Abstract
BackgroundA wide range of self-directed weight-loss interventions are available, providing users with a variety of tools delivered through various formats to regulate weight-related behavior patterns. However, it is unclear how effective self-directed interventions are and how they promote weight loss and weight maintenance.ObjectiveA systematic review of reviews was conducted to examine the effectiveness of such interventions and to identify intervention content associated with effectiveness.MethodsMEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Library for systematic reviews were searched from 2000-2012 for reviews of the effectiveness of self-directed interventions on weight loss and weight maintenance in adults. Two reviewers used predefined inclusion criteria to select relevant reviews and assess their quality using the Overview Quality Assessment Questionnaire (OQAQ). We extracted data on effectiveness and on relationships between intervention characteristics and effectiveness.ResultsTwenty reviews were included and quality assessed. Findings relevant to self-directed interventions, including interactive websites, smartphone applications, and text messaging (short message service, SMS) were summarized. Findings were mixed but promising. For example, one review of Internet-based interventions found that, when used in conjunction with standard weight loss programs, these interventions resulted in a significant average increase in weight loss of 1.5 kg over evaluation periods. Unfortunately, only 7 of 20 reviews were of high methodological quality according to OQAQ scores, and only 4 employed meta-analyses. Few reviews linked intervention content to effectiveness.ConclusionsCurrent evidence suggests that self-directed interventions can independently promote weight loss and can augment interventions involving personal contact. Particular change techniques and delivery modes including individualized feedback, email counseling, and online social support appear to enhance effectiveness. Further reviews of the content of self-directed weight-loss intervention studies are needed to clarify which change techniques delivered through which delivery formats optimize intervention effectiveness.
Highlights
Weight reduction is a global health priority because being overweight or obese is associated with multiple health problems, including the leading causes of preventable death such as cardiovascular disease, type 2 diabetes, and particular cancers [1,2]
One meta-analysis included in this review found that Internet-based interventions of longer duration, based on social cognitive theories, and including educational components with regular updates of intervention content increased physical activity levels [22]
We found that underlying components within self-directed interventions that contribute to weight loss success were largely unexplored at both study and review level
Summary
Weight reduction is a global health priority because being overweight or obese is associated with multiple health problems, including the leading causes of preventable death such as cardiovascular disease, type 2 diabetes, and particular cancers [1,2]. Pharmaceutical and bariatric surgery treatments are effective for some overweight and obese people but are expensive and often accompanied by adverse side effects They tend to be weight loss treatments of last resort [4]. A wide range of self-directed weight-loss interventions are available, providing users with a variety of tools delivered through various formats to regulate weight-related behavior patterns. It is unclear how effective self-directed interventions are and how they promote weight loss and weight maintenance. Further reviews of the content of self-directed weight-loss intervention studies are needed to clarify which change techniques delivered through which delivery formats optimize intervention effectiveness
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