Web-Based Digital Health Interventions for Weight Loss and Lifestyle Habit Changes in Overweight and Obese Adults: Systematic Review and Meta-Analysis

doi:10.2196/jmir.9609

Meta-Analysis

. 2019 Jan 8;21(1):e298.

doi: 10.2196/jmir.9609.

Web-Based Digital Health Interventions for Weight Loss and Lifestyle Habit Changes in Overweight and Obese Adults: Systematic Review and Meta-Analysis

Alline M Beleigoli^{1

2

3}, Andre Q Andrade⁴, Alexandre G Cançado¹, Matheus Nl Paulo¹, Maria De Fátima H Diniz¹, Antonio L Ribeiro^{1

5}

Affiliations

¹ Internal Medicine Department, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
² Department of Medicine, University of Adelaide, Adelaide, Australia.
³ Flinders Digital Health Research Centre, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.
⁴ Quality Use of Medicines and Pharmacy Research Center, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.
⁵ Telehealth Center, Hospital das Clinicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.

PMID: 30622090
PMCID: PMC6330028
DOI: 10.2196/jmir.9609

Meta-Analysis

Web-Based Digital Health Interventions for Weight Loss and Lifestyle Habit Changes in Overweight and Obese Adults: Systematic Review and Meta-Analysis

Alline M Beleigoli et al. J Med Internet Res. 2019.

. 2019 Jan 8;21(1):e298.

doi: 10.2196/jmir.9609.

Authors

Alline M Beleigoli^{1

2

3}, Andre Q Andrade⁴, Alexandre G Cançado¹, Matheus Nl Paulo¹, Maria De Fátima H Diniz¹, Antonio L Ribeiro^{1

5}

Affiliations

¹ Internal Medicine Department, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
² Department of Medicine, University of Adelaide, Adelaide, Australia.
³ Flinders Digital Health Research Centre, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.
⁴ Quality Use of Medicines and Pharmacy Research Center, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.
⁵ Telehealth Center, Hospital das Clinicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.

PMID: 30622090
PMCID: PMC6330028
DOI: 10.2196/jmir.9609

Abstract

Background: Obesity is a highly prevalent condition with important health implications. Face-to-face interventions to treat obesity demand a large number of human resources and time, generating a great burden to individuals and health system. In this context, the internet is an attractive tool for delivering weight loss programs due to anonymity, 24-hour-accessibility, scalability, and reachability associated with Web-based programs.

Objective: We aimed to investigate the effectiveness of Web-based digital health interventions, excluding hybrid interventions and non-Web-based technologies such as text messaging, short message service, in comparison to nontechnology active or inactive (wait list) interventions on weight loss and lifestyle habit changes in individuals with overweight and obesity.

Methods: We searched PubMed or Medline, SciELO, Lilacs, PsychNet, and Web of Science up to July 2018, as well as references of previous reviews for randomized trials that compared Web-based digital health interventions to offline interventions. Anthropometric changes such as weight, body mass index (BMI), waist, and body fat and lifestyle habit changes in adults with overweight and obesity were the outcomes of interest. Random effects meta-analysis and meta-regression were performed for mean differences (MDs) in weight. We rated the risk of bias for each study and the quality of evidence across studies using the Grades of Recommendation, Assessment, Development, and Evaluation approach.

Results: Among the 4071 articles retrieved, 11 were included. Weight (MD -0.77 kg, 95% CI -2.16 to 0.62; 1497 participants; moderate certainty evidence) and BMI (MD -0.12 kg/m2; 95% CI -0.64 to 0.41; 1244 participants; moderate certainty evidence) changes were not different between Web-based and offline interventions. Compared to offline interventions, digital interventions led to a greater short-term (<6 months follow-up) weight loss (MD -2.13 kg, 95% CI -2.71 to -1.55; 393 participants; high certainty evidence), but not in the long-term (MD -0.17 kg, 95% CI -2.10 to 1.76; 1104 participants; moderate certainty evidence). Meta-analysis was not possible for lifestyle habit changes. High risk of attrition bias was identified in 5 studies. For weight and BMI outcomes, the certainty of evidence was moderate mainly due to high heterogeneity, which was mainly attributable to control group differences across studies (R²=79%).

