Get ‘em while they’re young! Combatting the obesity epidemic with e-Health
By Emma Norris, on 2 July 2019
By Taylor Willmott – Griffith University, Australia
We are most likely to gain weight during our early twenties to mid-thirties, with incident obesity associated with chronic disease and mortality in later adult life. Young adults with increasing body mass index (BMI) are twenty times more likely to develop metabolic syndrome over the subsequent 15 years of life. Young adults who can maintain a stable BMI over time have minimal progression of risk factors and lower incidence of metabolic syndrome. Identifying strategies that can support young adults in adopting a healthier lifestyle and maintaining a healthy weight over the long term is critical to the prevention of future incident obesity and associated conditions. Given the current generation of young adults are among the highest users of digital technologies, an eHealth-based approach offers potential for engaging large numbers of young adults in weight management. To explore this further, we sought to gather all of the available evidence on eHealth weight management interventions targeting young adults.
Five strategies to prevent weight gain in young adults
We screened over 1301 peer reviewed articles locating 24 weight management interventions delivered via eHealth and targeting young adults aged 18-35 years. Among the eight studies reporting positive weight-related outcomes, we were able to identify five strategies that can be applied in future programs to help young adults manage their weight.
(1) Goal setting and self-monitoring (self-regulation)
In our review, all studies reporting positive weight-related outcomes implemented some form of self-monitoring. For example, the HEYMAN intervention used a wearable physical activity tracker with an associated mobile phone app to assist participants in goal setting and self-monitoring. Most weight management interventions promote goal setting along with some form of self-monitoring. Typically, this involves participants recording their dietary and physical activity behaviours (and weight) and reviewing their performance in line with their previously set goals to evaluate progress. Self-monitoring and goal setting are fundamental for well-developed self-regulation skills. The idea behind self-regulation is that monitoring of one’s behaviour will lead to self-evaluation of progress made toward previously set goals with the resulting reinforcement (positive or negative) directing future behavioural performance. The use of technology can lessen the effort and time required for goal setting and self-monitoring and increase adherence. Given the perceived lack of time among young adults and a lack of adequate self-regulation skills, future programs should focus on developing goal setting and self-monitoring skills.
(2) Tailoring delivery of intervention content
Tailoring involves gathering and assessing personal data to devise a strategy that meets the specific needs of an individual. Tailored content and messages command greater attention, are processed more deeply by recipients, and are perceived as more likable than a generic message. With ready access to data provision and retrieval, the internet provides a powerful tool for tailoring weight management interventions. Tailoring can range from simple Web-based assessments and feedback to highly sophisticated interventions that are completely customised to each individual participant. Most of the studies in our review employed only simple forms of tailoring. The TXT2BFiT intervention included a more sophisticated level of tailoring with a staging algorithm used to generate a personalised set of SMS text messages that were tailored to whether a participant was in precontemplation, contemplation, preparation, action, or maintenance stages of change. Future programs should experiment with more sophisticated forms of tailoring to promote adherence and in turn effectiveness.
(3) Contact with a trained coach or interventionist
Support from a trained coach or interventionist who is seen as trustworthy, benevolent, and having expertise can enhance intervention outcomes. In our review, coaching calls, emails, chat forums, and social network sites were identified as potentially cost-effective means of delivering expert support at scale. For example, the TXT2BFiT intervention included five coaching calls led by a dietician skilled in motivational interviewing. Future programs should consider the potential benefits and disadvantages of different communication mediums for engaging young adults and delivering expert support at scale.
(4) Social support
In our review, three out of the eight studies reporting positive weight-related outcomes included social support. Social support was typically delivered via online chat forums or social network sites. For example, the CHOICES intervention created a study specific social network site to encourage discussion and interaction among participants. Similarly, the HEYMAN intervention used a combination of in-person (via group-based sessions) and Web-based (via a private Facebook group) social support to facilitate interaction among participants. With access to large existing (or new) networks of influencers, social networking sites provide an ideal platform for facilitating social support. Given there is evidence to suggest that social contacts and normative beliefs influence weight status and intentions for weight control in young adults, the facilitation of social support should be a key consideration in future programs.
(5) Behavioural prompts (nudges and reminders) and booster messages
Technology offers a feasible means of delivering strategies that promote behavioural maintenance; however, few interventions in our review incorporated behavioural prompts and/or booster messages. For example, the TXT2BFiT intervention reported positive weight-related outcomes and incorporated both behavioural prompts and booster messages. A low dose maintenance phase which included monthly SMS text messages, emails, and booster coaching calls was delivered after the initial 12-week intervention to promote behavioural maintenance and sustain outcomes. Given weight management requires healthy lifestyle choices to be made consistently over the long term, future programs should include both behavioural prompts and booster messages to support behavioural maintenance and ensure outcomes are sustained over the long term.
Where to from here?
eHealth offers a cost-effective and scalable means of engaging young adults in weight management. Findings from our review indicate that programs incorporating a combination of self-regulation skill development, tailored intervention content, contact with a trained interventionist, social support, and behavioural prompts and booster messages are likely to be more effective than programs not employing these strategies. If we can successfully “get ‘em while they’re young,” we can prevent excess weight gain in young adulthood and lower the risk of chronic disease in later adult life, thereby lessening the health burden on both the individual and society.
Read the full paper here.
Taylor Willmott is a final year PhD candidate at Social Marketing @ Griffith, Griffith University. Taylor has held various research and teaching roles across leading higher education institutions in Australia including Queensland University of Technology, Griffith University, and the University of Queensland. The broad focus of Taylor’s research lies in applying marketing principles and techniques, combined with other evidence-based approaches, to create innovative behaviour change programs that benefit both individuals and society. Taylor’s research is multi-award winning, has been presented at world-renowned conferences, and published in top-tier academic journals such as the Journal of Marketing Management, International Journal of Consumer Studies, Health Education & Behavior, Health Psychology Review, and the Journal of Medical Internet Research.
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