Abstract
BackgroundThe effect of computer- or human-delivered personalized feedback on the effectivess of web-based behavior change platforms for weight loss is unclear.ObjectiveWe 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.MethodsThis 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.ResultsAmong 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).ConclusionsThe 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 RegistrationClinicalTrials.gov NCT03435445; https://clinicaltrials.gov/ct2/show/NCT03435445International Registered Report Identifier (IRRID)RR2-10.2196/10.1186/s12889-018-5882-y
Highlights
Obesity is associated with a range of health complications and might lead to increased mortality [1]
Improvement in multiple dietary habits, but not physical activity, were greater in the personalized programs compared with the nonpersonalized one
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]
Summary
Obesity is associated with a range of health complications and might lead to increased mortality [1]. Interventions that target healthy diet and physical activity behaviors are the cornerstones of weight management. Despite their limited success, for weight loss maintenance in the long term, these interventions remain pivotal due to their additional benefits, such as diabetes and premature mortality prevention [2]. The World Health Organization estimates that 39% of adults worldwide are overweight and 13% are obese [3]. Lack of confidence and knowledge among health professionals, uncomfortable feelings among people living with excessive weight about discussing the issue, and the limited timely access to health professionals such as dietitians are some of the challenges the health system faces in tackling obesity at the individual level [5]. The effect of computer- or human-delivered personalized feedback on the effectivess of web-based behavior change platforms for weight loss is unclear
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