JMIR Publications

ABSTRACT

Background:

Hunger and food cravings predict poor outcomes in lifestyle interventions for weight management. For this reason, flexible as opposed to restrictive weight management programs are needed. WW (formerly Weight Watchers), a widely available commercial weight management and wellness program, includes an approach which allows participants to get a personalized zero-point food (ZPF) list, which are foods that do not need to be weighed, measured, or tracked. With over 300 potential options, ZPFs can include fruits, vegetables, legumes, whole grains, non-fat dairy, and lean sources of protein. Participants are assigned an individualized daily and weekly point target and can use ZPFs to help budget their points throughout the day, which can nudge participants to a healthier overall dietary pattern.

Objective:

In a 6-month single arm trial, we examined the efficacy of WW delivered via multi-modal digital tools including a mobile app to assist with point tracking, weekly virtual workshops, weekly 5-minute wellness check-ins, and a Facebook group where participants could socialize and support each other.

Methods:

Outcomes included weight change from baseline as measured by Bluetooth scales provided to each participant, hunger (visual analogue scale), food cravings (Food Craving Inventory), intake of fruit and vegetables (The Five Factor Screener), physical activity (Global Physical Activity Questionnaire), and overall well-being (WHO-5 Well-Being Index).

Results:

Participants (N=153) were 70% female, 66% White, with a mean age of 41.09 (sd=13.78), and had a mean BMI of 31.8 (sd=5.0). Retention was high such that 91.5% provided 6-month follow-up data. Participants lost an average of 5.1% body weight from baseline to 6 months (mean= -4.4 kg, sd=4.87; p<.01), with 51% losing clinically significant weight (≥5%). Hunger significantly declined over 6 months (mean percent change= -14.74%, sd=64.28, p<.01), as did food cravings (mean percent change= -16.99%; sd=19.98). Intake of fruit (mean percent change= 65.95%, sd=188.78; p<.01), vegetables (mean percent change= 68.29%, sd=172.61; p<.05), and salad (mean percent change= 127.43%, sd=250.82; p<.001) significantly increased. Engagement in moderate physical activity increased an average of 32 minutes per day (sd=133; p<0.01) and sedentary time decreased by 90 minutes per day (sd=24.5; p<.001). Finally, well-being significantly increased (mean change=17.77%, sd=46.21; p<.01). This

Conclusions:

This program, which used a less restrictive method of food tracking and gave personalized ZPFs, resulted in significant weight loss and an increase in fruits, vegetables, and exercise, while also reducing hunger and food cravings. Future research should compare the effectiveness of these approaches to traditional programs that require self-monitoring of all foods and beverages. Clinical Trial: NCT04302389