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

Alline Beleigoli, Andre Q Andrade, Maria De Fatima Diniz, Antonio Luiz Ribeiro, Alline Beleigoli, Andre Q Andrade, Maria De Fatima Diniz, Antonio Luiz Ribeiro

Abstract

Background: The effect of computer- or human-delivered personalized feedback on the effectivess of web-based behavior change platforms for weight loss is unclear.

Objective: We aimed to compare the effectiveness of a web-based behavior change intervention personalized through either computerized or human-delivered feedback with a nonpersonalized intervention in promoting weight loss in community-based adults with overweight or obesity.

Methods: This pragmatic, 3-group, parallel-arm, randomized trial recruited students and staff in a Brazilian public university who were aged 18 to 60 years, had a BMI of ≥25 kg/m2, and were not pregnant. Participants were allocated to one of 3 groups: platform only (24-week behavior change program delivered using a web platform with personalized computer-delivered feedback), platform plus coaching (same 24-week web-based behavior change program plus 12 weeks of personalized feedback delivered online by a dietitian), or waiting list (nonpersonalized dietary and physical activity recommendations delivered through an e-booklet and videos). Self-reported weight at 24 weeks was the primary outcome. Changes in dietary and physical activity habits within 24 weeks were secondary outcomes.

Results: Among the 1298 participants, 375 (28.89%) were lost to follow-up. In the intention-to-treat analysis, the platform-only and platform plus coaching groups had greater mean weight loss than the waiting-list group at 24 weeks (-1.08 kg, 95% CI -1.41 to -0.75 vs -1.57 kg, 95% CI -1.92 to -1.22 vs -0.66 kg, 95% CI -0.98 to -0.34, respectively). The platform-only and platform plus coaching groups, compared with the waiting list group, had a greater increase in the consumption of vegetables (3%, 95% CI 1% to 6% vs 5%, 95% CI 2% to 8% vs -3%, 95% CI -5% to 0%) and fruits (9%, 95% CI 6% to 12% vs 6%, 95% CI 2% to 9% vs 2%, 95% CI 0% to 6%) and a larger reduction in ultraprocessed food intake (-18%, 95% CI -23% to -13% vs -25%, 95% CI -30% to -20% vs -12%, 95% CI -16% to -8%). Changes in physical activity did not differ across the groups. Engagement was higher in the platform plus coaching group than in the platform-only group (7.6 vs 5.2 completed sessions; P=.007). Longer usage of the platform was associated with clinically meaningful (≥5%) weight loss (odds ratio 1.02, 95% CI 1.01 to 1.04).

Conclusions: The web-based behavior change programs with computer- and human-delivered personalized feedback led to greater, albeit small-magnitude, weight loss within 24 weeks. Improvement in multiple dietary habits, but not physical activity, were also greater in the personalized programs compared with the nonpersonalized one. The human-delivered personalized feedback by the online dietitian coach increased user engagement with the program and was associated with a significantly higher chance of clinically meaningful weight loss.

Trial registration: ClinicalTrials.gov NCT03435445; https://ichgcp.net/clinical-trials-registry/NCT03435445.

International registered report identifier (irrid): RR2-10.2196/10.1186/s12889-018-5882-y.

Keywords: diet; digital health; healthy eating; obesity; online coaching; overweight; personalized web interventions; web platform.

Conflict of interest statement

Conflicts of Interest: AQA was the owner of the software company that provided the web platform by the time the study was conducted. All other authors declare no conflicts of interest.

©Alline Beleigoli, Andre Q Andrade, Maria De Fatima Diniz, Antonio Luiz Ribeiro. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 05.11.2020.

Figures

Figure 1
Figure 1
CONSORT flow diagram for the POEmaS randomized controlled trial. CONSORT: Consolidated Standards of Reporting Trials; POEmaS: Online Platform for Healthy Weight Loss.
Figure 2
Figure 2
Clinically meaningful weight loss, stability, and gain per group at 24 weeks.
Figure 3
Figure 3
Number of participants completing sessions per group (group B is the platform-only group and group C is the platform plus coaching group) over 24 weeks.

