An Acceptance-Based Guided Self-Help Program for Weight Loss Maintenance in Adults Who Have Previously Completed a Behavioral Weight Loss Program: The SWiM Feasibility Study.
Obesity science & practice 2024 ; 11: e70048.
Jones RA, Mueller J, Richards R, Woolston J, Stubbings M, Whittle F, Hughes CA, Sharp SJ, Chester M, Schwertel C, Tait S, Eustachio Colombo P, Kudlek L, Boothby CE, Lawlor ER, Griffin SJ, Ahern AL, Boothby C, Ahern A
DOI : 10.1002/osp4.70048
PubMed ID : 40124957
PMCID : PMC11929140
URL : https://onlinelibrary.wiley.com/doi/10.1002/osp4.70048
Abstract
Most weight lost during weight-loss programmes is eventually regained. Interventions based on Acceptance and Commitment Therapy (ACT) demonstrate good evidence for long-term weight loss, but are often costly and difficult to scale up. Guided self-help programmes delivered using technology and non-specialist coaches could increase scalability, but it is unclear whether delivering ACT-based interventions in this way is feasible and acceptable.
In this feasibility study, 61 people who recently completed a behavioral weight management intervention (BWMI) for weight management were randomly allocated to SWiM ("Supporting Weight Management": 4-month digital guided self-help ACT-based intervention for weight loss maintenance) or a standard care group (leaflet about maintaining weight loss) using a 2:1 allocation ratio. At baseline and 6 months, participants completed measures of weight, mental health, eating behavior, and other psychosocial variables. Participants completed an intervention evaluation questionnaire. At 3 and 6 months, qualitative interviews were conducted with participants from both trial arms and SWiM coaches. The analysis integrated statistics and thematic analysis, informed by the Medical Research Council (MRC) framework for process evaluations. Since this was a feasibility study, analyses focused on process outcomes instead of interpreting statistical significance.
Eighty-eight percent (36/41) of participants allocated to SWiM completed at least the first session and 22 (54%) completed all sessions. At 6 months, mean weight change was -2.2 (+/-6.4 SD) kg in SWiM participants and +2.2 (+/-6.6) kg in standard care participants. Descriptively, eating behavior and mental health scores improved in SWiM participants but not in standard care participants. In interviews, SWiM participants noted that they reinforced their existing knowledge while acquiring new skills and strategies, which were felt to contribute to positive behavioral changes.
The SWiM intervention is practical and well-received, and shows promise in supporting weight loss maintenance, though evaluation in a larger trial is needed to assess effectiveness.
ISRCTN12685964.
Lay Summary
Research Background
Behavioural weight management programmes are effective in reducing weight, but most people regain the weight they initially lost within 3-5 years. Weight management programmes based on Acceptance and Commitment Therapy (ACT) show promise for longer-term maintenance of weight loss, but programmes of this kind are typically expensive to deliver. The costs could be reduced by delivering the programmes online and by non-specialist staff, but it remains unclear whether this approach is acceptable to people or practical to deliver on a larger scale.
Study Design
A study was developed to understand whether a programme based on ACT delivered digitally by non-specialists (called ‘SWiM’ – Supporting Weight Management) could help people maintain the weight they previously lost, and whether people would find this kind of programme acceptable.
We recruited 61 people who had recently completed a behavioural weight management programme and randomly allocated them to either SWiM or a control group. The SWiM programme included 14 sessions over six months that used ACT to support weight loss maintenance; the programme was delivered on a website with telephone support from trained non-specialist coaches. The control group received a leaflet about weight loss maintenance.
At both the beginning and end of the programme, all participants completed questionnaires to assess their weight, eating behaviours, and mental wellbeing. Participants also completed questionnaires to evaluate their experience with the programme, such as how useful they found the content of the sessions.
We also interviewed people who took part in the study and all of the non-specialist coaches to understand what worked, what did not work, and why. The non-specialist coaches also completed a report form after each participant call to record their experiences of the calls. Interviews of people who withdrew from the SWiM programme helped to further understand what did and did not work. Throughout the project we had input from people with obesity who helped shape this project through their lived experience of managing their weight. This ensured the study is relevant for the people we are trying to support.
Our Findings
At the end of the SWiM programme, 36 out of 41 participants completed session one, and 25 participants completed all 14 sessions. On average, SWiM participants lost 2.15kg, while control participants gained 2.17kg during the 6-month study. SWiM participants reported improvements in their eating behaviour and mental health, while control participants did not. Most participants found the SWiM programme easy to use, useful, and enjoyable. It is important to note that this was a small study and, based on these results, we cannot draw firm conclusions. We will need to do a larger study to evaluate the effectiveness of the SWiM programme.
In interviews, SWiM participants reported learning new skills and reinforcing existing skills and strategies which supported them to manage their weight. They found the SWiM website easy to use, but some participants experienced problems accessing the website from mobile devices.
Next Steps
Overall, the findings suggest that the SWiM programme is acceptable and may support people to maintain their weight loss. We are making changes to the programme based on our learnings, and will conduct a larger study to determine if SWiM is effective in helping people maintain weight loss, whether it can be delivered at scale, and whether it is cost-effective (i.e., good value for money for the NHS).