Evaluation of the Aspects of Digital Interventions That Successfully Support Weight Loss: Systematic Review With Component Network Meta-Analysis

Abstract

Background: Obesity is a chronic complex disease associated with increased risks of developing several serious and potentially life-threatening conditions. It is a growing global health issue. Pharmacological treatment is an option for patients living with overweight or obesity. Digital technology may be leveraged to support patients with weight loss in the community, but it is unclear which of the multiple digital options are important for success.

Objective: This systematic review and component network meta-analysis aimed to identify components of digital support for weight loss interventions that are most likely to be effective in supporting patients to achieve weight loss goals.

Methods: We searched MEDLINE, Embase, APA PsycInfo, and Cochrane Central Register of Controlled Trials from inception to November 2023 for randomized controlled trials using any weight loss intervention with digital components and assessing weight loss outcomes in adults with BMI ≥25 kg/m² (≥23 kg/m² for Asian populations). Eligible trials were prioritized for synthesis based on intervention relevance and duration, and the target population. Trial arms with substantial face-to-face elements were deprioritized. Prioritized trials were assessed for quality using the Cochrane Risk of Bias Tool v1. We conducted intervention component analysis to identify key digital intervention features and a coding framework. All prioritized trial arms were coded using this framework and were included in component network meta-analysis.

Results: Searches identified 6528 reports, of which 119 were included. After prioritization, 151 trial arms from 68 trials were included in the synthesis. Nine common digital components were identified from the 151 trial arms: provision of information or education, goal setting, provision of feedback, peer support, reminders, challenges or competitions, contact with a specialist, self-monitoring, and incentives or rewards. Of these, 3 components were identified as "best bets" because they were consistently and numerically, but not usually significantly, most likely to be associated with weight loss at 6 and 12 months. These were patient information, contact with a specialist, and incentives or rewards. An exploratory model combining these 3 components was significantly associated with successful weight loss at 6 months (-2.52 kg, 95% CI -4.15 to -0.88) and 12 months (-2.11 kg, 95% CI -4.25 to 0.01). No trial arms used this specific combination of components.

Conclusions: Our findings indicate that the design of digital interventions to support weight loss should be carefully crafted around core components. On their own, no single digital component could be considered essential for success, but a combination of information, specialist contact, and incentives warrants further examination.

Trial registration: PROSPERO CRD42023493254; https://tinyurl.com/ysyj8j8s.

Keywords: PRISMA; component network meta-analysis; digital interventions; digital technology; obesity; systematic review; weight loss.

Figure 1

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart summarizing the results of the literature search and screening for eligibility.

Figure 2

Results of risk of bias appraisal of prioritized studies.

Figure 3

Component network meta-analysis of digital components of interventions for absolute weight loss at 6 and 12 months. ES: effect size.

Figure 4

Component network meta-analysis of digital components of interventions for change in BMI at 6 and 12 months. ES: effect size.

Figure 5

Component network meta-analysis of digital components of interventions for participants achieving 5% weight loss at 6 and 12 months. OR: odds ratio.