Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: May 10, 2024
Date Accepted: Jan 29, 2025
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Acceptance and Commitment Therapy Based eHealth Intervention with Enhanced support: Impact on Weight, Body Composition, and Laboratory Metrics of Occupational Health Patients Over 24 Months
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 aimed to investigate the effects of the ACT-based 12-month eHealth intervention between enhanced group, enhanced individual, and standard treatment delivered for occupational health patients, and investigate if potential intervention effects prevail during the 24-month follow-up.
Methods:
This study was a randomized controlled trial (RCT) with a 12-month intervention and 12-month follow-up period. Recruited from occupational health care, 111 working-age adults with BMI 30–40 kg/m2 were randomized to one of the three treatment arms: standard, enhanced group, or enhanced individual treatment. All treatment arms received a web-administrated, coach-assisted eHealth program based on ACT and, additionally, the enhanced groups received three remotely facilitated group or individual meetings. The participants were assessed for weight, body composition, blood pressure, and laboratory measurements at 0, 6, 12, and 24-month time-points.
Results:
Analysis comparing the three study arms did not yield between-group differences in the primary measurements of weight change or categorical weight change. Among all participants, 19.1% attained a ≥5% weight loss at the 12-month mark and 25.0% at the 24-month mark. Waist circumference decreased across the entire 24-month study period, showing a 2.8 cm mean decrease from 0 to 24 months (P <.001). Fasting glucose decreased 0.4 mmol/l at 12 months (P<.001) and 0.2 (P <.001) at 24 months. The high-density lipoprotein (HDL) increased 0.1 mmol/l at both 12-month (P <.001) and 24-month mark (P <.001). The triglycerides decrease was 0.2 mmol at both 6-months (P =.002) and 24-months (p=.004). The participants completed, on average, 58.5% of the eHealth program.
Conclusions:
Our findings indicate that incorporating three virtual group or individual meetings into the standard treatment arms does not confer additional advantages compared to the standard digital intervention alone. This suggests that the standard eHealth protocol effectively delivers health benefits to this occupational patient group. However, a more intensively enhanced treatment approach may be needed to improve outcomes in this population further. The findings highlight the efficacy of ACT-based eHealth interventions in facilitating significant improvements in body composition and metabolic health. It's noteworthy that beneficial physiological changes can occur without prominent weight loss, emphasizing the importance of focusing on overall health improvements rather than solely on weight loss outcomes. Clinical Trial: ClinicalTrials.gov Identifier: NCT04785586 (March 8, 2021)
Citation
