Health Evidence hosted a 60 minute webinar examining the effectiveness of internet-delivered interventions providing personalized feedback for weight loss in overweight and obese adults. Click here for access to the audio recording for this webinar: https://youtu.be/AZXuc2XtCUs Anna Haste, Research Associate at Newcastle University led the session and presented findings from her recent systematic review: Sherrington, A, Newham, J, Bell, R, Adamson, A, McColl, E, & Araujo-Soares, V. (2016). Systematic review and meta-analysis of internet-delivered interventions providing personalized feedback for weight loss in overweight and obese adults. Obesity Reviews, 17(6), 541-551. http://www.healthevidence.org/view-article.aspx?a=systematic-review-meta-analysis-internet-delivered-interventions-providing-29586 While prevalence of obesity is increasing, conventional weight loss interventions demonstrate barriers to implementation and mixed-results regarding effectiveness. This systematic review and meta-analysis examines the impact of internet-delivered interventions providing personalized feedback on weight loss in overweight and obese adults, in comparison to controls not receiving personalized feedback. Twelve randomized control trials, with a total of 3547 participants are included in this review. Evidence suggests internet-delivered interventions providing personalized feedback increase weight loss and 5% weight loss at 3 and 6 months, and decrease BMI and waist circumference at 3, 6 and ≥ 12 months. This webinar provided an overview of the effectiveness of internet-delivered interventions providing personalized feedback for weight loss in overweight and obese adults.

1. Welcome!
Internet interventions
providing personalized
feedback for weight loss in
overweight and obese adults:
What's the evidence?
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4. What’s the evidence?
Sherrington, A., Newham, J., Bell, R., Adamson, A.,
McColl, E., & Araujo-Soares, V. (2016). Systematic
review and meta-analysis of internet-delivered
interventions providing personalized feedback for
weight loss in overweight and obese adults. Obesity
Reviews, 17(6), 541-551.
http://www.healthevidence.org/view-
article.aspx?a=systematic-review-meta-analysis-
internet-delivered-interventions-providing-29586

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13. Poll Question #2
Have you heard of PICO(S) before?
A. Yes
B. No

14. Searchable Questions Think “PICOS”
1.Population (situation)
2.Intervention (exposure)
3.Comparison (other group)
4.Outcomes
5.Setting

15. How often do you use Systematic Reviews
to inform a program/services?
A. Always
B. Often
C. Sometimes
D. Never
E. I don’t know what a systematic review is
Poll Question #3

16. Internet interventions providing personalized
feedback are effective for weight loss in
overweight and obese adults
A. Strongly agree
B. Agree
C. Neutral
D. Disagree
E. Strongly disagree
Poll Question #4

17. Anna Haste,
Research Associate,
Newcastle University

18. Systematic Review
Internet interventions
providing personalized
feedback for weight loss in
overweight and obese adults.

20. Why is being obese a problem?
• Link between obesity and a number of serious
diseases and mental health problems:
• Cancer, hypertension, type 2 diabetes, high blood
pressure, depression, social stigmatisation,
premature death (World Health Organisation, 2014; Public Health England, 2014)
Higher BMI = Higher risk of disease

21. What is an internet-based
intervention?
• Software system, usually a website
• Participants required to log in to access
intervention
• Enables lifestyle information, modules or
assessments to be easily accessible
• Self-monitoring tools
• Systems may be interactive
• Personalised feedback – Automatic/Human
• Engagement with other users

22. Rationale for using an internet
intervention for weight loss
• Traditional primary care treatments (GP appointments, group
sessions) can be costly, have mixed effectiveness and experience
high attrition rates (Jolly et al., 2011)
• Acknowledged the need for intervention components to be
investigated (Neve et al., 2010)
• Personalised interventions have been shown to be more effective
(Kroeze et al., 2006; Neville et al., 2009)
• Internet weight loss studies have identified mixed findings (Morgan et al.,
2011; McConnon et al., 2007) but have the potential to reduce health
professional input and time per patient (Ramadas et al., 2011)

23. Research question
How effective is individualised internet
based feedback compared to those
receiving no feedback within weight
loss interventions for
overweight/obese adults?

24. Inclusion criteria
( P ): Adults aged > 18 years old with BMI > 25kg/ m2
( I ): Interventions targeting diet, physical activity or
both for weight loss. At least in part delivered
individually via internet.
( C ): Standard care or alternative interventions that do
not include individualised feedback via the internet
( O ): Weight loss, waist circumference, BMI change, 5%
weight loss
( S ): Randomised controlled trials
Prospero protocol:
http://www.crd.york.ac.uk/prospero/display_record.asp?ID=CRD42012002115

25. Feedback definition
Michie et al., 2011, pg. 9:
Provide feedback on performance –
“This involves providing the participant with data about
their own recorded behaviour or commenting on a
person’s behavioural performance (e.g. identifying a
discrepancy between behavioural performance and a set
goal or a discrepancy between one’s own performance in
relation to others).”

26. Feedback examples
‘Weekly feedback was given from a pre-programmed
computer that instantaneously returned tailored
feedback on a Web page when the weight loss diary was
submitted.’ (Tate et al., 2006)
‘Each participant who provided diary entries received up to 7
individualized feedback documents via email over the 3
months from the research team. Each sheet gave feedback on
a week of diary entries and suggested personalized strategies
to address weight loss, reduce energy intake and increase
energy expenditure.’ (Morgan et al., 2011)

27. Search strategy
Databases:
Scopus, Web of Science, EMBASE, MEDLINE, PsycINFO,
ASSIA, IBSS and the Sociological Abstracts
Clinical Trial Registers
Hand searching relevant journals, conference publications
and theses databases.

