Siniriikka A. Männistö

Depression and occupational burnout are prevalent and interrelated forms of psychological distress in working-age populations (Tóth‐Király et al., 2021). While depression reflects broader emotional...

Background: Mental health problems and adverse health behaviors are enriched in individuals with obesity and need to be considered in weight loss interventions. Regarding weight loss, hybrid interventions combining digital and in-person elements have proven superior to eHealth-only interventions. However, it remains unclear whether minimal group or individual enhancement could bring additional benefits to the mental health and health behavior domains in individuals with obesity. Objective: This study aimed to explore whether minimal group or individual enhancements could offer additional benefits to an eHealth intervention in relation to mental health, perceived work ability, and health behavior in a sample of occupational health patients with obesity. In addition, the study sought to examine the overall effects of the health behavior–focused intervention across these domains. Methods: This study was a randomized controlled trial with a 12-month intervention (March 2021-2022), with selected variables followed for another 12 months without additional support. Recruited from occupational health care, 111 working-age adults with BMI 30‐40 kg/m² were randomized to one of the 3 treatment arms, such as eHealth, eHealth+Group, or eHealth+Individual. All treatment arms received a web-administered, coach-assisted eHealth program based on acceptance and commitment therapy, and, in addition, the eHealth+Group and eHealth+Individual arms received 3 remotely facilitated group or individual meetings. The overall intervention effects were evaluated quasi-experimentally by combining the 3 treatment arms into a single eHealth arm. Participants were assessed for depression (the Beck Depression Index 21 [BDI-21]), burnout (Bergen Burnout Inventory 18 [BBI-15]), perceived work ability, eating behavior (ecSatter 2.0, Three Factor Eating Questionnaire [TFEQ], and Binge Eating Scale [BES]), and physical activity (Baecke Habitual Physical Activity Questionnaire, BHPAQ). Results: We observed inconsistent fluctuations between the treatment arms in depression and burnout scores, indicating a lack of meaningful intervention effects despite statistical significance. Therefore, none of the treatment arms showed superiority over another. Across all participants, depression showed an estimated mean decrease of 2.5 BDI-21 points, with older participants experiencing a greater reduction in depressive symptoms. Furthermore, binge eating tendency decreased by 4.9 BES points during the 12-month intervention. We also observed increases in eating competence, controlled restraint, and physical activity. However, the 24-month measurements showed an adverse effect on eating competence, especially on attitudes toward eating and food, during the follow-up period without further support. Conclusions: Minimal enhancement through either group or individual video-conference meetings did not provide additional benefits in the mental health or eating habit domains compared with the eHealth intervention alone. Nevertheless, our results indicate that eHealth interventions for weight loss have the potential to reduce depression symptoms and binge-eating tendencies, while also improving eating competence and physical activity across the study population. Continued support may be necessary to sustain positive changes.

Background: Acceptance and commitment therapy provides a psychobehavioral framework feasible for digital and hybrid weight loss interventions. In face-to-face studies, group-based interventions yield more favorable outcomes than individual interventions, but the effect of the intervention form has not been studied in combination with eHealth. Objective: This study investigated whether a minimal, 3-session group or individual enhancement could provide additional benefits compared to an eHealth-only intervention when assessing weight, body composition, and laboratory metrics in a sample of occupational health patients with obesity. Methods: This study was a randomized controlled trial with a 12-month intervention, followed by a 12-month follow-up period without additional support (March 2021 to March 2023). Recruited from occupational health care for Finnish municipal employees, 111 working-age adults with a BMI of 30-40 kg/m2 were randomized to 1 of the 3 treatment arms: eHealth, eHealth+group, or eHealth+individual. All treatment arms received a web-administrated, coach-assisted eHealth program based on acceptance and commitment therapy, and additionally, the eHealth+group and eHealth+individual arms received 3 remotely facilitated group or individual meetings with their designated coach. The participants were assessed for weight, body composition, blood pressure, and laboratory measurements at 0-, 6-, 12-, and 24-month time points. Applying estimated means to decrease bias caused by dropouts, generalized estimating equations were used to study the differences between the 3 groups over time. Results: There were no between-group differences in primary measurements of weight change or categorical weight change. Secondary outcomes also did not show changes attributable to the intervention arm. Across the entire sample, the total weight loss was 1.5% during the intervention, with 18% (20/111) of the participants attaining a ≥5% weight loss. Sustained at follow-up, waist circumference decreased, and high-density lipoprotein cholesterol increased slightly. The participants completed, on average, 58.6% of the eHealth program. Conclusions: There were no differences in weight or other somatic health variables between the eHealth arm and intervention combining eHealth with minimal group or individual enhancement. Despite a modest overall weight loss, the intervention shows promise in improving body composition and metabolic health. Moving forward, further research is needed to determine if there is a threshold where face-to-face meetings provide additional benefits in hybrid interventions. Moreover, there is a need to explore for whom and under what conditions eHealth and hybrid models may be most effective. Trial Registration: ClinicalTrials.gov NCT04785586; https://clinicaltrials.gov/study/NCT04785586

