What Intervention Elements Drive Weight Loss in Blended-Care Behavior Change Interventions? A Real-World Data Analysis with 25,706 Patients

Abstract

Background: Blended-care behavior change interventions (BBCI) are a combination of digital care and coaching by health care professionals (HCP), which are proven effective for weight loss. However, it remains unclear what specific elements of BBCI drive weight loss. Objectives: This study aims to identify the distinct impact of HCP-elements (coaching) and digital elements (self-monitoring, self-management, and education) for weight loss in BBCI. Methods: Long-term data from 25,706 patients treated at a digital behavior change provider were analyzed retrospectively using a ridge regression model to predict weight loss at 3, 6, and 12 months. Results: Overall relative weight loss was −1.63 kg at 1 month, −3.61 kg at 3 months, −5.28 kg at 6 months, and −6.55 kg at 12 months. The four factors of BBCI analyzed here (coaching, self-monitoring, self-management, and education) predict weight loss with varying accuracy and degree. Coaching, self-monitoring, and self-management are positively correlated with weight losses at 3 and 6 months. Learn time (i.e., self-guided education) is clearly associated with a higher degree of weight loss. Number of appointments outside of app coaching with a dietitian (coach) was negatively associated with weight loss. Conclusions: The results testify to the efficacy of BBCI for weight loss-with particular positive associations per time point-and add to a growing body of research that characterizes the distinct impact of intervention elements in real-world settings, aiming to inform the design of future interventions for weight management.

Real‐world data of a digitally enabled, time‐restricted eating weight management program in public sector workers living with overweight and obesity in the United Kingdom: A service evaluation of the Roczen program

“…Data from the digital stream of the NHS Diabetes Prevention Program revealed a mean weight reduction of 3.1 kg 38 . Roczen is also comparable to other digitally delivered lifestyle interventions, where care is delivered by dietitians or health coaches via digital applications rather than clinicians 39,40 . Our retention rates was comparable to those in other Tier 3 specialist obesity program, with drop out ranging from 10% to 78% at the end of follow‐up 41 .…”

Association between Body Mass Index and the Use of Digital Platforms to Record Food Intake: Cross-Sectional Analysis

“…In fact, app users have declared that having professional support for using the apps may be interesting [39]. It has been demonstrated that a combination of care with digital apps-based tools and support by health professionals is effective for healthy weight achievement [72]. The factors included in these interventions, which conditioned the best results in weight management, were as follows: self-management, particularly in the first phases of the interventions; early education in nutrition and diet; and totally online support messages from health professionals [72].…”

Practical strategies to manage obesity in type 2 diabetes

“…127,128 In addition, several effective behaviour change techniques implicate increasing cognitive awareness and self-efficacy in weight-loss interventions. Self-monitoring of weight or food intake is firmly associated with sustained weight-loss effects and should therefore be strongly encouraged, 129,130 particularly in a weight-loss maintenance phase, at weekly intervals. 111 who participated in a lifestyle intervention program rated a high level of professional supervision as the primary driver of weight loss.…”

“…In addition, several effective behaviour change techniques implicate increasing cognitive awareness and self‐efficacy in weight‐loss interventions. Self‐monitoring of weight or food intake is firmly associated with sustained weight‐loss effects and should therefore be strongly encouraged, 129,130 particularly in a weight‐loss maintenance phase, at weekly intervals 111 . Other important drivers of behavioural change that should be supported or implemented by HCPs are action planning, providing clear instructions and showing interventions when possible 131 …”