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Internet interventions providing personalized feedback for weight loss in overweight and obese adults: What's the evidence?

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Health Evidence hosted a 60 minute webinar examining the effectiveness of internet-delivered interventions providing personalized feedback for weight loss in overweight and obese adults. Click here for access to the audio recording for this webinar: https://youtu.be/AZXuc2XtCUs

Anna Haste, Research Associate at Newcastle University led the session and presented findings from her recent systematic review:

Sherrington, A, Newham, J, Bell, R, Adamson, A, McColl, E, & Araujo-Soares, V. (2016). Systematic review and meta-analysis of internet-delivered interventions providing personalized feedback for weight loss in overweight and obese adults. Obesity Reviews, 17(6), 541-551.
http://www.healthevidence.org/view-article.aspx?a=systematic-review-meta-analysis-internet-delivered-interventions-providing-29586

While prevalence of obesity is increasing, conventional weight loss interventions demonstrate barriers to implementation and mixed-results regarding effectiveness. This systematic review and meta-analysis examines the impact of internet-delivered interventions providing personalized feedback on weight loss in overweight and obese adults, in comparison to controls not receiving personalized feedback. Twelve randomized control trials, with a total of 3547 participants are included in this review. Evidence suggests internet-delivered interventions providing personalized feedback increase weight loss and 5% weight loss at 3 and 6 months, and decrease BMI and waist circumference at 3, 6 and ≥ 12 months. This webinar provided an overview of the effectiveness of internet-delivered interventions providing personalized feedback for weight loss in overweight and obese adults.

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Internet interventions providing personalized feedback for weight loss in overweight and obese adults: What's the evidence?

