Development of a web-based, guided self-help, acceptance and commitment therapy–based intervention for weight loss maintenance: evidence-, theory-, and person-based approach

Richards, R. et al. (2022) Development of a web-based, guided self-help, acceptance and commitment therapy–based intervention for weight loss maintenance: evidence-, theory-, and person-based approach. JMIR Formative Research, 6(1), e31801. (doi: 10.2196/31801) (PMID:34994698) (PMCID:PMC8783282)

Abstract

Background: The long-term impact and cost-effectiveness of weight management programs depend on posttreatment weight maintenance. There is growing evidence that interventions based on third-wave cognitive behavioral therapy, particularly acceptance and commitment therapy (ACT), could improve long-term weight management; however, these interventions are typically delivered face-to-face by psychologists, which limits the scalability of these types of intervention. Objective: The aim of this study is to use an evidence-, theory-, and person-based approach to develop an ACT-based intervention for weight loss maintenance that uses digital technology and nonspecialist guidance to minimize the resources needed for delivery at scale. Methods: Intervention development was guided by the Medical Research Council framework for the development of complex interventions in health care, Intervention Mapping Protocol, and a person-based approach for enhancing the acceptability and feasibility of interventions. Work was conducted in two phases: phase 1 consisted of collating and analyzing existing and new primary evidence and phase 2 consisted of theoretical modeling and intervention development. Phase 1 included a synthesis of existing evidence on weight loss maintenance from previous research, a systematic review and network meta-analysis of third-wave cognitive behavioral therapy interventions for weight management, a qualitative interview study of experiences of weight loss maintenance, and the modeling of a justifiable cost for a weight loss maintenance program. Phase 2 included the iterative development of guiding principles, a logic model, and the intervention design and content. Target user and stakeholder panels were established to inform each phase of development, and user testing of successive iterations of the prototype intervention was conducted. Results: This process resulted in a guided self-help ACT-based intervention called SWiM (Supporting Weight Management). SWiM is a 4-month program consisting of weekly web-based sessions for 13 consecutive weeks followed by a 4-week break for participants to reflect and practice their new skills and a final session at week 18. Each session consists of psychoeducational content, reflective exercises, and behavioral experiments. SWiM includes specific sessions on key determinants of weight loss maintenance, including developing skills to manage high-risk situations for lapses, creating new helpful habits, breaking old unhelpful habits, and learning to manage interpersonal relationships and their impact on weight management. A trained, nonspecialist coach provides guidance for the participants through the program with 4 scheduled 30-minute telephone calls and 3 further optional calls. Conclusions: This comprehensive approach facilitated the development of an intervention that is based on scientific theory and evidence for supporting people with weight loss maintenance and is grounded in the experiences of the target users and the context in which it is intended to be delivered. The intervention will be refined based on the findings of a planned pilot randomized controlled trial.

• Item Type: Articles
• Additional Information: This project was funded by the National Institute for Health Research Program Grants for Applied Research Programme (Reference Number RP-PG-0216-20010). ALA, RAJ, and SJG are funded by the Medical Research Council through grant MC_UU_00006/6.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Lawlor, Dr Emma
• Authors: Richards, R., Jones, R. A., Whittle, F., Hughes, C. A., Hill, A. J., Lawlor, E. R., Bostock, J., Bates, S., Breeze, P. R., Brennan, A., Thomas, C. V., Stubbings, M., Woolston, J., Griffin, S. J., and Ahern, A. L.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: JMIR Formative Research
• Publisher: JMIR Publications
• ISSN: 2561-326X
• ISSN (Online): 2561-326X
• Published Online: 05 July 2021
• Copyright Holders: Copyright © Rebecca Richards, Rebecca A Jones, Fiona Whittle, Carly A Hughes, Andrew J Hill, Emma R Lawlor, Jennifer Bostock, Sarah Bates, Penny R Breeze, Alan Brennan, Chloe V Thomas, Marie Stubbings, Jennifer Woolston, Simon J Griffin, Amy L Ahern 2022
• First Published: First published in JMIR Publications 6(1):e31801
• Publisher Policy: Reproduced under a Creative Commons licence