JMIR Publications

ABSTRACT

Background:

Overweight and obesity rates amongst the general population of The Netherlands keep increasing. In 2021, almost 50% of Dutch adults were living with overweight, including 13% with obesity. Combined lifestyle interventions (CLIs) focused on physical activity, nutrition, and other lifestyle pillars can be effective in reducing weight and improving health behaviors. Currently available CLIs consist of face-to-face and community-based sessions delivered by practice nurses, physiotherapists, and/or dieticians, and face scalability problems. Blended CLIs with digital and human components may provide a solution for this challenge; however, the potential effects of a blended CLI on cardiometabolic risk factors have not yet been assessed.

Objective:

The aim of this observational study was two-fold: first, to determine how weight and other cardiometabolic risk factors, namely lipids and blood pressure, changed over time in a Dutch population with overweight or obesity and cardiometabolic risk participating in a pilot, blended CLI. Second, to collect feedback from participants to further guide the development of future iterations of the intervention.

Methods:

We enrolled individuals from the general population who participated in a digitally-enabled lifestyle program between January 2020 and December 2021. The study was approved by the Ethics Review Board of the University Medical Center Groningen. Participants followed a 16-week blended, web-based lifestyle coaching program rooted in the Fogg Behaviour Model, focused on nutrition, physical activity, and other health behaviors. Participants could access the digital application to register and track health behaviors, weight, and anthropometrics data at any time. We retrospectively analysed the mean and percent changes in weight, blood pressure, and lipids for remeasured users. Lastly, we conducted surveys and semi-structured interviews to assess critical positive and improvement points reported by participants.

Results:

Of the 420 participants evaluated at baseline, 53 participated in the pilot. Of these, 37 (70%) were overweight, and 16 (30%) suffered from obesity. Mean weight loss was 3.7kg (-4.2%) after a median period of 10 months after the intervention was completed. The subpopulation with obesity (N=16) lost 5.4kg (-5.6%) weight on average. Total cholesterol decreased by 0.7 mmol/L (-10.9%), and LDL cholesterol decreased by 0.5 mmol/L (-11.9%) on average. Systolic blood pressure decreased by 5 mmHg (-3.5%), and diastolic blood pressure by 7 mmHg (-7.5%). Participants identified the possibility of setting clear health goals to work towards and the multiple weekly touchpoints with coaches as two of the most positive and distinctive components of the blended intervention. Importantly, virtually all participants wished to continue engaging with the program after the intervention.

Conclusions:

A first version of a blended, CLI can achieve weight loss in overweight and obese individuals after an average of 10 months follow-up. Albeit preliminary, these findings suggest that a behavioral lifestyle program with a digital component deployed for this intervention can achieve greater weight loss than currently available offline, CLIs. Such a program can also constitute a scalable alternative to current CLI programs, and will be further developed and made available across The Netherlands in the course of this year.