Effectiveness of web-based feedback interventions for people with overweight and obesity: systematic review and network meta-analysis of randomized controlled trials

Abstract

BACKGROUND Web-based delivered interventions have become an innovative option to treat health problems, like obesity. The aim of this systematic review and network meta-analysis was to analyze the effectiveness of web-based behavioral treatments for adults with overweight and obesity. Web-based interventions and comparison interventions (traditional weight control programs) were classified according to the following feedback characteristics: frequency, personalization, and provider (human versus machine). METHOD From the initial 1789 studies, 15 were included in this review. A network meta-analysis was conducted to analyze the efficacy of web-based programs with traditional interventions, considering direct and indirect comparisons. The main outcome was the weight loss mean difference (kg) between baseline and post-treatment. Heterogeneity and consistency assumptions were validated to conduct the network meta-analysis. RESULTS Network meta-analysis showed comparisons between different treatment options. The main results were that Intensive Contact Web-based programs were more effective than wait-list (Mean Difference - 1.86 kg; 95% Confidence Interval: - 3.61, - 0.12). Moreover, Intensive Contact Web-based programs were more effective than the other web-based options and self-help traditional interventions. However, the only significant comparison was Intensive Contact Web-based programs versus Guided Self-Help Web-based programs (Mean Difference - 4.31 kg; 95% Confidence Interval: - 5,22, - 3,41). Intensive Contact Web-based programs were the most effective treatment option according the obtained results, achieving the first place in the ranking provided by the network meta-analysis with 98.5% of probabilities. CONCLUSIONS Intensive Contact Web-based interventions have obtained the first position in the ranking, proving the relevance of frequent, personalized, and professional feedback and their association with a better prognosis for people with overweight and obesity. These results provide relevant information to design more effective treatments for people with overweight and obesity, in a new format especially appropriate for the current situation. The number of people with overweight and obesity has tripled worldwide since 1975. Obesity has become a serious problem for public health. For that reason, the design of innovative treatments for people with overweight and obesity is an urgent need. This systematic review and network meta-analysis assesses the effectiveness of innovative interventions, concretely web-based programs for overweight and obesity, comparing them with traditional behavioral treatments and wait-list groups. Both web-based and traditional behavioral treatments were classified according to three feedback characteristics: personalization, frequency, and provider (human versus machine). The literature has suggested that a frequent feedback is an indicator of good prognosis in traditional interventions. The results of this study showed that for web-based interventions, an intensive and personalized feedback provided by a healthcare professional was the treatment option that led to a better prognosis. The second and third option were web-based guided self-hep programs and traditional self-help programs. These interventions empowered the participants, providing more sense of self-efficacy. Web-based minimal-contact programs, web-based self-help programs and wait-list were the last options. An accurate ranking of available treatment options only can be provided by a network meta-analysis, the statistic technique used in this study.