References

    1. GBD 2015 Obesity Collaborators. Afshin A, Forouzanfar MH, Reitsma MB, Sur P, Estep K, Lee A, Marczak L, Mokdad AH, Moradi-Lakeh M, Naghavi M, Salama JS, Vos T, Abate KH, Abbafati C, Ahmed MB, Al-Aly Z, Alkerwi A, Al-Raddadi R, Amare AT, Amberbir A, Amegah AK, Amini E, Amrock SM, Anjana RM, Ärnlöv J, Asayesh H, Banerjee A, Barac A, Baye E, Bennett DA, Beyene AS, Biadgilign S, Biryukov S, Bjertness E, Boneya DJ, Campos-Nonato I, Carrero JJ, Cecilio P, Cercy K, Ciobanu LG, Cornaby L, Damtew SA, Dandona L, Dandona R, Dharmaratne SD, Duncan BB, Eshrati B, Esteghamati A, Feigin VL, Fernandes JC, Fürst T, Gebrehiwot TT, Gold A, Gona PN, Goto A, Habtewold TD, Hadush KT, Hafezi-Nejad N, Hay SI, Horino M, Islami F, Kamal R, Kasaeian A, Katikireddi SV, Kengne AP, Kesavachandran CN, Khader YS, Khang Y, Khubchandani J, Kim D, Kim YJ, Kinfu Y, Kosen S, Ku T, Defo BK, Kumar GA, Larson HJ, Leinsalu M, Liang X, Lim SS, Liu P, Lopez AD, Lozano R, Majeed A, Malekzadeh R, Malta DC, Mazidi M, McAlinden C, McGarvey ST, Mengistu DT, Mensah GA, Mensink GBM, Mezgebe HB, Mirrakhimov EM, Mueller UO, Noubiap JJ, Obermeyer CM, Ogbo FA, Owolabi MO, Patton GC, Pourmalek F, Qorbani M, Rafay A, Rai RK, Ranabhat CL, Reinig N, Safiri S, Salomon JA, Sanabria JR, Santos IS, Sartorius B, Sawhney M, Schmidhuber J, Schutte AE, Schmidt MI, Sepanlou SG, Shamsizadeh M, Sheikhbahaei S, Shin M, Shiri R, Shiue I, Roba HS, Silva DAS, Silverberg JI, Singh JA, Stranges S, Swaminathan S, Tabarés-Seisdedos R, Tadese F, Tedla BA, Tegegne BS, Terkawi AS, Thakur JS, Tonelli M, Topor-Madry R, Tyrovolas S, Ukwaja KN, Uthman OA, Vaezghasemi M, Vasankari T, Vlassov VV, Vollset SE, Weiderpass E, Werdecker A, Wesana J, Westerman R, Yano Y, Yonemoto N, Yonga G, Zaidi Z, Zenebe ZM, Zipkin B, Murray CJL. Health Effects of Overweight and Obesity in 195 Countries over 25 Years. N Engl J Med. 2017 Jul 06;377(1):13–27. doi: 10.1056/NEJMoa1614362.
    1. Ma C, Avenell A, Bolland M, Hudson J, Stewart F, Robertson C, Sharma P, Fraser C, MacLennan G. Effects of weight loss interventions for adults who are obese on mortality, cardiovascular disease, and cancer: systematic review and meta-analysis. BMJ. 2017 Nov 14;359:j4849. doi: 10.1136/bmj.j4849.
    1. Obesity and overweight. World Health Organization. [2020-10-01]. .
    1. 4 P. A. Centers for Disease Control and Prevention. [2020-10-08]. .
    1. Blackburn M, Stathi A, Keogh E, Eccleston C. Raising the topic of weight in general practice: perspectives of GPs and primary care nurses. BMJ Open. 2015 Aug 07;5(8):e008546. doi: 10.1136/bmjopen-2015-008546.
    1. Classification of digital health issues v1.0: a shared language to describe the uses of digital technology for health. World Health Organization. [2020-07-01]. .
    1. Pappa GL, Cunha TO, Bicalho PV, Ribeiro A, Couto SAP, Meira W, Beleigoli AMR. Factors Associated With Weight Change in Online Weight Management Communities: A Case Study in the LoseIt Reddit Community. J Med Internet Res. 2017 Jan 16;19(1):e17. doi: 10.2196/jmir.5816.
    1. Beleigoli AM, Andrade AQ, Cançado AG, Paulo MN, Diniz MDFH, Ribeiro AL. Web-Based Digital Health Interventions for Weight Loss and Lifestyle Habit Changes in Overweight and Obese Adults: Systematic Review and Meta-Analysis. J Med Internet Res. 2019 Jan 08;21(1):e298. doi: 10.2196/jmir.9609.