BACKGROUND Mental health problems and adverse health behaviors are enriched in individuals with obesity, and need to be considered in weight-loss interventions. Regarding weight-loss, hybrid interventions combining digital and in-person elements have proven superior compared to eHealth-only interventions. However, it remains unclear whether a minimal group or individual enhancement could bring additional benefits to mental health and health behavior domains in individuals with obesity. OBJECTIVE The study explored whether minimal group or individual enhancements could offer additional benefits to an eHealth intervention, specifically in relation to mental health, perceived work ability, and health behavior. Additionally, the study sought to examine the overall effects of the health behavior-focused intervention, which combined ACT and behavioral components, across these domains. METHODS This study was a randomized controlled trial (RCT) with a 12-month intervention with selected variables followed for another 12-months without additional support. Recruited from occupational health care, 111 working-age adults with BMI 30–40 kg/m2 were randomized to one of the three treatment arms: eHealth, eHealth+Group, or eHealth+Individual. All treatment arms received a web-administrated, coach-assisted eHealth program based on ACT and, additionally, the eHealth+Group and eHealth+Individual arms received three remotely facilitated group or individual meetings. The participants were assessed for depression (BDI-21), burnout (BBI-18), perceived work ability, eating behavior (ecSatter2.0, TFEQ and BES) and physical activity (BPAQ). RESULTS Neither of the treatment arms showed superiority over another. Across all participants, depression showed an estimated mean decrease of 2.5 BDI-21-points, with older participants experiencing a greater reduction in depressive symptoms. Furthermore, there were increases in eating competence, controlled restraint and physical activity, and decreases in uncontrolled eating and binge eating tendency. However, the 24-month measurements showed an adverse effect in eating competence, especially in attitudes towards eating and food, during the follow-up without further support. CONCLUSIONS Minimal enhancement through either group or individual virtual meetings did not provide additional benefits in mental health or eating habit domains compared to the eHealth intervention alone. However, the eHealth intervention effectively reduced depression symptoms, uncontrolled eating, and binge eating tendencies, while also improving eating competence and physical activity across the study population. Future research should explore the effect of providing additional support during the follow-up period to sustain the positive outcomes achieved during the intervention. CLINICALTRIAL ClinicalTrials.gov Identifier: NCT04785586 (March 8, 2021) RR2-10.1016/j.conctc.2020.100638 INTERNATIONAL REGISTERED REPORT RR2-https://doi.org/10.1016/j.conctc.2020.100638

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Acceptance and commitment therapy provides a psychobehavioral framework feasible for digital and hybrid weight loss interventions. In face-to-face studies, group-based interventions yield more favorable outcomes than individual interventions, but the effect of the intervention form has not been studied in combination with eHealth. Objective: This study investigated whether a minimal, 3-session group or individual enhancement could provide additional benefits compared to an eHealth-only intervention when assessing weight, body composition, and laboratory metrics in a sample of occupational health patients with obesity. Methods: This study was a randomized controlled trial with a 12-month intervention, followed by a 12-month follow-up period without additional support (March 2021 to March 2023). Recruited from occupational health care for Finnish municipal employees, 111 working-age adults with a BMI of 30-40 kg/m² were randomized to 1 of the 3 treatment arms: eHealth, eHealth+group, or eHealth+individual. All treatment arms received a web-administrated, coach-assisted eHealth program based on acceptance and commitment therapy, and additionally, the eHealth+group and eHealth+individual arms received 3 remotely facilitated group or individual meetings with their designated coach. The participants were assessed for weight, body composition, blood pressure, and laboratory measurements at 0-, 6-, 12-, and 24-month time points. Applying estimated means to decrease bias caused by dropouts, generalized estimating equations were used to study the differences between the 3 groups over time. Results: There were no between-group differences in primary measurements of weight change or categorical weight change. Secondary outcomes also did not show changes attributable to the intervention arm. Across the entire sample, the total weight loss was 1.5% during the intervention, with 18% (20/111) of the participants attaining a ≥5% weight loss. Sustained at follow-up, waist circumference decreased, and high-density lipoprotein cholesterol increased slightly. The participants completed, on average, 58.6% of the eHealth program. Conclusions: There were no differences in weight or other somatic health variables between the eHealth arm and intervention combining eHealth with minimal group or individual enhancement. Despite a modest overall weight loss, the intervention shows promise in improving body composition and metabolic health. Moving forward, further research is needed to determine if there is a threshold where face-to-face meetings provide additional benefits in hybrid interventions. Moreover, there is a need to explore for whom and under what conditions eHealth and hybrid models may be most effective. Trial Registration: ClinicalTrials.gov NCT04785586; https://clinicaltrials.gov/study/NCT04785586