Obesity: Technology-Supported Multicomponent Coaching or Counseling Interventions To Maintain Weight Loss

Summary of CPSTF Finding

The Community Preventive Services Task Force (CPSTF) recommends multicomponent interventions that use technology-supported coaching or counseling to help clients maintain weight loss.

The CPSTF also recommends this type of intervention to help clients lose weight.

Intervention

In these interventions, coaches or counselors use technology to communicate with individuals or groups and help them maintain weight loss. Such technologies may include computers, video conferencing, personal digital assistants, pedometers with computer interaction, or mobile applications. Interventions may be used with additional components such as tracking and monitoring, social interaction, in-person counseling, or education.

CPSTF Finding and Rationale Statement

Read the full CPSTF Finding and Rationale Statement for details including implementation issues, possible added benefits, potential harms, and evidence gaps.

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 4 studies (search period 1966-June 2008).

The review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to obesity prevention and control.

Summary of Results

All four studies included in the review showed that clients maintained weight loss for periods ranging from 12 to 18 months after the start of the intervention.

Summary of Economic Evidence

An economic review of this intervention did not find any relevant studies.

Applicability

Findings of the review should be applicable to the following:
  • Adults
  • Home and community settings
  • U.S.
  • Interventions delivered by counselors, therapists, or health coaches
  • Assorted technologies (e.g., websites, email, interactive TV modalities)

Evidence Gaps

CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)
  • Does the type of technology and whether it is mobile make a difference?
  • Are technology-based interventions as effective in subpopulations? Does effectiveness vary by age, cultural, SES, gender, race, or ethnicity?
  • Is there an interaction between subpopulations (e.g., cultural, age) and type of technology (e.g. computer, mobile device)?
  • How does provider training or credentialing affect services to clients?
  • Are clients and providers more likely to engage if technical support or training on computer applications are provided?

Study Characteristics

  • All of the included studies used randomized controlled trials.
  • Studies were conducted in the U.S. and targeted adults.

Analytic Framework

Effectiveness Review

Analytic Framework

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Summary Evidence Table

Effectiveness Review

Summary Evidence Table
Contains evidence from reviews of technology-supported multicomponent coaching or counseling interventions to reduce weight and maintain weight loss

Included Studies

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Effectiveness Review

Gold BC, Burke S, Pintauro S, Buzzell P, Harvey-Berino J. Weight loss on the web: a pilot study comparing a structured behavioral intervention to a commercial program. Obesity (Silver Spring) 2007;15(1):155-64.

Harvey-Berino J, Pintauro S, Buzzell P, DiGiulio M, Casey Gold B, Moldovan C, Ramirez E. Does using the Internet facilitate the maintenance of weight loss? Int J Obes Relat Metab Disord 2002;26(9):1254-60.

Harvey-Berino J, Pintauro S, Buzzell P, Gold EC. Effect of internet support on the long-term maintenance of weight loss. Obes Res 2004;12(2):320-9.

Haugen HA, Tran ZV, Wyatt HR, Barry MJ, Hill JO. Using telehealth to increase participation in weight maintenance programs. Obesity (Silver Spring) 2007;15(12):3067-77.

Search Strategies

The following outlines the search strategy for technology-supported multicomponent coaching or counseling interventions to reduce weight and maintain weight loss.

Effectiveness Review

The review reflects systematic searches of four computerized databases (Medline, CINAHL, EMBASE, and PsycINFO). The search combined terms related to technology (e.g., computer, Internet, videoconference) with terms related to weight, physical activity, diet outcomes, health education/promotion, and overweight. The specific search terms used are shown below.

The reference lists from search-identified studies, as well as those of prior literature reviews and systematic reviews, also were used to identify relevant articles. Experts in interventions that address obesity and/or screen time (i.e., time spent watching TV, videotapes, or DVDs; playing video or computer games; and surfing the Internet) were consulted for additional citations.

Searches were limited to literature published in English-language journals between 1966 and the June 2008. To be considered for inclusion in the review of effectiveness, studies had to (1) be primary investigations of interventions rather than guidelines or reviews, and (2) provide data on either weight-related outcomes, physical activity, or nutrition.

Studies were excluded if outcomes were collected in pregnant or post-partum populations, or the study specifically recruited patients with the following medical conditions: end stage disease (e.g., renal), cancer survivor, bulimic, anorexic, or psychiatric disorder. Also excluded were studies that focused specifically on diabetic monitoring (as opposed to nutrition, physical activity, or obesity interventions targeting people with diabetes).

Search Terms

  • Internet
  • Website, Web site, Web
  • Message Board, Discussion Board
  • Chat
  • Telephone
  • Cell phone
  • Compact Disc
  • DVD
  • Video recording, videodisc recording, videotape recording
  • Digital video
  • Electronic
  • Interactive voice response
  • Computer
  • Computer assisted instruction
  • User-computer interface
  • Touch screen
  • Interactive
  • Personal digital assistant, palm pilot, pocket pc
  • Electronic mail, email
  • Telehealth
  • Enhanced pedometer
  • Ipod
  • Podcast
  • Telemedicine
  • Health education, health promotion, health behavior
  • Health knowledge, attitudes, practice
  • Overweight, Body mass index, Skinfold thickness, Waist-hip ratio, BMI, Obese, Weight, Body fat
  • Physical activity, Motor activity, Exercise, Physical fitness, Physical education, Training, Sports
  • Diet, Nutrition, Food
  • Coach, counsel
  • Reminder Systems
  • Provision of Information
  • Computer tailored feedback
  • Video games

