JMIR Publications

ABSTRACT

Background:

Obesity is a global public health concern. Interventions rely predominantly on managing dietary intake and/or increasing physical activity but sustained adherence to behavioural regimens is often poor. As with all interventions, the lack of sustained motivation, self-efficacy and poor adherence to behavioural regimens are recognized barriers to successful weight loss. Avatar-based interventions have been found to achieve better patient outcomes in the management of chronic conditions by promoting more active engagement and the virtual representations of ‘self’ have been shown to impact real-world behaviour, acting as a catalyst for sustained weight loss behaviour.

Objective:

We aimed to evaluate whether a personalised avatar, offered as an adjunct to an established weight loss programme, could increase participant motivation and sustain engagement, optimise service delivery, and improve participant health outcomes.

Methods:

A feasibility randomised design was used to determine the case for future development and evaluation of avatar-based technology in a randomised controlled trial. Participants were recruited from GP referrals to a 12-week NHS weight improvement programme. The main outcome measure was weight loss. Secondary outcome measures were quality-of-life and self-efficacy. Quantitative data were subjected to descriptive statistical tests and exploratory comparison between intervention and control arms. Feasibility and acceptability were assessed through interviews analysed using the framework approach. HRA ethical approval was granted.

Results:

10 males (7 intervention; 3 routine care) and 33 females (23 intervention; 10 routine care) were recruited. Initial mean weight of participants was greater in the intervention than routine care arm (126.3 kg vs 122.9 kg); pattern of weight loss was similar across both arms of the study in period T0-T1 but accelerated in period T1-T2 for intervention participants, suggesting that access to the self-resembling avatar may promote greater engagement with weight loss initiatives in the short to medium term. Mean change in weight of participants from T0 to T2 was 4.5kg (95% CI: 2.7-6.3) in routine care arm and 5.3kg (95% CI: 3.9-6.8) in the intervention arm. Quality-of-life and self-efficacy measures demonstrated greater improvement in the intervention arm at both T1 (105.5 routine care; 99.7 intervention arm) and T2 (100.1 routine care; 81.2 intervention arm). 13 participants (11 Female, 2 Male) and two healthcare professionals were interviewed about their experience of using the avatar programme.

Conclusions:

Overall, participants found using the personalised avatar acceptable and feedback reiterated that seeing a future ‘self’ helped reinforce motivation to change behaviour. This feasibility study demonstrated that avatar-based technology may successfully promote engagement and motivation in weight loss programmes, enabling participants to achieve greater weight loss gains and build self-confidence and belief. Clinical Trial: 17953876