Conclusions: Web-based digital interventions led to greater short-term but not long-term weight loss than offline interventions in overweight and obese adults. Heterogeneity was high across studies, and high attrition rates suggested that engagement is a major issue in Web-based interventions.

Keywords: internet; meta-analysis; mobile phone; obesity; telemedicine.

©Alline M Beleigoli, Andre Q Andrade, Alexandre G Cançado, Matheus NL Paulo, Maria De Fátima H Diniz, Antonio L Ribeiro. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 08.01.2019.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

**Figure 1**
Preferred Reporting Items for Systematic Reviews and Meta-analysis flowchart.

**Figure 2**
Meta-analysis results for mean weight change (kg) in Web-based-only versus offline interventions. df: degrees of freedom; IV: interval variable; random: random effects model.

**Figure 3**
Meta-analysis results for mean body mass index change (kg/m2) in Web-based-only versus offline interventions. df: degrees of freedom; IV: interval variable; random: random effects model.

**Figure 4**
Meta-analysis results for mean waist change (cm) in Web-based-only versus offline interventions for studies with a specific intervention in the control group. df: degrees of freedom; IV: interval variable; random: random effects model.

**Figure 5**
Meta-analysis results for mean weight change (kg) in Web-based-only versus active nontechnology interventions in the control group. df: degrees of freedom; IV: interval variable; random: random effects model.

**Figure 6**
Meta-analysis results for mean weight change (kg) in Web-based-only versus nonactive interventions (wait list) in the control group. df: degrees of freedom; IV: interval variable; random: random effects model.

**Figure 7**
Meta-analysis results for mean weight change (kg) in Web-based-only versus offline interventions for studies with <6 months follow-up duration. df: degrees of freedom; IV: interval variable; random: random effects model.

**Figure 8**
Meta-analysis results for mean weight change (kg) in Web-based-only versus offline interventions for studies with ≥6 months follow-up duration. df: degrees of freedom; IV: interval variable; random: random effects model.

See this image and copyright information in PMC

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References

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1. Bray GA, Frühbeck Gema, Ryan DH, Wilding JPH. Management of obesity. Lancet. 2016 May 07;387(10031):1947–56. doi: 10.1016/S0140-6736(16)00271-3.S0140-6736(16)00271-3 - DOI - PubMed
1. Wadden TA, Butryn ML, Hong PS, Tsai AG. Behavioral treatment of obesity in patients encountered in primary care settings: a systematic review. JAMA. 2014 Nov 05;312(17):1779–91. doi: 10.1001/jama.2014.14173. http://europepmc.org/abstract/MED/25369490 1920976 - DOI - PMC - PubMed
1. Douketis JD, Macie C, Thabane L, Williamson DF. Systematic review of long-term weight loss studies in obese adults: clinical significance and applicability to clinical practice. Int J Obes (Lond) 2005 Oct;29(10):1153–67. doi: 10.1038/sj.ijo.0802982.0802982 - DOI - PubMed

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[1] World Health Organization Fact Sheets. [2018-08-14]. 2017 http://www.who.int/en/news-room/fact-sheets/detail/obesity-and-overweight .

[2] World Health Organization Fact Sheets. [2018-08-14]. 2017 http://www.who.int/en/news-room/fact-sheets/detail/obesity-and-overweight .

