success (2) . The main objective of this systematic review was to assess the effectiveness of individualised feedback in internet-based weight loss interventions for overweight adults.A systematic review of randomised controlled trials recruiting adult participants with BMI > 25 kg/m^2 was conducted. Interventions targeting diet and/or physical activity for weight loss were included. Interventions had to be delivered at least in part via the internet and incorporate some form of individualised feedback to the participants. Comparator groups included standard care or an alternative intervention without individualised feedback.Nine studies were included (n = 2129). At three months, interventions providing individualised feedback showed significantly greater weight loss (Mean difference (95% CI) = -2.53 ( -3.13, -1.92); p < 0.00001), reduced BMI ( -1.17 ( -1.52, -0.82); p < 0.00001), reduced waist circumference ( -3.90 ( -4.96, -2.83; p < 0.0001) and a higher proportion of participants reaching 5 % weight loss (25.79 (1.59, 417.21); p = 0.02), compared to comparison groups without feedback. Subgroup analysis explored the effectiveness of different types of feedback. Different types of feedback consisting of human communication, automated algorithms or a mixture of both techniques.Incorporating individualised feedback may be a key behaviour change technique for effective interventions delivered via the internet. More research is needed to investigate how internet interventions with individualised feedback could be incorporated into primary care.
BackgroundThe NHS diabetes prevention programme (NHS DPP) aims to identify people at high-risk of developing Type 2 diabetes, and offer them an intensive lifestyle change intervention (ILCI). The development, evaluation and implementation of the NHS DPP is planned in phases, starting with formative evaluation of a demonstrator phase. This study aims to 1) review and appraise activities related to recruitment, intervention delivery and equality across the seven NHS DPP demonstrator sites; and 2) inform the further development and ability to evaluate the programme.MethodsInformation from documentation supplied by demonstrator sites was extracted and mapped against recommendations contained in NICE guidance PH38 (prevention of diabetes), NHS DPP specification and equality indicators. To facilitate the mapping exercise, themes within the guidance documents were identified and used in a coding framework to characterise demonstrator site programmes. Mapping was conducted by three reviewers and discrepancies were resolved through discussion.ResultsElements identified were categorised within four themes: (a) raising awareness and recruitment; (b) intervention components, design and delivery; (c) inequalities and adaptation and; (d) quality assurance, monitoring and training. Responsibilities for awareness raising and enrolment in the ILCI were unclear. In all sites referral to ILCI was via primary care or NHS Health Checks. Where a blood test was reported HbA1c was the most usual measure. Intervention content reporting was insufficiently detailed and varied across sites. The proposed programmes were less intensive and shorter than recommended. Place of residence and gender impacted on ILCI delivery in terms of choice of venue and availability of single-sex groups. Recommended minimum data items to evaluate programmes (age, sex, ethnicity, postcode, height, weight, HbA1c and physical activity levels) were specified by five sites, whereas dietary data were only specified by one site. Programme deliverers included a range of professionals. The training received varied across sites, with regular review of intervention delivery, the deliverer and their training needs in some sites.ConclusionThis review developed a useful framework to reflect on the different elements, actors and responsibilities needed to implement an evaluable NHS DPP. Information provided at baseline from some sites, had items missing from intervention content, equality indicators and quality assurance procedures. Findings were used to make recommendations for the subsequent stages of the NHS DPP implementation and evaluation. Lack of clarity and detail in intervention specification will jeopardise evaluability of the NHS DPP.
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