28. Screening process
5861
Total articles identified
2251
Duplicates excluded
3610
Articles remaining
3472
Title and abstract exclusions
138
Articles remaining
23 additional found from
reference list search
124 Exclusions as did not
meet inclusion criteria:
•Participants (n=17)
•Design (n=77)
•Outcome (n=52)
•Intervention (n=52)
14 included articles = 12 separate studies
23 excluded as did not
meet inclusion criteria:
•Participants (n=6)
•Design (n=11)
•Outcome (n=12)
•Intervention (n=8)

29. Results
Feedback
versus
No Feedback

30. Outcomes and timeframes
• Intention-to-treat (ITT) for all analyses
• Ordered by effect size
• Mean difference compared with continuous
outcome measures
• Risk ratio used for dichotomous variables
Control group Total 3 months 6 months 12 months
Minimal
intervention
(TAU or leaflet)
9 5 5 3
Website w/o
feedback
3 2 2 1

31. Weight Loss (kg) – End point

32. Weight loss(kg) – 3, 6 and 12 months

33. BMI change – End point

34. BMI change – 3, 6 and 12 months

35. Waist circumference – End
point

36. Waist change – 3, 6 and 12 months

37. 5% weight loss – End point

38. 5% WL– 3, 6 and 12 months

39. Summary of significant
results
Outcome End 3 months 6 months 12 months
Weight loss    ~
Waist
circumference
   
BMI    
5% weight loss    ~

40. BCTs most commonly identified
• Provide feedback on performance
• Provide information on consequences
• Self-monitoring of behaviour/behaviour
outcome
• Social support/social change
• Goal setting (behaviour/outcome)

41. Wait list or minimal
intervention

42. Control interventions without
feedback

43. Future work
• Behaviour change techniques in relation
to effectiveness, engagement and
retention rates
• Variety of feedback types
(provided by a human or automatically)
• Internet feedback versus other modality
feedback

44. Conclusion
Incorporating individualised
feedback may be a key behaviour
change technique for effective
interventions delivered via the
internet

45. References
Jolly K., Lewis A, Beach J, et al. (2011). Comparison of range of commercial or primary care led weight reduction programmes with minimal intervention control for
weight loss in obesity: Lighten Up randomised controlled trial. BMJ 343.
Kroeze, W., Werkman, A., Brug, J. (2006) A systematic review of randomised trials on the effectivenss of computer-tailored education on physical activity and dietary
behaviors. Annals of Behavioural Medicine, 31 (3), 205-223.
McConnon, Á., Kirk, S. F. L., Cockroft, J. E., Harvey, E. L., Greenwood, D. C., Thomas, J. D., . . . Bojke, L. (2007). The Internet for weight control in an obese sample:
Results of a randomised controlled trial. BMC Health Services Research, 7.
Michie, S., Ashford, S., Sniehotta, F. F., Dombrowski, S. U., Bishop, A., & French, D. P. (2011). A refined taxonomy of behaviour change techniques to help people
change their physical activity and healthy eating behaviours: The CALO-RE taxonomy. Psychology and Health, 26(11), 1479-1498.
Morgan, P. J., Collins, C. E., Plotnikoff, R. C., Cook, A. T., Berthon, B., Mitchell, S., & Callister, R. (2011). Efficacy of a workplace-based weight loss program for
overweight male shift workers: The workplace POWER (preventing obesity without eating like a rabbit) randomized controlled trial. Preventive Medicine, 52(5), 317-
325.
Neve M, Morgan PJ, Jones PR, et al. (2010). Effectiveness of web-based interventions in achieving weight loss and weight loss maintenance in overweight and obese
adults: a systematic review with meta-analysis. Obes Rev, 11 (4), 306-321.
Neville, L. M., Milat, A. J., & O'Hara, B. (2009). Computer-tailored weight reduction interventions targeting adults: A narrative systematic review. Health Promotion
Journal of Australia, 20(1), 48-57.
Public Health England. (2014). Obesity and Health. from www.noo.org.uk/NOO_about_obesity/obesity_and_health
Ramadas, A., Quek, K. F., Chan, C. K. Y., & Oldenburg, B. (2011). Web-based interventions for the management of type 2 diabetes mellitus: A systematic review of
recent evidence. International Journal of Medical Informatics, 80(6), 389-405
Tate DF, Jackvony EH, Wing RR. A Randomized Trial Comparing Human e-Mail Counseling, Computer-Automated Tailored Counseling, and No Counseling in an
Internet Weight Loss Program. Arch Intern Med. 2006;166(15):1620-1625.
World Health Organisation. (2014). Obesity and Overweight Fact Sheet. From http://www.who.int/mediacentre/factsheets/fs311/en/.

46. Acknowledgements
Co-authors:
James Newham
Ruth Bell
Ashley Adamson
Elaine McColl
Vera Araujo-Soares
Funders:

47. Internet interventions providing personalized
feedback are effective for weight loss in
overweight and obese adults
A. Strongly agree
B. Agree
C. Neutral
D. Disagree
E. Strongly disagree
Poll Question #5

48. Poll Question #6
The information presented today was
helpful
A.Strongly agree
B.Agree
C.Neutral
D.Disagree
E.Strongly disagree

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50. Poll Question #7
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that apply]
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51. Thank you!
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