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

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.

Weight loss

• All of the studies reported weight loss with a median decrease of 8.1 lbs (3.7 kgs) over a median follow-up time of 6 months (13 studies).

Physical activity

• Most of the studies reported an increase in physical activity (5 of 7 studies).

Nutrition

• All of the studies showed small decreases in caloric and fat intake (7 studies).

• One study evaluated a 6-month, Internet-based program that used case management to assist patients with cardiac rehabilitation and risk factor reduction.
  • The estimated cost for the program was $528 per participant.
  • Net savings from the intervention were $1125/person, for an estimated return of $2.13 for every $1.00 spent.
• Another study evaluated an Internet-based weight loss program in Sweden.
  • The cost-effectiveness for participants who stayed in the program for 6 months was $0.49/pound lost.
  • A large number of participants dropped out of the study or had incomplete data. When these participants were included in the analysis, the cost-effectiveness of the program increased to $2.45/pound lost.

• Adults
• Home and community settings
• U.S.
• Interventions delivered by counselors and other types of healthcare providers
• Assorted technologies (e.g., websites, email, interactive TV modalities)

• Does the type of technology and whether it is mobile make a difference?
• Are technology-based interventions as effective across subpopulations? Does effectiveness vary by age, cultural, SES, sex, race, or ethnicity?
• Does effectiveness vary based on 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?

• Studies included randomized controlled trials (13 studies), and one before-and-after study design. Comparison groups, however, were exposed to a variety of treatment conditions.
• Studies were conducted in the U.S. (12 studies), U.S. and Canada (1 study), and Taiwan (1 study).
• The primary purpose for interventions included weight loss (10 studies) and diabetes management (4 studies).
• Studies targeted adults (13 studies) and children and adolescents (1 study).

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.

Effectiveness Review

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

Effectiveness Review

Bond GE, Burr R, Wolf FM, Price M, McCurry SM, Teri L. The effects of a web-based intervention on the physical outcomes associated with diabetes among adults age 60 and older: a randomized trial. Diabetes Technol Ther 2007;9(1):52-9.

Glasgow RE, Boles SM, McKay HG, Feil EG, Barrera M, Jr. The D-Net diabetes self-management program: long-term implementation, outcomes, and generalization results. Prev Med 2003;36(4):410-9.

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. Changing health behavior via telecommunications technology: Using interactive television to treat obesity. Behavior Therapy 1998;29(3):505-19.

Liou TH, Chen CH, Hsu CY, Chou P, Chiu HW. A pilot study of videoconferencing for an Internet-based weight loss programme for obese adults in Taiwan. J Telemed Telecare 2006;12(7):370-3.

McKay HG, Glasgow RE, Feil EG, Boles SM, Barrera M, Jr. Internet-based diabetes self-management and support: Initial outcomes from the Diabetes Network project. Rehabilitation Psychology 2002;47(1):31-48.

McKay HG, King D, Eakin EG, Seeley JR, Glasgow RE. The diabetes network internet-based physical activity intervention: a randomized pilot study. Diabetes Care 2001;24(8):1328-34.

Micco N, Gold B, Buzzell P, Leonard H, Pintauro S, Harvey-Berino J. Minimal in-person support as an adjunct to internet obesity treatment. Ann Behav Med 2007;33(1):49-56.

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):1620-5.

Tate DF, Jackvony EH, Wing RR. Effects of Internet behavioral counseling on weight loss in adults at risk for type 2 diabetes: a randomized trial. JAMA 2003;289(14):1833-6.

Tate DF, Wing RR, Winett RA. Using Internet technology to deliver a behavioral weight loss program. JAMA 2001;285(9):1172-7.

Webber KH, Tate DF, Bowling JM. A randomized comparison of two motivationally enhanced Internet behavioral weight loss programs. Behav Res Ther 2008;46(9):1090-5.

Webber KH, Tate DF, Quintiliani LM. Motivational interviewing in internet groups: a pilot study for weight loss. J Am Diet Assoc 2008;108(6):1029-32.

Williamson DA, Walden HM, White MA, York-Crowe E, Newton RL, Jr., Alfonso A, Gordon S, Ryan D. Two-year internet-based randomized controlled trial for weight loss in African-American girls. Obesity (Silver Spring) 2006;14(7):1231-43.

Womble LG, Wadden TA, McGuckin BG, Sargent SL, Rothman RA, Krauthamer-Ewing ES. A randomized controlled trial of a commercial internet weight loss program. Obes Res 2004;12(6): 1011-8.

Economic Review

Jonasson J, Linn Y, Neovius M, R ssner S. An internet-based weight loss programme a feasibility study with preliminary results from 4209 completers. Scand J Public Health 2009;37(1):75-82.

Southard BH, Southard DR, Nuckolls J. Clinical trial of an internet-based case management system for secondary prevention of heart disease. J Cardiopulm Rehabil Prev 2003;23(5):341-8.

Implementation Resource

Rural Health Information Hub, Obesity Prevention Toolkit
This toolkit compiles information, resources, and best practices to support development and implementation of obesity prevention programs in rural communities. Modules include program models, implementation and evaluation resources, and funding and dissemination strategies.

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.

• Technology-supported counseling may offer increased access for people living in remote areas, people who cannot travel easily, or people with unusual work schedules. It also allows 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).

Healthy People 2030

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

• Reduce the proportion of adults with obesity — NWS‑03