Examining weekly facilitated group sessions and counselor‐crafted self‐monitoring feedback on treatment outcome in digital weight control: A pilot factorial study

Abstract

Objective Weight control programs that incorporate group sessions produce greater weight losses, but this has not been explored in the context of online programs. Further, counselor‐crafted self‐monitoring feedback is a core element of lifestyle interventions, although pre‐scripted, modular feedback which does not require detailed counselor review may adequately promote weight loss. The current study explored the weight losses achieved in an online program that included facilitated group sessions, as well as outcomes when counselor‐crafted self‐monitoring feedback was provided. Methods A 2 × 2 pilot factorial randomized participants (90% women) with overweight/obesity ( N = 73) to facilitated group sessions (yes/no) and type of feedback (counselor‐crafted/pre‐scripted, modular) within a 16‐week online behavioral weight control program. Weight change outcomes were collected digitally. Treatment engagement and intervention delivery time were also tracked. Results Individuals offered weekly facilitated online group sessions lost more weight (−5.3% ± 4.9%) than those receiving the same digital program without group sessions (−3.1% ± 4.0%; p = 0.04). Those receiving group sessions also demonstrated significantly greater treatment engagement. Individuals receiving pre‐scripted, modular feedback lost significantly more weight (−5.3% ± 4.8%) than those receiving the more traditional counselor‐crafted feedback (−3.1% ± 4.1%; p = 0.04), but treatment engagement did not differ between conditions. However, interventionist time required to provide feedback was markedly lower for pre‐scripted than counselor‐crafted feedback (1.4 vs. 3.5 h per participant over 16 weeks, respectively, p = 0.01). Conclusions Incorporating weekly facilitated online group sessions significantly increased weight losses achieved in a digital lifestyle program. Further, pre‐scripted, modular feedback required significantly less staff time than counselor‐crafted feedback without diminishing weight losses. Thus, group sessions and pre‐scripted feedback warrant consideration when designing digital lifestyle programs.

The Effect of Tailored, Daily, Smartphone Feedback to Lifestyle Self-Monitoring on Weight Loss at 12 Months: the SMARTER Randomized Clinical Trial

“…A recent pilot study that used a 2 × 2 factorial design provides some insights into FB (counselor-crafted vs pre-scripted [ 51 ]) and group sessions (yes or no). Participants in the group sessions were more engaged in SM and lost more weight than did those not offered group sessions; however, the group that received pre-scripted, modular FB had significantly greater weight loss than did the group that received the counselor-crafted FB while there was no consistent difference in their treatment engagement.…”

Impact of feedback generation and presentation on self-monitoring behaviors, dietary intake, physical activity, and weight: a systematic review and meta-analysis

“…Of the 19 studies, 6 focused on diet [ 27 , 28 , 40 – 43 ], 14 focused on physical activity [ 24 – 26 , 36 , 41 , 43 – 52 ], 3 focused on sedentary behaviors [ 24 , 26 , 53 ], and 9 focused on weight management [ 24 , 27 – 29 , 40 – 43 , 51 ] (with some studies focusing on more than one of these behaviors) (Table 2 ). Outcomes for the different behaviors, however, varied widely between studies.…”

“…The majority of studies included samples with a mean age between 30 and 50 [ 27 , 28 , 40 – 42 , 44 , 46 , 51 , 52 ] who were predominantly female [ 25 , 27 – 29 , 36 , 40 – 44 , 46 , 48 , 51 , 52 ] and White [ 26 – 29 , 41 , 42 , 44 , 46 , 51 , 53 ] (although ethnicity or race was not reported in 7 publications). Studies were conducted in the United States ( n = 10, 52.6%; [ 27 – 29 , 41 , 42 , 46 , 47 , 51 – 53 ], Brazil ( n = 1, 5.3% [ 43 ]), the Netherlands ( n = 1, 5.3% [ 40 ]), Finland ( n = 1, 5.3% [ 24 ]), Thailand ( n = 1, 5.3% [ 25 ]), China ( n = 1, 5.3% [ 45 ]), and the United Kingdom ( n = 4, 21.1% [ 26 , 36 , 44 , 48 ]. Study duration ranged from 2 days to 24 months, although most interventions ( n = 11) were shorter than 12 weeks.…”

“…Schembre et al [ 21 ] concentrated on just-in-time feedback in diet and physical activity-focused interventions and was unable to conduct a meta-analysis due to the variability in targeted behaviors, study duration, and feedback types. Thus, it is essential to identify and evaluate feedback types that may optimize this intervention component, given the widespread use of feedback in behavioral interventions for weight management, dietary change and physical activity change, the personnel costs of human-generated feedback [ 22 ], as well as the various forms in which feedback may be presented (e.g., positive reinforcement messages vs. areas for change [ 23 ]; numerical displays [ 24 , 25 ] vs. vibrations [ 26 ] vs. text [ 27 – 29 ]).…”

Detailed Versus Simplified Dietary Self-monitoring in a Digital Weight Loss Intervention Among Racial and Ethnic Minority Adults: Fully Remote, Randomized Pilot Study

“…To our knowledge, few past studies on behavioral weight management interventions have been conducted entirely remotely [ 28 , 105 , 106 ]. Two recent studies switched from an in-person to a fully remote format due to the COVID-19 pandemic and reported how outcomes differed by format: the weight loss maintenance study by Leahey et al [ 45 ] observed higher treatment attendance when done remotely versus in-person and excellent retention at study assessments for up to 18 months in both formats.…”