JMIR Publications

ABSTRACT

Background:

Digital health interventions show promise for weight management. However, few text-based behavior change interventions have been designed to support patients receiving intragastric balloons, and none have simultaneously evaluated weight loss, psychological well-being, and behavior change despite the crucial interplay of these factors in weight management.

Objective:

To assess whether a health coach-led, asynchronous text-based, Digital Behavior Change Coaching Intervention (DBCCI) delivered to participants receiving an intragastric balloon and its after-care program: (1) was feasible and acceptable to participants, and (2) supported improved outcomes including weight loss, psychological well-being, and lifestyle behavior change conducive to weight loss maintenance.

Methods:

This 12-month, single-arm, prospective study enrolled adults 21-65 years with body mass index (BMI)≥27 kg/m2 receiving a procedureless intragastric balloon (PIGB) at 5 bariatric clinics in the United Kingdom and the Netherlands. Participants received both the DBCCI and the clinic-led PIGB after-care program (remotely delivered) for 6 months after PIGB placement, then no interventions for an additional 6 months. The DBCCI was an evidence-based, personalized, digital behavior change coaching intervention wherein health coaches supported participants via exchanged asynchronous, in-app text messages. Over the 12-month study, we assessed percentage of total body weight loss (TBWL) and psychological well-being via self-administered validated questionnaires (Warwick-Edinburgh Mental Wellbeing Scale [WEMWBS], Generalized Anxiety Disorder [GAD-7], Impact of Weight on Quality of Life-Lite Clinical Trials Version scale [IWQOL-Lite-CT], Loss of Control Over Eating Scale-Brief [LOCES], Weight Efficacy Lifestyle questionnaire-Short Form [WEL-SF], and Barriers to Being Active Quiz [BBAQ]). Participant engagement and acceptability of the intervention were assessed via self-reported surveys.

Results:

107 participants (89.7% female, mean baseline BMI=35.4 kg/m2) were included in the analysis. Mean TBWL was 13.50% at the end of the DBCCI and 11.22% at the 12-month follow-up (P<.001). Significant improvements were observed for all psychological well-being measures throughout the 12 months, except for GAD-7 (improvement at Month 1) and BBAQ (improvements at Months 3 and 6). Surveys showed overall high levels of engagement with, and acceptability of the health coaching provided via the DBCCI, especially during the active intervention period.

Conclusions:

This study provides evidence that a health coach–led, asynchronous text-based, digital behavior change intervention was engaging and acceptable to participants with overweight and obesity. This behavior change intervention, delivered alongside the PIGB and its after-care program, supported improved weight loss outcomes and psychological well-being versus baseline, and was associated with lifestyle behavior changes known to help achieve and maintain long-term weight loss and improved health outcomes. Findings at follow-up suggest a potential need for longer-term, more intense coaching to focus on weight loss maintenance and support ongoing self-coaching. This could be achieved by leveraging artificial intelligence to provide ongoing automated behavior change coaching support to augment human-led care. Clinical Trial: ClinicalTrials.gov NCT05884606