JMIR Publications

ABSTRACT

Background:

Mental health problems and adverse health behaviors are enriched in individuals with obesity, and need to be considered in weight-loss interventions. Regarding weight-loss, hybrid interventions combining digital and in-person elements have proven superior compared to eHealth-only interventions. However, it remains unclear whether a minimal group or individual enhancement could bring additional benefits to mental health and health behavior domains in individuals with obesity.

Objective:

The study explored whether minimal group or individual enhancements could offer additional benefits to an eHealth intervention, specifically in relation to mental health, perceived work ability, and health behavior. Additionally, the study sought to examine the overall effects of the health behavior-focused intervention, which combined ACT and behavioral components, across these domains.

Methods:

This study was a randomized controlled trial (RCT) with a 12-month intervention with selected variables followed for another 12-months without additional support. Recruited from occupational health care, 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. The participants were assessed for depression (BDI-21), burnout (BBI-18), perceived work ability, eating behavior (ecSatter2.0, TFEQ and BES) and physical activity (BPAQ).

Results:

Neither of the treatment arms showed superiority over another. Across all participants, depression showed an estimated mean decrease of 2.5 BDI-21-points, with older participants experiencing a greater reduction in depressive symptoms. Furthermore, there were increases in eating competence, controlled restraint and physical activity, and decreases in uncontrolled eating and binge eating tendency. However, the 24-month measurements showed an adverse effect in eating competence, especially in attitudes towards eating and food, during the follow-up without further support.

Conclusions:

Minimal enhancement through either group or individual virtual meetings did not provide additional benefits in mental health or eating habit domains compared to the eHealth intervention alone. However, the eHealth intervention effectively reduced depression symptoms, uncontrolled eating, and binge eating tendencies, while also improving eating competence and physical activity across the study population. Future research should explore the effect of providing additional support during the follow-up period to sustain the positive outcomes achieved during the intervention. Clinical Trial: ClinicalTrials.gov Identifier: NCT04785586 (March 8, 2021) RR2-10.1016/j.conctc.2020.100638