Obesity and overweight are significant public health concerns, increasing the risk of chronic diseases and impacting quality of life. Interventions aimed at weight loss are crucial, but their effectiveness hinges on participant engagement and adherence. Digital behavior change interventions (DBCIs) offer a scalable approach to address these issues, yet they often face challenges with declining engagement over time. This article delves into various aspects of weight loss interventions, including the impact of depression on engagement and adherence in eHealth programs, the effectiveness of different dietary tracking methods, and the potential health benefits of even modest weight loss (less than 5%).
Simplified vs. Standard Dietary Self-Monitoring
A study involving 72 participants with overweight or obesity, all of whom had children aged 2 to 12 living at home, compared two mobile-delivered weight loss interventions. Participants were randomly assigned to either a group using simplified dietary self-monitoring of high-calorie foods (Simplified) or a group tracking calories (Standard). After 6 months, the Standard group experienced a 5.7% weight loss (95% CI: -8.3% to -3.2%), while the Simplified group had a 4.0% weight loss (95% CI: -5.7% to -2.3%). The difference between the two groups was not statistically significant. Furthermore, similar proportions in both groups achieved 5% weight loss at 6 months (43.2% in Standard and 42.9% in Simplified).
These findings suggest that both mobile-delivered weight loss interventions led to clinically meaningful weight loss at 6 months. Importantly, there were no significant differences in dietary tracking adherence or dietary intake between the simplified and standard approaches. This indicates that a simplified approach to dietary self-monitoring can be as effective as traditional calorie tracking in achieving weight loss.
The Impact of Depression on Engagement and Adherence in eHealth Interventions
Digital behavior change interventions (DBCIs) have the potential to promote clinically significant weight loss, but declining engagement and adherence can limit their effectiveness. Depression is often suspected to contribute to reduced engagement, but it is rarely studied in-depth.
To investigate this, structural equation modeling was applied to data from the LoseNow PA (LNPA) study, an NIH-funded 12-month cluster-randomized controlled eHealth DBCI for weight management. The analysis aimed to determine the effects of baseline depression symptoms on weight change outcomes, mediated through latent constructs of engagement and adherence.
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The study found that depression symptoms had no direct association with weight change (p’s ≥ 0.6). However, depression symptoms were negatively associated with both engagement and adherence (p’s < 0.001), which in turn were negatively associated with weight change in both models (p’s < 0.001). This indicates that depression symptoms had a significant, undesirable effect on weight loss outcomes, fully mediated through participant engagement and adherence. In other words, higher levels of depression led to decreased engagement and adherence, resulting in less weight loss or possible weight gain.
These findings highlight the importance of addressing depression symptoms in DBCIs to improve engagement, adherence, and ultimately, weight loss outcomes.
Health Benefits of Modest Weight Loss (Less Than 5%)
While guidelines often recommend aiming for 5-10% weight loss, the health benefits of losing less than 5% of body weight are not well understood. A systematic review was conducted to synthesize the evidence on the potential health benefits of low-level weight loss (< 5% body weight).
The review included 70 studies, with participants ranging from 14 to 10,742. A total of 137 health markers were assessed, categorized into metabolic, cardiovascular, anthropometric, quality of life, inflammatory, renal and hepatic, psychosocial and behavioral, pulmonary function, total mortality, ovulatory function, and muscle strength.
Overall, 60% of studies reported improvements in health markers, 37% found no change or mixed results, and 3% observed a worsening of health markers. Based on the available data, 87% of participants (n = 15,839) in the studies reported improvements in health markers as a result of low-level weight loss.
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This review suggests that even modest weight loss can lead to improvements in various health markers, supporting the idea that any weight loss can be beneficial, particularly for individuals with obesity.
Adaptive Interventions for Weight Loss
Adaptive interventions, which tailor treatments based on individual responses, may improve the effectiveness and scalability of behavioral weight loss interventions. A study explored the feasibility, acceptability, and preliminary outcomes of a two-stage sequential multiple assignment randomized trial (SMART).
In the first stage, 99 adults with overweight/obesity were randomized at baseline to a kick-off session with or without additional human support. In the second stage, "early non-responders" (those who had not achieved a 2% weight loss) were re-randomized after 4 weeks to either biweekly counseling or a one-time check-in with a dietitian. "Early responders" continued with the mHealth program alone.
The study met all feasibility and acceptability criteria. The rate of early response was 52.5%. Mean 3-month percent weight losses were significantly greater in early responders (−6.63%) than non-responders (−1.70%, p < 0.001).
This study demonstrates the potential of adaptive interventions to optimize weight loss outcomes by providing tailored support based on individual responses to treatment.
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Roy Hurley's Weight Loss Journey: A Case Study
Beyond clinical trials and systematic reviews, individual experiences offer valuable insights into weight loss and health. Roy T. Hurley's story exemplifies the proactive approach one individual took to address health risks associated with weight and cholesterol levels.
At the age of sixty-two, Mr. Hurley, a successful executive, was motivated by the heart attacks suffered by his friends and colleagues to investigate his own health risks. He learned that weight, blood pressure, and cholesterol level are closely correlated with the likelihood of a heart attack. Discovering that he was overweight and had high cholesterol, Hurley embarked on a journey to improve his health through dietary changes.
He consulted with nutrition experts, researched various diets, and ultimately adopted a diet prescribed by Dr. Theodore Van Itallie. This diet, similar to that advocated by Ancel Keys, focused on reducing saturated fats and increasing unsaturated fats. Hurley also made modifications to the diet, such as incorporating a hearty breakfast consisting of corn oil, wheat germ, powdered lecithin, non-fat milk, and fruit.
As a result of his dietary changes, Hurley lost weight and significantly lowered his serum cholesterol. He emphasized the importance of a hearty breakfast and believed in the potential benefits of lecithin. Hurley's experience highlights the importance of individual initiative, informed decision-making, and consistent effort in achieving weight loss and improving health.
Additional Factors Influencing Weight Loss
The Potential Role of Piceatannol
Piceatannol, a natural compound found in red grapes, is believed to block insulin's ability to activate genes that carry out further stages of fat cell formation. While more research is needed, this suggests a potential role for piceatannol in weight management.
Wine Consumption and Weight Loss
Some studies suggest that moderate wine consumption may have health benefits. However, it's crucial to adhere to recommended limits: up to 7 glasses of wine or servings of alcohol per week for women. It's important to remember that "low risk" doesn't mean "no risk," and some individuals should limit or avoid alcohol altogether. If you don't currently drink, you shouldn't start. Red grapes and grape juice offer the same antioxidant benefits as wine without the alcohol. Individuals considering alcohol consumption should consult their doctor.
The Metawell Program: A Chinese Weight Loss Intervention
A study in China evaluated the safety and efficacy of the Metawell program, a weight loss program using prepackaged biscuits, a Bluetooth body composition scale, and a mobile app for daily guidance from health care professionals. The intervention lasted for 3 months, with follow-up visits at months 3 and 6.
The study found that participants in the intervention group had significantly greater decreases in BMI, total body fat, visceral adipose area, and subcutaneous adipose area compared to the control group. The rate of change in lean mass was not significantly different between the two groups.
This study suggests that the Metawell program is an effective weight loss intervention in a Chinese population.