  1. 1. Welcome! Internet interventions providing personalized feedback for weight loss in overweight and obese adults: What's the evidence? You will be placed on hold until the webinar begins. The webinar will begin shortly, please remain on the line.
  2. 2. Poll Questions: Consent • Participation in the webinar poll questions is voluntary • Names are not recorded and persons will not be identified in any way • Participation in the anonymous polling questions is accepted as an indication of your consent to participate Benefits: • Results inform improvement of the current and future webinars • Enable engagement; stimulate discussion. This session is intended for professional development. Some data may be used for program evaluation and research purposes (e.g., exploring opinion change) • Results may also be used to inform the production of systematic reviews and overviews Risks: None beyond day-to-day living
  3. 3. After Today • The PowerPoint presentation and audio recording will be made available • These resources are available at: – PowerPoint: http://www.slideshare.net/HealthEvidence – Audio Recording: https://www.youtube.com/user/healthevidence/videos 3
  4. 4. What’s the evidence? Sherrington, A., Newham, J., Bell, R., Adamson, A., McColl, E., & Araujo-Soares, V. (2016). Systematic review and meta-analysis of internet-delivered interventions providing personalized feedback for weight loss in overweight and obese adults. Obesity Reviews, 17(6), 541-551. http://www.healthevidence.org/view- article.aspx?a=systematic-review-meta-analysis- internet-delivered-interventions-providing-29586
  5. 5. • Use CHAT to post comments / questions during the webinar – ‘Send’ questions to All (not privately to ‘Host’) • Connection issues – Recommend using a wired Internet connection (vs. wireless) • WebEx 24/7 help line – 1-866-229-3239 Participant Side Panel in WebEx Housekeeping
  6. 6. Housekeeping (cont’d) • Audio – Listen through your speakers – Go to ‘Communicate > Audio Broadcast’ • WebEx 24/7 help line – 1-866-229-3239
  7. 7. Poll Question #1 How many people are watching today’s session with you? A. Just me B. 2-3 C. 4-5 D. 6-10 E. >10
  8. 8. The Health Evidence™ Team Maureen Dobbins Scientific Director Heather Husson Manager Susannah Watson Project Coordinator Students: Emily Belita (PhD candidate) Jennifer Yost Assistant Professor Olivia Marquez Research Coordinator Emily Sully Research Assistant Liz Kamler Research Assistant Zhi (Vivian) Chen Research Assistant Research Assistants: Claire Howarth Rawan Farran Kristin Read Research Coordinator
  9. 9. What is www.healthevidence.org? Evidence Decision Making inform
  10. 10. Why use www.healthevidence.org? 1. Saves you time 2. Relevant & current evidence 3. Transparent process 4. Supports for EIDM available 5. Easy to use
  11. 11. A Model for Evidence- Informed Decision Making National Collaborating Centre for Methods and Tools. (revised 2012). A Model for Evidence-Informed Decision-Making in Public Health (Fact Sheet). [http://www.nccmt.ca/pubs/FactSheet_EIDM_EN_WEB.pdf]
  12. 12. Stages in the process of Evidence-Informed Public Health National Collaborating Centre for Methods and Tools. Evidence-Informed Public Health. [http://www.nccmt.ca/eiph/index-eng.html]
  13. 13. Poll Question #2 Have you heard of PICO(S) before? A. Yes B. No
  14. 14. Searchable Questions Think “PICOS” 1.Population (situation) 2.Intervention (exposure) 3.Comparison (other group) 4.Outcomes 5.Setting
  15. 15. How often do you use Systematic Reviews to inform a program/services? A. Always B. Often C. Sometimes D. Never E. I don’t know what a systematic review is Poll Question #3
  16. 16. Internet interventions providing personalized feedback are effective for weight loss in overweight and obese adults A. Strongly agree B. Agree C. Neutral D. Disagree E. Strongly disagree Poll Question #4
  17. 17. Anna Haste, Research Associate, Newcastle University
  18. 18. Systematic Review Internet interventions providing personalized feedback for weight loss in overweight and obese adults.
  19. 19. Why is being obese a problem? • Link between obesity and a number of serious diseases and mental health problems: • Cancer, hypertension, type 2 diabetes, high blood pressure, depression, social stigmatisation, premature death (World Health Organisation, 2014; Public Health England, 2014) Higher BMI = Higher risk of disease
  20. 20. What is an internet-based intervention? • Software system, usually a website • Participants required to log in to access intervention • Enables lifestyle information, modules or assessments to be easily accessible • Self-monitoring tools • Systems may be interactive • Personalised feedback – Automatic/Human • Engagement with other users
  21. 21. Rationale for using an internet intervention for weight loss • Traditional primary care treatments (GP appointments, group sessions) can be costly, have mixed effectiveness and experience high attrition rates (Jolly et al., 2011) • Acknowledged the need for intervention components to be investigated (Neve et al., 2010) • Personalised interventions have been shown to be more effective (Kroeze et al., 2006; Neville et al., 2009) • Internet weight loss studies have identified mixed findings (Morgan et al., 2011; McConnon et al., 2007) but have the potential to reduce health professional input and time per patient (Ramadas et al., 2011)
  22. 22. Research question How effective is individualised internet based feedback compared to those receiving no feedback within weight loss interventions for overweight/obese adults?
  23. 23. Inclusion criteria ( P ): Adults aged > 18 years old with BMI > 25kg/ m2 ( I ): Interventions targeting diet, physical activity or both for weight loss. At least in part delivered individually via internet. ( C ): Standard care or alternative interventions that do not include individualised feedback via the internet ( O ): Weight loss, waist circumference, BMI change, 5% weight loss ( S ): Randomised controlled trials Prospero protocol: http://www.crd.york.ac.uk/prospero/display_record.asp?ID=CRD42012002115
  24. 24. Feedback definition Michie et al., 2011, pg. 9: Provide feedback on performance – “This involves providing the participant with data about their own recorded behaviour or commenting on a person’s behavioural performance (e.g. identifying a discrepancy between behavioural performance and a set goal or a discrepancy between one’s own performance in relation to others).”
  25. 25. Feedback examples ‘Weekly feedback was given from a pre-programmed computer that instantaneously returned tailored feedback on a Web page when the weight loss diary was submitted.’ (Tate et al., 2006) ‘Each participant who provided diary entries received up to 7 individualized feedback documents via email over the 3 months from the research team. Each sheet gave feedback on a week of diary entries and suggested personalized strategies to address weight loss, reduce energy intake and increase energy expenditure.’ (Morgan et al., 2011)
