Abstract
BackgroundAdherence to weight loss interventions is crucial to successful outcomes, yet little is known about how best to improve it. This suggests a need for developing and improving adherence strategies, such as formal commitments. This review aims to identify the effect of including a commitment device alongside lifestyle interventions on weight loss, and identify the most appropriate delivery mechanisms and target behaviours.MethodsWe searched five databases and hand-searched reference lists for trials of behavioural interventions to achieve weight loss among adults with excess weight or obesity. Interventions incorporating commitment devices were included in a narrative review and meta-analysis where appropriate. Commitment devices with financial incentives were excluded.ResultsOf 2675 unique studies, ten met the inclusion criteria. Data from three randomised trials including 409 participants suggests that commitment interventions increases short-term weight loss by a mean of 1.5 kg (95% CI: 0.7, 2.4). Data from two randomised trials including 302 patients suggests that benefits were sustained at 12 months (mean difference 1.7 kg; 95% CI: 0.0, 3.4). Commitment devices appeared most successful when made publicly, and targeting diet rather than physical activity.ConclusionsUsing commitment devices, such as behavioural contracts, as part of a weight loss intervention may be useful in improving weight loss outcomes and dietary changes, at least in the short-term. However, evidence is limited and of variable quality so results must be interpreted with caution. Poor reporting of intervention details may have limited the number of identified studies. More rigorous methodology and longer term follow-ups are required to determine the effectiveness of behavioural contracts given their potential for use in public health interventions.
Highlights
Adherence to weight loss interventions is crucial to successful outcomes, yet little is known about how best to improve it
We provide our own definition here, given that some forms of commitment devices identified in our scoping review were based on commitment to achieving a certain outcome, which would not be included if we had exclusively used the definition of the behaviour change techniques (BCTs) ‘commitment’ from the Behaviour Change Technique Taxonomy version 1 (BCTTv1) [30]
In terms of commitment device type, eight studies reported the use of behavioural contracts (1.8 BCTTv1), one specified the use of verbal commitments (1.9) by male spouses of female participants in addition to the contracts [43], one described an online/app based pledge [38], and one reported a public commitment to an outcome [39]
Summary
Adherence to weight loss interventions is crucial to successful outcomes, yet little is known about how best to improve it. This suggests a need for developing and improving adherence strategies, such as formal commitments. ‘Commitment device’ is an umbrella term for any technique that helps people commit to performing a particular behaviour, or achieving a particular outcome. They include behavioural contracts, pledges, verbal agreements/commitments, and can be categorised into two broad categories; ‘soft’ and ‘hard’. Soft commitments do not have any incentives or rewards attached, but tend to rely on social consequences such as making a commitment publicly [17]
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