JMIR Publications

ABSTRACT

Background:

Acceptance and commitment therapy (ACT) provides a psychobehavioral framework feasible for digital and hybrid weight loss interventions. In face-to-face studies, group-based interventions yield more favorable outcomes than individual interventions but the effect of the intervention form has not been studied in combination with eHealth.

Objective:

The study investigated whether a minimal, three-session group or individual enhancement could provide additional benefits compared to an eHealth-only intervention when assessing weight, body composition, and laboratory metrics in a sample of occupational health patients with obesity.

Methods:

This study was a randomized controlled trial (RCT) with a 12-month intervention, followed by a 12-month follow-up period without additional support (March 2021 to March 2023). Recruited from occupational health care for Finnish municipal employees, 111 working-age adults with BMI 30–40 kg/m2 were randomized to one of the three treatment arms: eHealth, eHealth+Group, or eHealth+Individual. All treatment arms received a web-administrated, coach-assisted eHealth program based on ACT and, additionally, the eHealth+Group and eHealth+Individual arms received three remotely facilitated group or individual meetings with their designated coach. The participants were assessed for weight, body composition, blood pressure, and laboratory measurements at 0, 6, 12, and 24-month time-points. Applying estimated means to decrease bias caused by drop-outs, Generalized Estimating Equations was used to study the differences between the three groups over time.

Results:

There were no between-group differences in primary measurements of weight change or categorical weight change. Secondary outcomes also did not show changes attributable to the intervention arm. Across the entire sample, the mean estimated weight loss was 1.5% during the intervention with 18% of the participants attaining a ≥5% weight loss. Sustained at follow-up, the mean waist circumference decreased and HDL cholesterol increased slightly. The participants completed, on average, 58.5% of the eHealth program.

Conclusions:

There were no differences in weight or other somatic health variables between the eHealth arm and intervention combining eHealth with minimal Group or Individual enhancement. Despite a modest overall weight-loss, the intervention shows promise in improving body composition and metabolic health. Moving forward, further research is needed to determine if there is a threshold where f2f meetings provide additional benefits in hybrid interventions. Moreover, there is a need to explore for whom and under what conditions eHealth and hybrid models may be most effective. Clinical Trial: ClinicalTrials.gov Identifier: NCT04785586 (March 8, 2021) RR2-10.1016/j.conctc.2020.100638