Perspectives into the experience of successful, substantial long-term weight-loss maintenance: a systematic review

Spreckley, Marie; Seidell, J.C.; Halberstadt, Jutka

doi:10.1080/17482631.2020.1862481

Cited by 33 publications

(45 citation statements)

References 42 publications

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“…The primary research question was: What are the characteristics, needs and expectations of patients with a BMI >27kg/m2 who participate in a weight-loss programme upon commencement of the programme? This study is building on the thematic findings of the systematic review previously conducted titled: “Perspectives into the experience of successful, substantial long-term weight-loss maintenance—A Systematic Review” [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

Patient insights into the experience of trying to achieve weight-loss and future expectations upon commencement of a primary care-led weight management intervention: A qualitative, baseline exploration

et al. 2022

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Introduction The long-term effects of interventions aiming to achieve substantial, sustainable weight loss maintenance have been disappointing. Most people regain their lost weight over time but some seem to be able to maintain their weight loss. We are following the experiences of patients over time prospectively. This study forms the baseline to provide insights into patient experiences prior to entering a primary care-led weight management intervention and their expectations going forward. Materials and methods We recruited 21 adult male and female patients of varying ethnicity with a BMI between 27.7kg/m2 and 48.4kg/m2 from a cohort of patients entering a primary care-led weight management intervention. Patients were offered video and audio interview options during the COVID-19 lockdown. In total, twenty chose the audio option, while one chose the video option. The interview format was semi-structured with room for individual exploration. Discussion We found that participants experienced feeling unable to control their weight and encountered a multitude of internal and external barriers to weight management. Some had supportive environments, while others experienced discouraging external influences. Though personal characteristics varied, motivations, goals and expected benefits were similar across this cohort. Most participants had previously experienced transient successful weight-loss attempts with varying approaches. COVID-19 was experienced as an opportunity or barrier for change. Conclusion This study illustrates the importance of gaining comprehensive insights into the diverse experiences patients encounter when trying to achieve weight loss. Personalized support taking into account individual experiences and circumstances may enhance long-term treatment outcomes. Future research into the complexities of weight management based on individual accounts can aid in the creation of improved treatment protocols.

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Section: Introductionmentioning

confidence: 99%

Patient insights into the experience of trying to achieve weight-loss and future expectations upon commencement of a primary care-led weight management intervention: A qualitative, baseline exploration

et al. 2022

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“…This may suggest that technologies for digital weight loss maintenance should aim to support healthy lifestyles and sustained motivation in line with the self-determination theory, supporting psychological needs such as competence, relatedness, and autonomy [ 26 , 92 , 95 ]. Digital interventions incorporating features supporting habit formation in line with self-determined goals, individual values, and identity, as well as focusing on meaningful areas such as improved health, might also enhance a sense of purpose and facilitate long-term health behavior changes and weight outcomes [ 17 , 26 , 32 , 98 - 101 ]. The results also indicate that the application of PSD principles from the primary support , dialogue support , social support, and credibility support categories might be required to aid weight loss maintenance and that the application of PSD principles such as personalization and tailoring of design features is important to match individual challenges, goals, and key values.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, self-regulation strategies and skills are essential to enhance when new physically active lifestyles or healthy eating patterns are not fully automated and are likely vital to maintain healthy behaviors and not relapse into previous habits [ 26 , 105 ]. The findings from this study show that targeting holistic aspects (eg, cognitive, emotional, social, and behavioral) of behavior change [ 103 ] during the design of digital technologies may be essential when aiming to deal with the often multifaceted challenges and needs of weight loss maintenance [ 23 , 32 , 98 ]. Informed by the self-determination and self-regulation theories [ 91 , 92 , 95 ], some of the features identified in this study focus on the generation of habitual behaviors through recognized self-regulation and habit formation techniques.…”

Section: Discussionmentioning

confidence: 99%

Combining Persuasive System Design Principles and Behavior Change Techniques in Digital Interventions Supporting Long-term Weight Loss Maintenance: Design and Development of eCHANGE

