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Randomized Controlled Trial
. 2024 Apr 5:26:e51558.
doi: 10.2196/51558.

Assessing the Clinical Efficacy of a Virtual Reality Tool for the Treatment of Obesity: Randomized Controlled Trial

Dimitra Anastasiadou  1   2 , Pol Herrero  2 , Paula Garcia-Royo  2 , Julia Vázquez-De Sebastián  2   3 , Mel Slater  4   5   6 , Bernhard Spanlang  4 , Elena Álvarez de la Campa  4 , Andreea Ciudin  7   8   9 , Marta Comas  7   8   9 , Josep Antoni Ramos-Quiroga  2   10   11   12 , Pilar Lusilla-Palacios  2   10   11   12
Affiliations
Randomized Controlled Trial

Assessing the Clinical Efficacy of a Virtual Reality Tool for the Treatment of Obesity: Randomized Controlled Trial

Dimitra Anastasiadou et al. J Med Internet Res. .

Abstract

Background: Virtual reality (VR) interventions, based on cognitive behavioral therapy principles, have been proven effective as complementary tools in managing obesity and have been associated with promoting healthy behaviors and addressing body image concerns. However, they have not fully addressed certain underlying causes of obesity, such as a lack of motivation to change, low self-efficacy, and the impact of weight stigma interiorization, which often impede treatment adherence and long-term lifestyle habit changes. To tackle these concerns, this study introduces the VR self-counseling paradigm, which incorporates embodiment and body-swapping techniques, along with motivational strategies, to help people living with obesity effectively address some of the root causes of their condition.

Objective: This study aims to assess the clinical efficacy of ConVRself (Virtual Reality self-talk), a VR platform that allows participants to engage in motivational self-conversations.

Methods: A randomized controlled trial was conducted with 68 participants from the bariatric surgery waiting list from the obesity unit of the Vall d'Hebron University Hospital in Barcelona, Spain. Participants were assigned to 1 of 3 groups: a control group (CG), which only received treatment as usual from the obesity unit; experimental group 1 (EG1), which, after intensive motivational interviewing training, engaged in 4 sessions of VR-based self-conversations with ConVRself, and underwent embodiment and body-swapping techniques; and experimental group 2 (EG2), which engaged in 4 VR-based sessions led by a virtual counselor with a prerecorded discourse, and only underwent the embodiment technique. In the case of both EG1 and EG2, the VR interventions were assisted by a clinical researcher. Readiness to change habits, eating habits, and psychological variables, as well as adherence and satisfaction with ConVRself were measured at baseline, after the intervention, 1 week after the intervention, and 4 weeks after the intervention.

Results: Regarding the primary outcomes, EG1 (24/68, 35%) and EG2 (22/68, 32%) showed significant improvements in confidence to lose weight compared to the CG (22/68, 32%) at all assessment points (β=-.16; P=.02). Similarly, EG1 demonstrated a significant increase after the intervention in readiness to exercise more compared to the CG (β=-.17; P=.03). Regarding the secondary outcomes, EG1 participants showed a significant reduction in uncontrolled eating (β=.71; P=.01) and emotional eating (β=.29; P=.03) compared to the CG participants, as well as in their anxiety levels compared to EG2 and CG participants (β=.65; P=.01). In addition, participants from the experimental groups reported high adherence and satisfaction with the VR platform (EG1: mean 59.82, SD 4.00; EG2: mean 58.43, SD 5.22; d=0.30, 95% CI -0.30 to 0.89).

Conclusions: This study revealed that using VR self-conversations, based on motivational interviewing principles, may have benefits in helping people with obesity to enhance their readiness to change habits and self-efficacy, as well as reduce dysfunctional eating behaviors and anxiety.

Trial registration: ClinicalTrials.gov NCT05094557; https://www.clinicaltrials.gov/study/NCT05094557.

Keywords: embodiment; motivational interviewing; obesity; psychological treatment; self-conversation; virtual reality.

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Conflict of interest statement

Conflicts of Interest: MS and BS are founders of Virtual Bodyworks SL, a spin-off company of the Universitat de Barcelona. EAdlC was employed by Virtual Bodyworks SL. All other authors declare no other conflicts of interest.

