Engagement and effectiveness of digitally enabled behavioural change support for people living with type 2 diabetes

Kar, Partha; Goward, Charlotte; Whitman, Michael; Davies, Mark; Willner, Tamara; Shaw, Ken

doi:10.1002/pdi.2295

Cited by 10 publications

(4 citation statements)

References 31 publications

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“…Overall, the mediation analysis found that participants who engaged more with program components tended to lose more weight, as reported previously [ 48 - 50 ], but this was independent of the type of goal set. Therefore, engagement can be considered an independent predictor of weight loss but not a mediator of the association between goals and weight.…”

Section: Discussionsupporting

confidence: 81%

The Association Between Goal Setting and Weight Loss: Prospective Analysis of a Community Weight Loss Program

Wren¹,

Koutoukidis²,

Scragg³

et al. 2023

J Med Internet Res

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Background Goal setting aids health-related behavior changes; however, the influence of different types of goals on weight loss remains unclear. Objective We aimed to investigate the association of 3 aspects of goal setting with weight and program dropout over a 24-week period. Methods This study was a prospective longitudinal analysis of participants in a 12-week digital behavioral weight loss program. Weight and engagement data for eligible participants (N=36,794) were extracted from the database. Eligible participants were adults in the United Kingdom who had enrolled in the program, had a BMI ≥25 kg/m2, and a weight reading recorded at baseline. Three aspects of goal setting were self-reported at enrollment: weight loss motivation (appearance, health, fitness, or self-efficacy), overall goal preference (low, medium, or high), and percentage weight loss goal (<5%, 5%-10%, or >10%). Weight was measured at 4, 12, and 24 weeks. Mixed models for repeated measures were used to explore the association between goals and weight across the 24-week period. To measure sustained weight change, the primary outcome was weight at 24 weeks. We explored dropout rates over the 24-week period by goal and whether engagement mediated the association between goals and weight loss. Results Of the 36,794 participants (mean 46.7, SD 11.1 years; 33,902/36,794, 92.14% female) included in the cohort, 13.09% (n=4818) reported weight at 24 weeks. Most participants set goals of 5%-10% weight loss (23,629/36,794, 64.22%), but setting goals for >10% was associated with greater weight loss (mean difference 5.21 kg, 95% CI 5.01-5.41; P<.001). There was no difference between goals of 5%-10% and <5% (mean difference 0.59 kg, 95% CI 0.00-1.18; P=.05). Appearance was the most prevalent motivational factor (14,736/36,794, 40.05%), but health and fitness were associated with greater weight losses (mean difference health vs appearance 1.40 kg, 95% CI 1.15-1.65; P<.001 and mean difference fitness vs appearance 0.38 kg, 95% CI 0.05-0.70; P=.03). Goal preference had no association with weight. Engagement was an independent predictor of weight loss but not a mediator of the effect of goal setting. At 24 weeks, those who set goals of >10% were less likely to drop out compared with 5%-10% goals (odds ratio [OR] 0.40, 95% CI 0.38-0.42; P<.001); those who liked to set overall high goals were more likely to drop out compared with medium goals (OR 1.20, 95% CI 1.11-1.29; P<.001); and those motivated by fitness or health were less likely to drop out compared with appearance (OR 0.92, 95% CI 0.85-0.995; P=.04 and OR 0.84, 95% CI 0.78-0.89; P<.001, respectively). Conclusions Setting higher weight loss goals and being motivated by health or fitness were associated with greater weight loss and lower likelihood of dropout. Randomized trials for setting these types of goals are required to confirm causality.

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Section: Discussionsupporting

confidence: 81%

The Association Between Goal Setting and Weight Loss: Prospective Analysis of a Community Weight Loss Program

Wren¹,

Koutoukidis²,

Scragg³

et al. 2023

J Med Internet Res

Self Cite

View full text Add to dashboard Cite

show abstract

“…Overall, the mediation analysis found that participants who engaged more with program components tended to lose more weight, as reported previously [48][49][50], but this was independent of the type of goal set. Therefore, engagement can be considered an independent predictor of weight loss but not a mediator of the association between goals and weight.…”

Section: Comparison With Prior Worksupporting

confidence: 76%

The Association Between Goal Setting and Weight Loss: Prospective Analysis of a Community Weight Loss Program (Preprint)