Medline search example

#SearchesResults

  1. internet.mp.
  2. (website$ or web site$ or web$).tw.
  3. (message board$ or discussion board$).tw.
  4. chat$.tw.
  5. telephon$.mp.
  6. cell$ phone$.mp.
  7. exp Compact Disks/ or (compact disc$ or compact disk$ or CD-ROM$).mp.
  8. dvd$.mp.
  9. (Video Recording or Videodisc Recording or videotape recording$).mp.
  10. digital video dis$.mp.
  11. digital medi$.tw.
  12. electronic$.mp.
  13. (interactive voice response$ or ivr).tw.
  14. exp Computers/
  15. computer-assisted instruction.mp.
  16. user-computer interface/
  17. touch screen$.tw.
  18. interactive.tw.
  19. Computers, Handheld/ or personal digital assistant$.tw. or pda$.tw. or palm pilot$.tw. or pocket pc$.tw.
  20. exp software/ or software.tw.
  21. Electronic Mail/ or e-mail$.tw. or email$.tw.
  22. telehealth.tw.
  23. enhance$ pedometer$.tw.
  24. or/1-23310369
  25. 24 and (health education/ or “health education”.tw.)
  26. 24 and exp health promotion/
  27. 24 and exp health behavior/
  28. 24 and “Health Knowledge, Attitudes, Practice”/
  29. 24 and intervention studies/
  30. 24 and intervention$.mp.
  31. 24 and (trial$ or study or studies).mp.
  32. 24 and program evaluation/
  33. or/25-32141609
  34. 33 and (exp overweight/ or exp obesity/ or exp body weight changes/ or body mass index/ or skinfold thickness/ or waist-hip ratio/ or bmi.tw. or obes$.tw. or body fat.tw. or overweight.mp.)
  35. 33 and (physical activity.tw. or motor activity/ or exercise$.mp. or physical fitness/ or “physical education and training”/ or exp sports/)
  36. 33 and (diet$ or nutrition$ or food$).hw,tw.
  37. or/34-3612513
  38. limit 37 to (humans and english language and yr=”1966 – 2008″)
  39. 38 not (200807$ or 200808$).ed.
  40. from 38 keep 101
  41. 39 not Echocardiography.mp. [mp=title, original title, abstract, name of substance word, subject heading word]
  42. 41 not electrocardiograpy.mp.
  43. 42 not ekg.mp.
  44. 43 not mri.mp.
  45. 44 not magnetic resonance imaging/
  46. 45 not eeg.mp. [mp=title, original title, abstract, name of substance word, subject heading word]
  47. 46 not electroencephalography/
  48. 47 not cat scans.mp.
  49. 48 not Tomography, X-Ray Computed.mp.
  50. 49 not x-rays.mp. [mp=title, original title, abstract, name of substance word, subject heading word]
  51. 24 or (computer tailored feedback.mp. or exp video games/ or exp games, experimental/ or games.mp.)
  52. 51 and (health education/ or “health education”.tw. or exp health promotion/ or exp health behavior/ or “Health Knowledge, Attitudes, Practice”/ or intervention studies/ or intervention$.mp. or trial$.mp. or study.mp. or studies.mp. or program evaluation/ or coach$.mp. or counsel$.mp. or exp directive counseling/ or exp counseling/ or track$.mp. or monitor$.mp. or exp reminder systems/ or remind$.mp. or “provision of information”.tw. or exp education, professional/ or non-interactive education.mp.)
  53. 52 and (exp overweight/ or exp obesity/ or exp body weight changes/ or body mass index/ or skinfold thickness/ or waist-hip ratio/ or bmi.tw. or obes$.tw. or body fat.tw. or overweight.mp. or physical activity.tw. or motor activity/ or exercise$.mp. or physical fitness/ or “physical education and training”/ or exp sports/)
  54. 52 and (diet$ or nutrition$ or food$).hw,tw.
  55. 53 or 5414377
  56. limit 55 to (humans and english language and yr=”1966 – 2008″)
  57. 56 not (200807$ or 200808$).ed.
  58. 57 not ((Echocardiography or electrocardiography or ekg or ekg or mri).mp. or magnetic resonance imaging/ or eeg.mp. or electroencephalography/ or cat scans.mp. or Tomography, X-Ray Computed.mp. or x-rays.mp.)

Economic Review

For the economic review, the effectiveness review search was expanded to include additional databases: EconLit, SSCI, JSTOR, Google Scholar, and repositories of health economics research at selected universities and institutes, including the University of York.

The economic search combined economic-specific keywords such as cost, cost-benefit, cost-effectiveness, and cost-utility with the effectiveness search terms.

Considerations for Implementation

The following considerations are drawn from studies included in the evidence review, the broader literature, and expert opinion.
  • Technology supported counseling may offer increased access for people living in remote areas, people who cannot travel easily, or people with unusual work schedules. They also allow anonymity for those who prefer it, and can be available 24 hours a day.
  • Developing technology-supported interventions requires an initial investment in computer hardware, software, and application design.
  • Participants will need access to a computer or other technology.
  • Practitioners and participants may require training with new technology.
  • It may be difficult to keep up with rapid changes in technology (data security).

Crosswalks

Evidence-Based Cancer Control Programs (EBCCP)

Find programs from the EBCCP website that align with this systematic review. (What is EBCCP?)

Healthy People 2030

Healthy People 2030 icon Healthy People 2030 includes the following objectives related to this CPSTF recommendation.