    1. Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011 Apr 23;6:42. doi: 10.1186/1748-5908-6-42.
    1. Yardley L, Spring BJ, Riper H, Morrison LG, Crane DH, Curtis K, Merchant GC, Naughton F, Blandford A. Understanding and Promoting Effective Engagement With Digital Behavior Change Interventions. Am J Prev Med. 2016 Nov;51(5):833–842. doi: 10.1016/j.amepre.2016.06.015. doi: 10.1016/j.amepre.2016.06.015.
    1. Jolly K, Sidhu MS, Hewitt CA, Coventry PA, Daley A, Jordan R, Heneghan C, Singh S, Ives N, Adab P, Jowett S, Varghese J, Nunan D, Ahmed K, Dowson L, Fitzmaurice D. Self management of patients with mild COPD in primary care: randomised controlled trial. BMJ. 2018 Jun 13;361:k2241. doi: 10.1136/bmj.k2241.
    1. Tiede M, Dwinger S, Herbarth L, Härter M, Dirmaier J. Long-term effectiveness of telephone-based health coaching for heart failure patients: A post-only randomised controlled trial. J Telemed Telecare. 2017 Sep;23(8):716–724. doi: 10.1177/1357633X16668436.
    1. Beleigoli AM, Queiroz de Andrade A, Haueisen Diniz MDF, Alvares RS, Ribeiro AL. Online platform for healthy weight loss in adults with overweight and obesity - the "POEmaS" project: a randomized controlled trial. BMC Public Health. 2018 Aug 01;18(1):945. doi: 10.1186/s12889-018-5882-y.
    1. Beleigoli AM, Andrade AQ, Diniz MFH, Alvares RS, Ferreira MH, Silva LA, Rodrigues MC, Jacomassi L, Cerqueira AG, Ribeiro AL. Using the Behaviour Change Wheel for Designing an Online Platform for Healthy Weight Loss - "POEmaS". Stud Health Technol Inform. 2018;254:1–10.
    1. Dietary Guidelines for the Brazilian population. Ministry of Health of Brazil. [2020-10-10]. .
    1. US Preventive Services Task Force. Grossman DC, Bibbins-Domingo K, Curry SJ, Barry MJ, Davidson KW, Doubeni CA, Epling JW, Kemper AR, Krist AH, Kurth AE, Landefeld CS, Mangione CM, Phipps MG, Silverstein M, Simon MA, Tseng CW. Behavioral Counseling to Promote a Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Cardiovascular Risk Factors: US Preventive Services Task Force Recommendation Statement. JAMA. 2017 Jul 11;318(2):167–174. doi: 10.1001/jama.2017.7171.
    1. Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, Eccles MP, Cane J, Wood CE. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med. 2013 Aug;46(1):81–95. doi: 10.1007/s12160-013-9486-6.
    1. Beleigoli A, Andrade A, Diniz M, Alvares R, Ferreira M, Silva L, Rodrigues M, Jacomassi L, Cerqueira A, Ribeiro A. Validation of Anthropometric Measures Self-Reported in a Randomized Controlled Trial of a Web-Based Platform for Weight Loss. Stud Health Technol Inform. 2019 Aug 08;266:30–36. doi: 10.3233/SHTI190769.
    1. Molina MDCB, Benseñor IM, Cardoso LDO, Velasquez-Melendez G, Drehmer M, Pereira TSS, Faria CPD, Melere C, Manato L, Gomes ALC, Fonseca MDJMD, Sichieri R. Reprodutibilidade e validade relativa do Questionário de Frequência Alimentar do ELSA-Brasil. Cad Saúde Pública. 2013 Feb;29(2):379–389. doi: 10.1590/s0102-311x2013000600024.
    1. Marshall AL, Smith BJ, Bauman AE, Kaur S. Reliability and validity of a brief physical activity assessment for use by family doctors. Br J Sports Med. 2005 May;39(5):294–297. doi: 10.1136/bjsm.2004.013771.
