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Virtual Communities for Weight Management: A Systematic Review

MAP Defense
by

Ilana Schriftman

on 29 March 2015

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Transcript of Virtual Communities for Weight Management: A Systematic Review

Obesity in the United States
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Summary
In most cases, VCs appeared to be equally efficacious to control arms
Most of these control arms were group therapy for weight management
VCs might be a cost-effective, broad-reaching, and easily disseminable alternative to standard in-person treatments for weight management
We were unable to make conclusions about associations between engagement and design features, due to heterogeneity in reporting
These findings suggest that metrics should be standardized to facilitate comparability
Results
Acknowledgements
Dr. Gary G. Bennett

Dr. Phil Costanzo

Dr. Kathy Sikkema

Dr. Mark Leary

Ms. Charlotte Stoute

Duke Obesity Prevention Program
Limitations
Heterogeneity in designs
Homogeneity in populations
No restrictions on study length or number of participants
Implications of placing participants into a VC inorganically are unclear
Virtual Communities For Weight Management:
A Systematic Review

Ilana B. Schriftman
Over 1/3 of U.S. Adults are Obese
Why does this matter?
Obesity is associated with a wealth of negative health outcomes

These health conditions can be costly to treat
(about $147 billion in 2008)

Concerning from both public health and economic perspectives
Standard Obesity Treatments
Often group-based

Frequent meetings

Can produce clinically significant weight change
Transportation

Time

Cost
Need for Obesity Treatments that Can Be:
Accessible, with limited constraints

Broad-reaching

Potentially cost-effective
eHealth
interventions have the potential to address these goals and barriers
Barriers:
eHealth for Weight Management
Questions?
Virtual Communities
Clinically significant weight loss can be achieved

Outcomes often less than those seen in standard interventions:
eHealth
Electronic environments through which participants can give and receive peer social support

Self-led or professionally facilitated

Real-time or asynchronous

VCs are popular
Efficacy of Virtual Communities for Weight Management

Extent to which Engagement has been Examined

Associations Between Engagement and Design Features
Why VCs for Weight Management?
What We Don't Know
The Present Study
Methods
I/E Criteria
Population
>= 18 years old
Overweight or Obese
Interventions
RCTs
Weight Management
No restrictions on length or setting
VC = Primary component
Comparators
Standard in-person
eHealth without a VC
Outcomes
Primary: Weight change
Secondary: Engagement
Data Sources and Searches
Data Extraction
Design Features

Participant Demographics

Outcomes
Assessed Risk of Bias
Weight Loss Trials
Weight Maintenance Trials
Chat Rooms
Message Board
Chat Rooms
Message Board/Chat Room
Twitter
Weight Outcomes
In-Person
eHealth
In-Person
Intervention
Control
Intervention
Control
Intervention = Control
3 out of 4 studies

Control > Intervention in 1 study
Mean Weight Change Intervention: -5.5 kg. to -2.57 kg.

Mean Weight Change Control: -8.0 kg. to -1.66 kg.
Retention and Engagement Outcomes
Retention was high:
Ranged from 76%-82%
No variation by treatment group
Engagement metrics widely varied, including:
Proportion of meetings attended
Proportion of weeks that participant self-monitored
Proportion of participants interacting with different sections of site
Mean number of Twitter posts per week per participant
Association between engagement and weight loss outcomes:
Reported in 1 study
Metric not related to VC
Weight Outcomes
Intervention = Control
4 out of 5 studies

Control > Intervention in 1 study

Pre-randomization as baseline weight
Intervention: -5.7 kg. to -5.1 kg.
Control: -10.4 kg. to -5.5 kg.

Post-randomization as baseline weight
Intervention: +0.4 kg .to +4.7 kg.
Control: 0 kg. to +4.9 kg.
Retention and Engagement Outcomes
Retention was high:
Ranged from 69% to 93%
No variation by treatment group
Engagement metrics widely varied, including:
Proportion of meetings attended
Number of meetings attended
Number of contacts with peers
Proportion of weeks self-monitoring data was submitted
Association between engagement and weight loss outcomes:
Examined in 3 studies
engagement
weight
Implications and Future Directions
Findings and designs would likely be different for future studies, due to the popularity of social networking sites
Implications of integrating virtual communities within these sites?
Implications of joining a virtual community organically vs. within the context of an RCT?
Engagement: the need to develop and test approaches to promote engagement, and to standardize reporting metrics
VCs for different populations: men, racial/ethnic minorities, other age groups
Strong association between engagement and outcomes
Attrition and declining engagement are common
General Characteristics
Participants were mostly upper-middle-class, middle-aged, White women

Ns ranged from 21 to 481

Study length ranged from 3 months to 18 months
VCs might help with social support
Social support has been demonstrated to be beneficial for weight management
VCs can assist with self-regulation
VCs might help to eliminate barriers
Modeling, communication of norms, reinforcement, etc.
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