[3] GBD 2015 Obesity Collaborators. Afshin A, Forouzanfar MH, Reitsma MB, Sur P, Estep K, Lee A, Marczak L, Mokdad AH, Moradi-Lakeh M, Naghavi M, Salama JS, Vos T, Abate KH, Abbafati C, Ahmed MB, Al-Aly Z, Alkerwi A, Al-Raddadi R, Amare AT, Amberbir A, Amegah AK, Amini E, Amrock SM, Anjana RM, Ärnlöv Johan, Asayesh H, Banerjee A, Barac A, Baye E, Bennett DA, Beyene AS, Biadgilign S, Biryukov S, Bjertness E, Boneya DJ, Campos-Nonato I, Carrero JJ, Cecilio P, Cercy K, Ciobanu LG, Cornaby L, Damtew SA, Dandona L, Dandona R, Dharmaratne SD, Duncan BB, Eshrati B, Esteghamati A, Feigin VL, Fernandes JC, Fürst T, Gebrehiwot TT, Gold A, Gona PN, Goto A, Habtewold TD, Hadush KT, Hafezi-Nejad N, Hay SI, Horino M, Islami F, Kamal R, Kasaeian A, Katikireddi SV, Kengne AP, Kesavachandran CN, Khader YS, Khang Y, Khubchandani J, Kim D, Kim YJ, Kinfu Y, Kosen S, Ku T, Defo BK, Kumar GA, Larson HJ, Leinsalu M, Liang X, Lim SS, Liu P, Lopez AD, Lozano R, Majeed A, Malekzadeh R, Malta DC, Mazidi M, McAlinden C, McGarvey ST, Mengistu DT, Mensah GA, Mensink GBM, Mezgebe HB, Mirrakhimov EM, Mueller UO, Noubiap JJ, Obermeyer CM, Ogbo FA, Owolabi MO, Patton GC, Pourmalek F, Qorbani M, Rafay A, Rai RK, Ranabhat CL, Reinig N, Safiri S, Salomon JA, Sanabria JR, Santos IS, Sartorius B, Sawhney M, Schmidhuber J, Schutte AE, Schmidt MI, Sepanlou SG, Shamsizadeh M, Sheikhbahaei S, Shin M, Shiri R, Shiue I, Roba HS, Silva DAS, Silverberg JI, Singh JA, Stranges S, Swaminathan S, Tabarés-Seisdedos R, Tadese F, Tedla BA, Tegegne BS, Terkawi AS, Thakur JS, Tonelli M, Topor-Madry R, Tyrovolas S, Ukwaja KN, Uthman OA, Vaezghasemi M, Vasankari T, Vlassov VV, Vollset SE, Weiderpass E, Werdecker A, Wesana J, Westerman R, Yano Y, Yonemoto N, Yonga G, Zaidi Z, Zenebe ZM, Zipkin B, Murray CJL. Health Effects of Overweight and Obesity in 195 Countries over 25 Years. N Engl J Med. 2017 Dec 06;377(1):13–27. doi: 10.1056/NEJMoa1614362. http://europepmc.org/abstract/MED/28604169 - DOI - PMC - PubMed