    1. Arem H, Irwin M. A review of web-based weight loss interventions in adults. Obes Rev. 2011 May;12(5):e236–43. doi: 10.1111/j.1467-789X.2010.00787.x.
    1. McKinney W. Data Structures for Statistical Computing in Python. 9th Python in Science Conference (SciPy 2010); June 28 - July 3, 2010; Austin, TX. 2010.
    1. Pedregosa F, Varoquaux G, Gramfort A, Michel V, Thirion B, Grisel O, Blondel M. Scikit-learn: Machine Learning in Python. J Machine Learning Res. 2011;12:2825–2830.
    1. Wieland LS, Falzon L, Sciamanna CN, Trudeau KJ, Brodney S, Schwartz JE, Davidson KW. Interactive computer-based interventions for weight loss or weight maintenance in overweight or obese people. Cochrane Database Syst Rev. 2012;8:CD007675. doi: 10.1002/14651858.CD007675.pub2.
    1. Vigitel Brasil 2016: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico. Ministério da Saúde. 2016. [2020-10-10]. .
    1. Wang X, Ouyang Y, Liu J, Zhu M, Zhao G, Bao W, Hu FB. Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: systematic review and dose-response meta-analysis of prospective cohort studies. BMJ. 2014 Jul 29;349:g4490. doi: 10.1136/bmj.g4490.
    1. Webb TL, Joseph J, Yardley L, Michie S. Using the internet to promote health behavior change: a systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy. J Med Internet Res. 2010 Feb;12(1):e4. doi: 10.2196/jmir.1376.
    1. Lau Y, Chee DGH, Chow XP, Cheng LJ, Wong SN. Personalised eHealth interventions in adults with overweight and obesity: A systematic review and meta-analysis of randomised controlled trials. Prev Med. 2020 Mar;132:106001. doi: 10.1016/j.ypmed.2020.106001.
    1. Tate DF, Jackvony EH, Wing RR. A randomized trial comparing human e-mail counseling, computer-automated tailored counseling, and no counseling in an Internet weight loss program. Arch Intern Med. 2006 Aug;166(15):1620–5. doi: 10.1001/archinte.166.15.1620.
    1. Teixeira PJ, Silva MN, Mata J, Palmeira AL, Markland D. Motivation, self-determination, and long-term weight control. Int J Behav Nutr Phys Act. 2012;9:22. doi: 10.1186/1479-5868-9-22.
    1. Lemstra M, Bird Y, Nwankwo C, Rogers M, Moraros J. Weight loss intervention adherence and factors promoting adherence: a meta-analysis. Patient Prefer Adherence. 2016;10:1547–59. doi: 10.2147/PPA.S103649. doi: 10.2147/PPA.S103649.
    1. Mastellos N, Gunn LH, Felix LM, Car J, Majeed A. Transtheoretical model stages of change for dietary and physical exercise modification in weight loss management for overweight and obese adults. Cochrane Database Syst Rev. 2014;2:CD008066. doi: 10.1002/14651858.CD008066.pub3.
    1. Tate DF, Wing RR, Winett RA. Using Internet technology to deliver a behavioral weight loss program. JAMA. 2001 Mar 07;285(9):1172–7. doi: 10.1001/jama.285.9.1172.
    1. Alexander GL, McClure JB, Calvi JH, Divine GW, Stopponi MA, Rolnick SJ, Heimendinger J, Tolsma DD, Resnicow K, Campbell MK, Strecher VJ, Johnson CC. A randomized clinical trial evaluating online interventions to improve fruit and vegetable consumption. Am J Public Health. 2010 Feb;100(2):319–26. doi: 10.2105/AJPH.2008.154468.

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