Figures

Figure 1
Figure 1
Flow of participants through each stage of the randomized controlled trial. CG: control group; EG1: experimental group 1; EG2: experimental group 2; T0: baseline; T1: after the intervention; T2: 1 week after the intervention; T3: 4 weeks after the intervention.
Figure 2
Figure 2
Estimated means of primary outcomes confidence to lose weight and readiness to exercise more in group versus time effect. The values are based on estimated means derived from hierarchical linear models with intent-to-treat analysis. Within each group, the central line represents the estimated mean outcome, while the surrounding error areas, delimited by 2 outer lines, illustrate the upper and lower bounds of the 95% CI around the estimated mean. CG: control group; EG1: experimental group 1; EG2: experimental group 2; RR: readiness ruler; T0: baseline; T1: after the intervention; T2: 1 week after the intervention; T3: 4 weeks after the intervention.
See this image and copyright information in PMC

References

    1. Obesity and overweight. World Health Organization. 2021. Jun 9, [2024-03-06]. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight .
    1. Vallis M, Macklin D, Russell-Mayhew S. Effective psychological and behavioural interventions in obesity management. Adult Obesity Clinical Practice Guidelines. 2020. [2024-03-06]. https://obesitycanada.ca/wp-content/uploads/2020/08/10-Psych-Interventio... .
    1. Wharton S, Lau DC, Vallis M, Sharma AM, Biertho L, Campbell-Scherer D, Adamo K, Alberga A, Bell R, Boulé N, Boyling E, Brown J, Calam B, Clarke C, Crowshoe L, Divalentino D, Forhan M, Freedhoff Y, Gagner M, Glazer S, Grand C, Green M, Hahn M, Hawa R, Henderson R, Hong D, Hung P, Janssen I, Jacklin K, Johnson-Stoklossa C, Kemp A, Kirk S, Kuk J, Langlois MF, Lear S, McInnes A, Macklin D, Naji L, Manjoo P, Morin MP, Nerenberg K, Patton I, Pedersen S, Pereira L, Piccinini-Vallis H, Poddar M, Poirier P, Prud'homme D, Salas XR, Rueda-Clausen C, Russell-Mayhew S, Shiau J, Sherifali D, Sievenpiper J, Sockalingam S, Taylor V, Toth E, Twells L, Tytus R, Walji S, Walker L, Wicklum S. Obesity in adults: a clinical practice guideline. CMAJ. 2020 Aug 04;192(31):E875–91. doi: 10.1503/cmaj.191707. http://www.cmaj.ca/cgi/pmidlookup?view=long&pmid=32753461 192/31/E875 - DOI - PMC - PubMed
    1. Breen C, O'Connell J, Geoghegan J, O'Shea D, Birney S, Tully L, Gaynor K, O'Kelly M, O'Malley G, O'Donovan C, Lyons O, Flynn M, Allen S, Arthurs N, Browne S, Byrne M, Callaghan S, Collins C, Courtney A, Crotty M, Donohue C, Donovan C, Dunlevy C, Duggan D, Fearon N, Finucane F, Fitzgerald I, Foy S, Garvey J, Gibson I, Glynn L, Gregg E, Griffin A, Harrington JM, Heary C, Heneghan H, Hogan A, Hynes M, Kearney C, Kelly D, Neff K, le Roux CW, Manning S, McAuliffe F, Moore S, Moran N, Murphy M, Murrin C, O'Brien SM, O'Donnell C, O'Dwyer S, O'Grada C, O'Malley E, O'Reilly O, O'Reilly S, Porter O, Roche HM, Rhynehart A, Ryan L, Seery S, Soare C, Shaamile F, Walsh A, Woods C, Woods C, Yoder R. Obesity in adults: a 2022 adapted clinical practice guideline for Ireland. Obes Facts. 2022 Oct 24;15(6):736–52. doi: 10.1159/000527131. doi: 10.1159/000527131.000527131 - DOI - DOI - PMC - PubMed
    1. Obesity: identification, assessment and management. National Institute for Health and Care Excellence. 2014. Nov 27, [2024-03-06]. https://www.nice.org.uk/guidance/cg189/chapter/Recommendations#behaviour... .

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