An Ecological Momentary Intervention for weight loss and healthy eating via smartphone and Internet: study protocol for a randomised controlled trial.

Bastiaan Boh,Anita Jansen,Anne Roefs,Gerhard Weiss,Chantal Nederkoorn,Vincent Kerkhofs,Lotte H J M Lemmens,Gerasimos Spanakis

doi:10.1186/s13063-016-1280-x

Abstract

BackgroundLong-term weight loss maintenance is difficult to achieve. Effectiveness of obesity interventions could be increased by providing extended treatment, and by focusing on person-environment interactions. Ecological Momentary Intervention (EMI) can account for these two factors by allowing an indefinite extension of a treatment protocol in everyday life. EMI relies on observations in daily life to intervene by providing appropriate in-the-moment treatment. The Think Slim intervention is an EMI based on the principles of cognitive behavioural therapy (CBT), and its effectiveness will be investigated in the current study.MethodsA randomised controlled trial (RCT) will be conducted. At least 134 overweight adults (body mass index (BMI) above 25 kg/m2) will be randomly assigned to an 8-week immediate intervention group (Diet + Think Slim intervention, n = 67) or to an 8-week diet-only control group (followed by the Think Slim intervention, n = 67). The Think Slim intervention consists of (1) an app-based EMI that estimates and intervenes when people are likely to overeat, based on Ecological Momentary Assessment data, and (2) ten online computerised CBT sessions which work in conjunction with an EMI module in the app. The primary outcome is BMI. Secondary outcomes include (1) scores on self-report questionnaires for dysfunctional thinking, eating styles, eating disorder pathology, general psychological symptomatology, and self-esteem, and (2) eating patterns, investigated via network analysis. Primary and secondary outcomes will be obtained at pre- and post-intervention measurements, and at 3- and 12-month follow-up measurements.DiscussionThis is the first EMI aimed at treating obesity via a cognitive approach, provided via a smartphone app and the Internet, in the context of an RCT.Trial registrationThis trial has been registered at the Netherlands Trial Register, part of the Dutch Cochrane Centre (NTR5473; registration date: 26 October 2015).

Highlights

MotivationInformation on weight-gain and weight-loss Introduction of the cognitive model and the concept of dysfunctional thinking Information on how to select a diet, diet coach and exercise planaPersonal reasons for losing weightb Realistic weight loss goalsb Identifying and responding to sabotaging cognitions about dieting Personal list of sabotaging cognitions about dietingbCoping with food desireInformation on the difference between hunger and food desireTips on how to deal with food desire Personal list of distraction techniquesbIdentifying dysfunctional cognitionsIdentifying dysfunctional cognitions about eating Introducing the concept of dietary temptations Instruction on how to do this in the app Responding to dysfunctional cognitions
Aims and hypotheses The current study aims to test the effectiveness of the Think Slim intervention
Participants were divided to six groups according to their rule-triggering occurrence and each group is represented by a set of rule that describes 80 % of the eating behaviour of participants in the group

Summary

Introduction

MotivationInformation on weight-gain and weight-loss Introduction of the cognitive model and the concept of dysfunctional thinking Information on how to select a diet, diet coach and exercise planaPersonal reasons for losing weightb Realistic weight loss goalsb Identifying and responding to sabotaging cognitions about dieting Personal list of sabotaging cognitions about dietingbCoping with food desireInformation on the difference between hunger and food desireTips on how to deal with food desire Personal list of distraction techniquesbIdentifying dysfunctional cognitionsIdentifying dysfunctional cognitions about eating Introducing the concept of dietary temptations Instruction on how to do this in the app Responding to dysfunctional cognitions. Meta-analyses on weight maintenance have shown that diet programmes with or without exercise [6, 7], very-low-energy diets [6, 8], dietary counselling [9], behavioural therapy [10], lifestyle advice [11] and pharmacotherapy [8, 11, 12] mostly lead to weight loss of between 5–9 % of initial body weight, which levels off at around 6 months [8] After these 6 months, around 50 % of the lost weight (on average) is gradually regained [8, 13]. This indicates that it is important to investigate methods for improving immediate weight loss resulting from treatment, and to prevent weight regain in the long term

Methods

Discussion

Conclusion