Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Aug 15, 2024
Open Peer Review Period: Aug 15, 2024 - Oct 10, 2024
Date Accepted: Apr 16, 2025
(closed for review but you can still tweet)
Which aspects of digital interventions to support weight loss are associated with success? Systematic review with component network-meta-analysis
ABSTRACT
Background:
Obesity is a chronic complex disease associated with increased risks of developing several serious and potentially life-threatening conditions. It is a growing global health issue. Pharmacological treatment is an option for patients living with overweight or obesity. Digital technology may be leveraged to support patients with weight loss in the community, but it is unclear which of the multiple digital options are important for success.
Objective:
This systematic review and component network meta-analysis aimed to identify components of digital support for weight loss interventions that are most likely to be effective in supporting patients to achieve weight loss goals.
Methods:
We searched MEDLINE, Embase, APA PsycInfo and Cochrane Central Register of Controlled Trials, inception to November 2023, for randomised controlled trials in adults with BMI ≥25 (≥23 for Asian populations) using any weight loss intervention with digital components, with weight loss outcomes. Eligible trials were prioritised for synthesis based on intervention relevance and duration, and target population. Trial arms with substantial face to face elements were de-prioritised. Prioritised trials were assessed for quality using the Cochrane Risk of Bias tool v1. We conducted an Intervention Component Analysis to identify key digital intervention features and coding framework. All prioritised trials arms were coded using this framework and into a component network-meta-analysis.
Results:
Searches identified 6528 reports of which 119 were included. After prioritisation, 151 arms from 68 trials were included in the synthesis. Nine common digital components were identified from 151 trial arms: provision of information and education, goal setting, provision of feedback, peer support, reminders, challenge, and competition, contact with a specialist, self-monitoring, incentives and rewards. Of these, three were identified as ‘best bets’ because they were consistently and numerically, but not usually statistically significantly most likely to be associated with weight loss at 6 and 12 months. These were patient information, contact with a specialist and incentives/rewards. An exploratory model combining these three components was statistically significantly associated with successful weight loss at 6 (-2.52 kg, 95% CI [-4.15, -0.88]) and 12 (-2.11 kg, [-4.25, 0.01]) months. No trial arms used this specific combination of components.
Conclusions:
Our findings indicate that the design of digital interventions to support weight loss should be carefully crafted around core components. On their own, no one digital component could be considered essential for success, but a combination of information, specialist contact and incentives warrants further examination. Clinical Trial: PROSPERO:IDCRD42023493254 https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023493254
Citation
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