Wren¹,

Koutoukidis²,

Scragg³

et al. 2022

Preprint

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BACKGROUND Goal setting aids health-related behaviour change, but the influence of different types of goals on weight loss remains unclear. OBJECTIVE To investigate the association between three measures of goals setting and weight change during a 12-week digital behavioural weight loss programme delivered across the UK. METHODS Prospective longitudinal analysis of 36,794 UK adults with a body mass index of ≥25 kg/m2 that enrolled in the programme. Measures of goal setting were self-reported at enrolment including percentage weight loss goal (<5%, 5-10%, or >10%); overall goal preference (low, medium, or high); and weight loss motivation (appearance, health, fitness, or self-efficacy). Weight was measured at 4, 12, and 24 weeks. To measure sustained weight change, the primary outcome was weight at 24 weeks, assessed using mixed-model repeated-measures analyses to explore the effect of goal setting adjusted for known confounders. We explored drop-out rates by goal and whether engagement mediated the association between goals and weight loss. RESULTS Of the 36,794 participants included in the cohort, 13.1% (n=4,818) reported weight at 24 weeks. Most participants set goals of 5-10% weight loss (64.3%), but setting goals for >10% weight loss was associated with larger weight loss (mean difference between 5-10% vs >10%: 5.21kg; 95% CI: 5.01, 5.41; P<.001). There was no difference between goals of 5-10% and <5% (mean difference: 0.59kg; 95% CI: 0.00, 1.18; P=.05). Appearance was the most prevalent motivational factor (40.1%), but health or fitness were associated with greater weight losses than appearance (mean difference health vs appearance: 1.40kg; 95% CI: 1.15, 1.65; P<.001 and mean difference fitness vs appearance: 0.38kg; 95% CI: 0.05, 0.70; P=.03). Goal preference had no clear association with weight loss. Engagement with programme components was a significant independent predictor of weight loss but not a mediator of the effect of goal setting. At 24 weeks, those who set goals of >10% were less likely to drop-out compared to those setting 5-10% goals (OR: 0.40; 95% CI: 0.38, 0.42; P<.001); those who liked to set overall high goals were more likely to drop-out compared to those with medium goals (OR: 1.20; 95% CI: 1.11, 1.29; P<.001); and those motivated by fitness or health were less likely to drop-out compared with those motivated by appearance (OR: 0.92; 95% CI: 0.85, 0.995; P=.038 , and OR: 0.84; 95% CI: 0.78, 0.89; P<.001, respectively). CONCLUSIONS Setting higher and specific weight loss goals and being motivated by health or fitness were associated with greater weight loss and lower likelihood of drop-out. Randomised trials of setting these types of goals are needed to confirm causality.

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“…The effectiveness of Second Nature’s DWMI has previously been explored in self-paying consumers and patients with type 2 diabetes; however, these studies included populations with lower average baseline BMIs of 33.7 and 35.9 kg/m 2 , measured shorter-term outcomes at 6 and 12 months [ 28 , 43 ]. This study builds on this earlier work by exploring longer-term outcomes with a population similar to that seen in SWMS [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

The Potential of a Digital Weight Management Program to Support Specialist Weight Management Services in the UK National Health Service: Retrospective Analysis

Richards,

Wren,

Whitman

2024

JMIR Diabetes

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Background Digital weight management interventions (DWMIs) have the potential to support existing specialist weight management services (SWMS) in the National Health Service (NHS) to increase access to treatment for people living with obesity and type 2 diabetes. At present, there is limited real-world evidence and long-term outcomes on the potential effectiveness of DWMIs to support such services. Objective This study aimed to examine real-world data to evaluate the impact of Second Nature’s 12-month DWMI for patients living with obesity with or without type 2 diabetes, referred from NHS primary care services, on sustained weight loss over a 2-year period. Methods Retrospective data were extracted in August 2023 for participants who participated in the program between January 1, 2017, and January 8, 2021. Eligible participants were adults with a BMI ≥35 kg/m2, with or without type 2 diabetes. The primary outcomes were weight change in kilograms and percentage weight change at 2 years. Secondary outcomes were weight loss at 1 year, program engagement, and the proportion of participants who achieved >5% and >10% weight loss. Differences in weight loss between baseline and the 1- and 2-year follow-up points were compared using paired 2-tailed t tests. Linear regression models were used to examine whether participants’ ethnicity, indices of multiple deprivation, presence of type 2 diabetes, or program engagement were associated with weight loss at 1 year or 2 years. Results A total of 1130 participants with a mean baseline BMI of 46.3 (SD 31.6) kg/m2 were included in the analysis. Of these participants, 65% (740/1130) were female (mean age 49.9, SD 12.0 years), 18.1% (205/339) were from Black, Asian, mixed, or other ethnicities, and 78.2% (884/1130) had type 2 diabetes. A total of 281 (24.9%) participants recorded weight readings at 2 years from baseline, with a mean weight loss of 13.8 kg (SD 14.2 kg; P<.001) or 11.8% (SD 10.9%; P<.001). A total of 204 (18.1%) participants achieved ≥5% weight loss, and 130 (11.5%) participants reached ≥10% weight loss. Weight loss did not significantly differ by ethnicity, indices of multiple deprivation, presence of type 2 diabetes, or engagement in the program. Conclusions The findings suggested that Second Nature’s DWMI has the potential to support people living with obesity and type 2 diabetes remotely to achieve clinically significant and sustained weight loss at 2 years from baseline. Further research is needed to compare the intervention to standard care and assess integration with multidisciplinary clinical teams and pharmacotherapy in order to support this study’s findings.

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Engagement and effectiveness of digitally enabled behavioural change support for people living with type 2 diabetes

Cited by 10 publications

References 31 publications

The Association Between Goal Setting and Weight Loss: Prospective Analysis of a Community Weight Loss Program

The Association Between Goal Setting and Weight Loss: Prospective Analysis of a Community Weight Loss Program

The Association Between Goal Setting and Weight Loss: Prospective Analysis of a Community Weight Loss Program (Preprint)

The Potential of a Digital Weight Management Program to Support Specialist Weight Management Services in the UK National Health Service: Retrospective Analysis

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