Web-Based Digital Health Interventions for Weight Loss and Lifestyle Habit Changes in Overweight and Obese Adults: Systematic Review and Meta-Analysis

Abstract

BackgroundObesity is a highly prevalent condition with important health implications. Face-to-face interventions to treat obesity demand a large number of human resources and time, generating a great burden to individuals and health system. In this context, the internet is an attractive tool for delivering weight loss programs due to anonymity, 24-hour-accessibility, scalability, and reachability associated with Web-based programs.ObjectiveWe aimed to investigate the effectiveness of Web-based digital health interventions, excluding hybrid interventions and non-Web-based technologies such as text messaging, short message service, in comparison to nontechnology active or inactive (wait list) interventions on weight loss and lifestyle habit changes in individuals with overweight and obesity.MethodsWe searched PubMed or Medline, SciELO, Lilacs, PsychNet, and Web of Science up to July 2018, as well as references of previous reviews for randomized trials that compared Web-based digital health interventions to offline interventions. Anthropometric changes such as weight, body mass index (BMI), waist, and body fat and lifestyle habit changes in adults with overweight and obesity were the outcomes of interest. Random effects meta-analysis and meta-regression were performed for mean differences (MDs) in weight. We rated the risk of bias for each study and the quality of evidence across studies using the Grades of Recommendation, Assessment, Development, and Evaluation approach.ResultsAmong the 4071 articles retrieved, 11 were included. Weight (MD −0.77 kg, 95% CI −2.16 to 0.62; 1497 participants; moderate certainty evidence) and BMI (MD −0.12 kg/m2; 95% CI −0.64 to 0.41; 1244 participants; moderate certainty evidence) changes were not different between Web-based and offline interventions. Compared to offline interventions, digital interventions led to a greater short-term (<6 months follow-up) weight loss (MD −2.13 kg, 95% CI −2.71 to −1.55; 393 participants; high certainty evidence), but not in the long-term (MD −0.17 kg, 95% CI −2.10 to 1.76; 1104 participants; moderate certainty evidence). Meta-analysis was not possible for lifestyle habit changes. High risk of attrition bias was identified in 5 studies. For weight and BMI outcomes, the certainty of evidence was moderate mainly due to high heterogeneity, which was mainly attributable to control group differences across studies (R2=79%).ConclusionsWeb-based digital interventions led to greater short-term but not long-term weight loss than offline interventions in overweight and obese adults. Heterogeneity was high across studies, and high attrition rates suggested that engagement is a major issue in Web-based interventions.

Personalized Web-Based Weight Loss Behavior Change Program With and Without Dietitian Online Coaching for Adults With Overweight and Obesity: Randomized Controlled Trial

“…Weight and BMI loss were greater after 12 weeks and 24 weeks in the groups using the platform (with or without coaching) than in the group receiving a minimal intervention. The magnitude of weight loss (<2 kg) across the groups was small, which is similar to mean differences found in recent meta-analyses, in which weight loss programs delivered through the web were compared with face-to-face or to no interventions for people with overweight or obesity [ 8 , 24 ]. However, clinically meaningful weight loss (≥5%) was significantly more common in the platform groups with personalized feedback (83/420, 19.8% of the platform-only group and 64/408, 15.7% of the platform plus coaching group) than in the control group that received a nonpersonalized intervention (61/470, 13.0%).…”

“…We attribute this to a very successful recruitment process, which involved a mass communication strategy. Knowing from previous studies that interventions for weight loss, including web-based interventions, are usually associated with high dropout rates [ 8 ], we decided to increase our team capacity and resources to follow up with this higher number of participants. Across all groups, 375 of the 1298 participants (28.89%) were lost to follow-up.…”

“…Despite all these potential benefits, results have been heterogeneous in regard to weight loss results. In a recent systematic review, we found that behavior change interventions delivered exclusively through the web led to clinically small benefits in the short term and no significant long-term weight loss when compared with offline interventions in overweight and obese adults [ 8 ]. This seems to be related to low long-term adherence to web-delivered weight loss interventions, similar to the problems faced by face-to-face interventions.…”

Third‐wave cognitive behaviour therapies for weight management: A systematic review and network meta‐analysis

“…Similarly, a review of online mindful eating interventions found only two studies focusing on weight loss, and none were delivered through mobile telephone, highlighting a dearth of investigation into this research area. Greater consideration may need to be given to the use of digital technology to facilitate intervention delivery, with its 24‐hour accessibility, improved scalability, and increased reach …”

Moxibustion combined with characteristic lifestyle intervention of Traditional Chinese Medicine in the treatment of abdominal obesity

“…The interventions such as diet, physical activity, and cognition education have shown short-term weight loss effects, but poor long-term results and adherence rates. [ 10 – 12 ] In addition, drug therapy is always difficult to be accepted by the majority of obese patients based on its safety. Recent research reported that the surgical treatment of gastrointestinal surgery is the fastest way to lose weight in clinical practice.…”