Pagoto Sherry L, Schroeder Matthew W, Xu Ran, Waring Molly E, Groshon Laurie, Goetz Jared M, Idiong Christie, Troy Haley, DiVito Joseph, Bannor Richard
Department of Allied Health Sciences, Institute for Collaboration in Health, Interventions, and Policy, University of Connecticut, Storrs, CT, United States.
JMIR Form Res. 2022 May 6;6(5):e33663. doi: 10.2196/33663.
Behavioral weight loss programs typically enroll 12-40 people into groups that then suffer from declining engagement over time. Web-based patient communities, on the other hand, typically offer no limits on capacity and membership is fluid. This model may be useful for boosting engagement in behavioral weight loss interventions, which could lead to better outcomes.
In this study, we aimed to examine the feasibility and acceptability of continuously enrolling participants into a Facebook-delivered weight loss intervention for the first 8 of 16 weeks relative to the same intervention where no new participants were enrolled after randomization.
We conducted a randomized pilot trial to compare a Facebook weight loss group that used open enrollment with a group that used closed enrollment on feasibility and acceptability in adults with BMI 27-45 kg/m. The feasibility outcomes included retention, engagement, and diet tracking adherence. We described the percentage loss of ≥5% weight in both groups as an exploratory outcome. We also explored the relationship between total volume of activity in the group and weight loss. The participants provided feedback via web-based surveys and focus groups.
Randomized participants (68/80, 85% women) were on average, aged 40.2 (SD 11.2) years with a mean BMI of 34.4 (SD 4.98) kg/m. We enrolled an additional 54 participants (50/54, 93% female) in the open enrollment condition between weeks 1 and 8, resulting in a total group size of 94. Retention was 88% and 98% under the open and closed conditions, respectively. Randomized participants across conditions did not differ in engagement (P=.72), or diet tracking adherence (P=.42). Participant feedback in both conditions revealed that sense of community was what they liked most about the program and not enough individualized feedback was what they liked the least. Weight loss of ≥5% was achieved by 30% (12/40) of the participants randomized to the open enrollment condition and 18% (7/40) of the participants in the closed enrollment condition. Exploratory analyses revealed that the open condition (median 385, IQR 228-536.5) had a greater volume of engagement than the closed condition (median 215, IQR 145.5-292; P=.007). Furthermore, an increase of 100 in the total volume of engagement in the Facebook group each week was associated with an additional 0.1% weekly weight loss among the randomized participants (P=.02), which was independent of time, individual participant engagement, and sociodemographic characteristics.
Open enrollment was as feasible and acceptable as closed enrollment. A greater volume of engagement in the Facebook group was associated with weight loss, suggesting that larger groups that produce more engagement overall may be beneficial. Future research should examine the efficacy of the open enrollment approach for weight loss in a fully powered randomized trial.
ClinicalTrials.gov NCT02656680; https://clinicaltrials.gov/ct2/show/NCT02656680.
行为减肥项目通常将12至40人编入小组，但随着时间推移，小组成员的参与度会下降。另一方面，基于网络的患者社区通常容量没有限制，成员流动性大。这种模式可能有助于提高行为减肥干预措施的参与度，从而产生更好的效果。
在本研究中，我们旨在检验在16周的前8周持续招募参与者加入通过脸书提供的减肥干预措施的可行性和可接受性，并将其与随机分组后不再招募新参与者的相同干预措施进行比较。
我们进行了一项随机试点试验，比较一个采用开放招募的脸书减肥小组和一个采用封闭招募的小组在BMI为27至45kg/m²的成年人中的可行性和可接受性。可行性结果包括留存率、参与度和饮食跟踪依从性。我们将两组中体重减轻≥5%的百分比作为探索性结果进行描述。我们还探讨了小组活动总量与体重减轻之间的关系。参与者通过网络调查和焦点小组提供反馈。
随机分组的参与者（68/80，85%为女性）平均年龄为40.2（标准差11.2）岁，平均BMI为34.4（标准差4.98）kg/m²。在第1周和第8周之间，我们在开放招募条件下额外招募了54名参与者（50/54，93%为女性），使总小组规模达到94人。开放和封闭条件下的留存率分别为88%和98%。不同条件下随机分组的参与者在参与度（P = 0.72）或饮食跟踪依从性（P = 0.42）方面没有差异。两种条件下参与者的反馈都表明，社区感是他们最喜欢该项目的地方，而个性化反馈不足是他们最不喜欢的地方。随机分配到开放招募条件的参与者中有30%（12/40）体重减轻≥5%，而在封闭招募条件下这一比例为18%（7/40）。探索性分析显示，开放条件下（中位数385，四分位间距228 - 536.5）的参与度高于封闭条件下（中位数215，四分位间距145.5 - 292；P = 0.007）。此外，脸书小组每周参与度总量每增加100，随机分组的参与者每周体重额外减轻0.1%（P = 0.02）,这与时间、个体参与者参与度及社会人口学特征无关。
开放招募与封闭招募一样可行且可接受。脸书小组中更高的参与度与体重减轻相关，这表明总体上能产生更多参与度的更大规模小组可能有益。未来研究应在一项充分有力的随机试验中检验开放招募方法对减肥的疗效。
ClinicalTrials.gov NCT02656680；https://clinicaltrials.gov/ct2/show/NCT02656680