  26. 26. Search strategy Databases: Scopus, Web of Science, EMBASE, MEDLINE, PsycINFO, ASSIA, IBSS and the Sociological Abstracts Clinical Trial Registers Hand searching relevant journals, conference publications and theses databases.
  27. 27. Screening process 5861 Total articles identified 2251 Duplicates excluded 3610 Articles remaining 3472 Title and abstract exclusions 138 Articles remaining 23 additional found from reference list search 124 Exclusions as did not meet inclusion criteria: •Participants (n=17) •Design (n=77) •Outcome (n=52) •Intervention (n=52) 14 included articles = 12 separate studies 23 excluded as did not meet inclusion criteria: •Participants (n=6) •Design (n=11) •Outcome (n=12) •Intervention (n=8)
  28. 28. Results Feedback versus No Feedback
  29. 29. Outcomes and timeframes • Intention-to-treat (ITT) for all analyses • Ordered by effect size • Mean difference compared with continuous outcome measures • Risk ratio used for dichotomous variables Control group Total 3 months 6 months 12 months Minimal intervention (TAU or leaflet) 9 5 5 3 Website w/o feedback 3 2 2 1
  30. 30. Weight Loss (kg) – End point
  31. 31. Weight loss(kg) – 3, 6 and 12 months
  32. 32. BMI change – End point
  33. 33. BMI change – 3, 6 and 12 months
  34. 34. Waist circumference – End point
  35. 35. Waist change – 3, 6 and 12 months
  36. 36. 5% weight loss – End point
  37. 37. 5% WL– 3, 6 and 12 months
  38. 38. Summary of significant results Outcome End 3 months 6 months 12 months Weight loss    ~ Waist circumference     BMI     5% weight loss    ~
  39. 39. BCTs most commonly identified • Provide feedback on performance • Provide information on consequences • Self-monitoring of behaviour/behaviour outcome • Social support/social change • Goal setting (behaviour/outcome)
  40. 40. Wait list or minimal intervention
  41. 41. Control interventions without feedback
  42. 42. Future work • Behaviour change techniques in relation to effectiveness, engagement and retention rates • Variety of feedback types (provided by a human or automatically) • Internet feedback versus other modality feedback
  43. 43. Conclusion Incorporating individualised feedback may be a key behaviour change technique for effective interventions delivered via the internet
  44. 44. References Jolly K., Lewis A, Beach J, et al. (2011). Comparison of range of commercial or primary care led weight reduction programmes with minimal intervention control for weight loss in obesity: Lighten Up randomised controlled trial. BMJ 343. Kroeze, W., Werkman, A., Brug, J. (2006) A systematic review of randomised trials on the effectivenss of computer-tailored education on physical activity and dietary behaviors. Annals of Behavioural Medicine, 31 (3), 205-223. McConnon, Á., Kirk, S. F. L., Cockroft, J. E., Harvey, E. L., Greenwood, D. C., Thomas, J. D., . . . Bojke, L. (2007). The Internet for weight control in an obese sample: Results of a randomised controlled trial. BMC Health Services Research, 7. Michie, S., Ashford, S., Sniehotta, F. F., Dombrowski, S. U., Bishop, A., & French, D. P. (2011). A refined taxonomy of behaviour change techniques to help people change their physical activity and healthy eating behaviours: The CALO-RE taxonomy. Psychology and Health, 26(11), 1479-1498. Morgan, P. J., Collins, C. E., Plotnikoff, R. C., Cook, A. T., Berthon, B., Mitchell, S., & Callister, R. (2011). Efficacy of a workplace-based weight loss program for overweight male shift workers: The workplace POWER (preventing obesity without eating like a rabbit) randomized controlled trial. Preventive Medicine, 52(5), 317- 325. Neve M, Morgan PJ, Jones PR, et al. (2010). Effectiveness of web-based interventions in achieving weight loss and weight loss maintenance in overweight and obese adults: a systematic review with meta-analysis. Obes Rev, 11 (4), 306-321. Neville, L. M., Milat, A. J., & O'Hara, B. (2009). Computer-tailored weight reduction interventions targeting adults: A narrative systematic review. Health Promotion Journal of Australia, 20(1), 48-57. Public Health England. (2014). Obesity and Health. from www.noo.org.uk/NOO_about_obesity/obesity_and_health Ramadas, A., Quek, K. F., Chan, C. K. Y., & Oldenburg, B. (2011). Web-based interventions for the management of type 2 diabetes mellitus: A systematic review of recent evidence. International Journal of Medical Informatics, 80(6), 389-405 Tate DF, Jackvony EH, Wing RR. A Randomized Trial Comparing Human e-Mail Counseling, Computer-Automated Tailored Counseling, and No Counseling in an Internet Weight Loss Program. Arch Intern Med. 2006;166(15):1620-1625. World Health Organisation. (2014). Obesity and Overweight Fact Sheet. From http://www.who.int/mediacentre/factsheets/fs311/en/.
  45. 45. Acknowledgements Co-authors: James Newham Ruth Bell Ashley Adamson Elaine McColl Vera Araujo-Soares Funders:
  46. 46. Internet interventions providing personalized feedback are effective for weight loss in overweight and obese adults A. Strongly agree B. Agree C. Neutral D. Disagree E. Strongly disagree Poll Question #5
  47. 47. Poll Question #6 The information presented today was helpful A.Strongly agree B.Agree C.Neutral D.Disagree E.Strongly disagree
  48. 48. What can I do now? Visit the website; a repository of over 5,000+ quality-rated systematic reviews related to the effectiveness of public health interventions. Health Evidence™ is FREE to use. Register to receive monthly tailored registry updates AND monthly newsletter to keep you up to date on upcoming events and public health news. Tell your colleagues about Health Evidence™: helping you use best evidence to inform public health practice, program planning, and policy decisions! Follow us @HealthEvidence on Twitter and receive daily public health review- related Tweets, receive information about our monthly webinars, as well as announcements and events relevant to public health. Encourage your organization to use Health Evidence™ to search for and apply quality-rated review level evidence to inform program planning and policy decisions. Contact us to suggest topics or provide feedback. info@healthevidence.org
  49. 49. Poll Question #7 What are your next steps? [Check all that apply] A. Access the full text systematic review B. Access the quality assessment for the review on www.healthevidence.org C. Consider using the evidence D. Tell a colleague about the evidence
  50. 50. Thank you! Contact us: info@healthevidence.org For a copy of the presentation please visit: http://www.healthevidence.org/webinars.aspx

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