[4] GBD 2015 Obesity Collaborators. Afshin A, Forouzanfar MH, Reitsma MB, Sur P, Estep K, Lee A, Marczak L, Mokdad AH, Moradi-Lakeh M, Naghavi M, Salama JS, Vos T, Abate KH, Abbafati C, Ahmed MB, Al-Aly Z, Alkerwi A, Al-Raddadi R, Amare AT, Amberbir A, Amegah AK, Amini E, Amrock SM, Anjana RM, Ärnlöv Johan, Asayesh H, Banerjee A, Barac A, Baye E, Bennett DA, Beyene AS, Biadgilign S, Biryukov S, Bjertness E, Boneya DJ, Campos-Nonato I, Carrero JJ, Cecilio P, Cercy K, Ciobanu LG, Cornaby L, Damtew SA, Dandona L, Dandona R, Dharmaratne SD, Duncan BB, Eshrati B, Esteghamati A, Feigin VL, Fernandes JC, Fürst T, Gebrehiwot TT, Gold A, Gona PN, Goto A, Habtewold TD, Hadush KT, Hafezi-Nejad N, Hay SI, Horino M, Islami F, Kamal R, Kasaeian A, Katikireddi SV, Kengne AP, Kesavachandran CN, Khader YS, Khang Y, Khubchandani J, Kim D, Kim YJ, Kinfu Y, Kosen S, Ku T, Defo BK, Kumar GA, Larson HJ, Leinsalu M, Liang X, Lim SS, Liu P, Lopez AD, Lozano R, Majeed A, Malekzadeh R, Malta DC, Mazidi M, McAlinden C, McGarvey ST, Mengistu DT, Mensah GA, Mensink GBM, Mezgebe HB, Mirrakhimov EM, Mueller UO, Noubiap JJ, Obermeyer CM, Ogbo FA, Owolabi MO, Patton GC, Pourmalek F, Qorbani M, Rafay A, Rai RK, Ranabhat CL, Reinig N, Safiri S, Salomon JA, Sanabria JR, Santos IS, Sartorius B, Sawhney M, Schmidhuber J, Schutte AE, Schmidt MI, Sepanlou SG, Shamsizadeh M, Sheikhbahaei S, Shin M, Shiri R, Shiue I, Roba HS, Silva DAS, Silverberg JI, Singh JA, Stranges S, Swaminathan S, Tabarés-Seisdedos R, Tadese F, Tedla BA, Tegegne BS, Terkawi AS, Thakur JS, Tonelli M, Topor-Madry R, Tyrovolas S, Ukwaja KN, Uthman OA, Vaezghasemi M, Vasankari T, Vlassov VV, Vollset SE, Weiderpass E, Werdecker A, Wesana J, Westerman R, Yano Y, Yonemoto N, Yonga G, Zaidi Z, Zenebe ZM, Zipkin B, Murray CJL. Health Effects of Overweight and Obesity in 195 Countries over 25 Years. N Engl J Med. 2017 Dec 06;377(1):13–27. doi: 10.1056/NEJMoa1614362. http://europepmc.org/abstract/MED/28604169 - DOI - PMC - PubMed

[5] Bray GA, Frühbeck Gema, Ryan DH, Wilding JPH. Management of obesity. Lancet. 2016 May 07;387(10031):1947–56. doi: 10.1016/S0140-6736(16)00271-3.S0140-6736(16)00271-3 - DOI - PubMed

[6] Bray GA, Frühbeck Gema, Ryan DH, Wilding JPH. Management of obesity. Lancet. 2016 May 07;387(10031):1947–56. doi: 10.1016/S0140-6736(16)00271-3.S0140-6736(16)00271-3 - DOI - PubMed

[7] Wadden TA, Butryn ML, Hong PS, Tsai AG. Behavioral treatment of obesity in patients encountered in primary care settings: a systematic review. JAMA. 2014 Nov 05;312(17):1779–91. doi: 10.1001/jama.2014.14173. http://europepmc.org/abstract/MED/25369490 1920976 - DOI - PMC - PubMed

[8] Wadden TA, Butryn ML, Hong PS, Tsai AG. Behavioral treatment of obesity in patients encountered in primary care settings: a systematic review. JAMA. 2014 Nov 05;312(17):1779–91. doi: 10.1001/jama.2014.14173. http://europepmc.org/abstract/MED/25369490 1920976 - DOI - PMC - PubMed

[9] Douketis JD, Macie C, Thabane L, Williamson DF. Systematic review of long-term weight loss studies in obese adults: clinical significance and applicability to clinical practice. Int J Obes (Lond) 2005 Oct;29(10):1153–67. doi: 10.1038/sj.ijo.0802982.0802982 - DOI - PubMed

[10] Douketis JD, Macie C, Thabane L, Williamson DF. Systematic review of long-term weight loss studies in obese adults: clinical significance and applicability to clinical practice. Int J Obes (Lond) 2005 Oct;29(10):1153–67. doi: 10.1038/sj.ijo.0802982.0802982 - DOI - PubMed

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Web-Based Digital Health Interventions for Weight Loss and Lifestyle Habit Changes in Overweight and Obese Adults: Systematic Review and Meta-Analysis

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Web-Based Digital Health Interventions for Weight Loss and Lifestyle Habit Changes in Overweight and Obese Adults: Systematic Review and Meta-Analysis

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