Asbjornsen¹,

Hjelmesæth²,

Smedsrød³

et al. 2022

JMIR Hum Factors

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Background Long-term weight maintenance after weight loss is challenging, and innovative solutions are required. Digital technologies can support behavior change and, therefore, have the potential to be an effective tool for weight loss maintenance. However, to create meaningful and effective digital behavior change interventions that support end user values and needs, a combination of persuasive system design (PSD) principles and behavior change techniques (BCTs) might be needed. Objective This study aimed to investigate how an evidence-informed digital behavior change intervention can be designed and developed by combining PSD principles and BCTs into design features to support end user values and needs for long-term weight loss maintenance. Methods This study presents a concept for how PSD principles and BCTs can be translated into design features by combining design thinking and Agile methods to develop and deliver an evidence-informed digital behavior change intervention aimed at supporting weight maintenance. Overall, 45 stakeholders participated in the systematic and iterative development process comprising co-design workshops, prototyping, Agile development, and usability testing. This included prospective end users (n=17, 38%; ie, people with obesity who had lost ≥8% of their weight), health care providers (n=9, 20%), healthy volunteers (n=4, 9%), a service designer (n=1, 2%), and stakeholders from the multidisciplinary research and development team (n=14, 31%; ie, software developers; digital designers; and eHealth, behavior change, and obesity experts). Stakeholder input on how to operationalize the design features and optimize the technology was examined through formative evaluation and qualitative analyses using rapid and in-depth analysis approaches. Results A total of 17 design features combining PSD principles and BCTs were identified as important to support end user values and needs based on stakeholder input during the design and development of eCHANGE, a digital intervention to support long-term weight loss maintenance. The design features were combined into 4 main intervention components: Week Plan, My Overview, Knowledge and Skills, and Virtual Coach and Smart Feedback System. To support a healthy lifestyle and continued behavior change to maintain weight, PSD principles such as tailoring, personalization, self-monitoring, reminders, rewards, rehearsal, praise, and suggestions were combined and implemented into the design features together with BCTs from the clusters of goals and planning, feedback and monitoring, social support, repetition and substitution, shaping knowledge, natural consequences, associations, antecedents, identity, and self-belief. Conclusions Combining and implementing PSD principles and BCTs in digital interventions aimed at supporting sustainable behavior change may contribute to the design of engaging and motivating interventions in line with end user values and needs. As such, the design and development of the eCHANGE intervention can provide valuable input for future design and tailoring of evidence-informed digital interventions, even beyond digital interventions in support of health behavior change and long-term weight loss maintenance. Trial Registration ClinicalTrials.gov NCT04537988; https://clinicaltrials.gov/ct2/show/NCT04537988

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“…In the current study, the REPOWER-clinic-individual intervention was designed to be consistent with the CMS treatment approach and reimbursement strategy. Unfortunately, the REPOWER-clinic-individual group lost the least amount of weight substantial weight loss over time (26). Future research should focus on identifying inflection points for the transition from weight loss to weight maintenance and regain as well as developing optimal strategies for long-term weight loss in primary care settings.…”

Section: Discussionmentioning

confidence: 99%

Weight loss in primary care: A pooled analysis of two pragmatic cluster‐randomized trials

Katzmarzyk

Apolzan

Gajewski

et al. 2021

Obesity

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ObjectiveThe aim of this study was to report the results of five weight‐loss interventions in primary care settings in underserved patients and to compare the level of pragmatism across the interventions using the Pragmatic Explanatory Continuum Indicator Summary (PRECIS‐2) tool.MethodsData from 54 primary care clinics (2,210 patients) were pooled from the Promoting Successful Weight Loss in Primary Care in Louisiana (PROPEL) and Rural Engagement in Primary Care for Optimizing Weight Reduction (REPOWER) cluster‐randomized trials. Clinics were randomized to one of five comparators: PROPEL usual care, PROPEL combination of in‐clinic and telephone visits, REPOWER in‐clinic individual visits, REPOWER in‐clinic group visits, or REPOWER telephone group visits.ResultsAt 24 months, weight loss (kilograms) was −0.50 (95% CI: −1.77 to 0.76), −3.05 (−4.10 to −2.01), −4.30 (−5.35 to −3.26), −4.79 (−5.83 to −3.75), and −4.80 (−5.96 to −3.64) in the PROPEL usual care, REPOWER in‐clinic individual visits, REPOWER telephone group visits, REPOWER in‐clinic group visits, and PROPEL in‐clinic and telephone visits arms, respectively. At 24 months, percentage of weight loss was −0.360 (−1.60 to 0.88), −3.00 (−4.02 to −1.98), −4.23 (−5.25 to −3.20), −4.67 (−5.69 to −3.65), and −4.69 (−5.82 to −3.56), respectively, in the five arms. The REPOWER in‐clinic individual visits intervention was the most pragmatic and reflects the current Centers for Medicare and Medicaid Services funding model, although this intervention produced the least weight loss.ConclusionsClinically significant weight loss over 6 months in primary care settings is achievable using a variety of lifestyle‐based treatment approaches. Longer‐term weight‐loss maintenance is more difficult to achieve.

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Perspectives into the experience of successful, substantial long-term weight-loss maintenance: a systematic review

Cited by 33 publications

References 42 publications

Patient insights into the experience of trying to achieve weight-loss and future expectations upon commencement of a primary care-led weight management intervention: A qualitative, baseline exploration

Patient insights into the experience of trying to achieve weight-loss and future expectations upon commencement of a primary care-led weight management intervention: A qualitative, baseline exploration

Combining Persuasive System Design Principles and Behavior Change Techniques in Digital Interventions Supporting Long-term Weight Loss Maintenance: Design and Development of eCHANGE

Weight loss in primary care: A pooled analysis of two pragmatic cluster‐randomized trials

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