Remotely Delivered Behavioral Weight Loss Intervention Using an Ad Libitum Plant-Based Diet: Pilot Acceptability, Feasibility, and Preliminary Results

Christina Chwyl, Nicholas Wright, Gabrielle M Turner-McGrievy, Meghan L Butryn, Evan M Forman, Christina Chwyl, Nicholas Wright, Gabrielle M Turner-McGrievy, Meghan L Butryn, Evan M Forman

Abstract

Background: Many traditional lifestyle interventions use calorie prescriptions, but most individuals have difficulty sustaining calorie tracking and thus weight loss. In contrast, whole food plant-based diets (WFPBDs) have previously shown significant weight loss without this issue. However, most WFPBD interventions are face-to-face and time-intensive, and do not leverage gold standard behavioral strategies for health behavior change.

Objective: This open pilot trial was the first to evaluate the feasibility of a fully featured, remotely delivered behavioral weight loss intervention using an ad libitum WFPBD.

Methods: Over 12 weeks, participants (N=15) with overweight or obesity received a newly designed program that integrated behavioral weight loss and a WFPBD prescription via weekly web-based modules and brief phone coaching calls. Assessments were performed at baseline, midtreatment (6 weeks), and after treatment (12 weeks).

Results: The intervention was rated as highly acceptable (mean 4.40 out of 5, SE 0.18), and attrition was low (6.7%). In all, intention-to-treat analyses revealed that 69% (10.4/15) of the participants lost 5% of their weight (mean -5.89, SE 0.68 kg). Predefined benchmarks for quality of life were met.

Conclusions: A pilot digital behavioral weight loss intervention with a non-energy-restricted WFPBD was feasible, and the mean acceptability was high. Minimal contact time (80-150 minutes of study interventionist time per participant over 12 weeks) led to clinically relevant weight loss and dietary adherence for most participants (10.4/15, 69% and 11.8/15, 79%, respectively), and quality of life improvements (reliable change indices >1.53). We hope that this work will serve as a springboard for future larger scale randomized controlled studies evaluating the efficacy of such programs for weight loss, dietary change, and quality of life.

Trial registration: ClinicalTrials.gov NCT04892030; https://ichgcp.net/clinical-trials-registry/NCT04892030.

Keywords: behavioral intervention; eHealth; overweight; vegan diet; vegetarian diet.

Conflict of interest statement

Conflicts of Interest: EF serves on the Scientific Advisory Board of Tivity Health. EF and MB receive royalties from Oxford University Press for a published acceptance-based treatment manual. GT-M received speaker honorarium from 2 nonprofit conferences, the Plant-Based Nutrition Healthcare Conference and the Plant-Based Prevention of Disease conferences.

©Christina Chwyl, Nicholas Wright, Gabrielle M Turner-McGrievy, Meghan L Butryn, Evan M Forman. Originally published in JMIR Formative Research (https://formative.jmir.org), 23.06.2022.

Figures

Figure 1
Figure 1
Outcomes at midtreatment and after treatment. Mean values for participants (N=15) at baseline, midtreatment (6 weeks), and after treatment (12 weeks) for (A) percent weight change, (B) diet change on the adapted food frequency questionnaire, (C) quality of life (physical component) as assessed by the 36-item Short-Form General Health Survey (SF-36), and (D) quality of life (mental component), as assessed by the SF-36. Error bars represent SE of the mean. Percent weight change and percent waist change, rather than percent weight loss and waist circumference loss, are depicted by the convention.

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