Supporting Weight Management during COVID-19 (SWiM-C): twelve-month follow-up of a randomised controlled trial of a web-based, ACT-based, guided self-help intervention.

OBJECTIVES: We developed a guided self-help intervention (Supporting Weight Management during COVID-19, "SWiM-C") to support adults with overweight or obesity in their weight management during the COVID-19 pandemic. This parallel, two-group trial (ISRCTN12107048) evaluated the effect of SWiM-C on weight and determinants of weight management over twelve months. METHODS: Participants (≥18 years, body-mass-index ≥25 kg/m2) were randomised to the SWiM-C intervention or to a standard advice group (unblinded). Participants completed online questionnaires at baseline, four months, and twelve months. The primary outcome was change in self-reported weight from baseline to twelve months; secondary outcomes were eating behaviour (uncontrolled eating, emotional eating, cognitive restraint of food intake), experiential avoidance, depression, anxiety, stress, wellbeing and physical activity. INTERVENTIONS: SWiM-C is based on acceptance and commitment therapy (ACT). Participants had access to an online web platform with 12 weekly modules and email and telephone contact with a trained, non-specialist coach. Standard advice was a leaflet on managing weight and mood during the COVID-19 pandemic. RESULTS: 388 participants were randomised (SWiM-C: n = 192, standard advice: n = 196). The baseline-adjusted difference in weight change between SWiM-C (n = 119) and standard advice (n = 147) was -0.81 kg (95% CI: -2.24 to 0.61 kg). SWiM-C participants reported a reduction in experiential avoidance (-2.45 [scale:10-70], 95% CI: -4.75 to -0.15), uncontrolled eating (-3.36 [scale: 0-100], 95% CI: -5.66 to -1.06), and emotional eating (-4.14 [scale:0-100], 95% CI: -7.25 to -1.02) and an increase in physical activity (8.96 [MET-min/week], 95% CI: 0.29 to 17.62) compared to standard advice participants. We found no evidence of an effect on remaining outcomes. No adverse events/side effects were reported. CONCLUSIONS: Whilst we were unable to conclude that the intervention had an effect on weight, SWiM-C improved eating behaviours, experiential avoidance and physical activity. Further refinement of the intervention is necessary to ensure meaningful effects on weight prior to implementation in practice. TRIAL REGISTRATION NUMBER: ISRCTN 12107048.

Supporting Weight Management During COVID (SWiM-C): A Randomized Trial of an ACT-Based Intervention

Background: We developed a web-based, acceptance-based, guided self-help intervention (Supporting Weight Management during COVID-19, "SWiM-C") which aimed to support adults with over-weight or obesity in their weight management and emotional well-being during the COVID-19 pandemic. This study evaluates the effect of SWiM-C on weight and determinants of weight over twelve months. Methods: We randomized 388 participants (>18 years, BMI >25kg/m2) to the SWiM-C intervention (n=192) or a control group (n=196). SWiM-C is based on acceptance and commitment therapy (ACT) and is delivered remotely via an online web platform (12 weekly modules) and contact via telephone and email with a trained, non-specialist coach. The control group received a leaflet on weight management and wellbeing during the pandemic. Participants completed online questionnaires at baseline, 4 months, and 12 months. The primary outcome was change in self-reported weight from baseline to 12 months;secondary outcomes were eating behavior, experiential avoidance, mental health, wellbeing and physical activity. Results: At 12 months, the adjusted difference in weight between SWiM-C and control group participants was -0.81kg (95% CI: -2.24 to 0.61kg). SWiM-C participants reported a greater reduction in experiential avoidance (-2.45, 95% CI: -4.75 to -0.15), uncontrolled eating (-3.36, 95% CI: -5.66 to -1.06), and emotional eating (-4.14, 95% CI: -7.25 to -1.02), and an increase in physical activity (8.96, 95% CI: 0.29 to 17.62) compared to the control group. No differences in mental health or wellbeing were observed at 12 months. Conclusions: Whilst the effect of the SWiM-C intervention on weight was inconclusive, SWiM-C improved eating behaviors, physical activity and psychological flexibility. These variables have been previously identified as determinants of successful weight management. Further refinement of the intervention is necessary to ensure meaningful effects on weight prior to implementation in practice. By being remotely delivered using non-specialists, SWiM-C enhances scalability and population reach while minimizing cost.

The Relationship Between Mental Health and Weight During the COVID-19 Pandemic: A Longitudinal Study

Background: Depression and anxiety have consistently been associated with obesity in observational studies. However, most studies make between-individual comparisons, which can mask important relationships. Less is known about within-individual associations. To address these limitations, we assessed longitudinal associations of depression, anxiety, and stress scores with self-reported body weight in a large sample at the within- and between-individual level during the COVID-19 pandemic. Methods: Participants from a sub-study of a population-based cohort of UK adults completed monthly mental health and body weight measurements (08/2020-04/2021). We used random intercepts regression models to examine longitudinal associations of depression, anxiety and stress with weight. In sub-group analyses, we included interaction terms of mental health variables with baseline characteristics (age, sex, BMI, education, occupation). Results: In 2133 participants, within-individual variation in depressive symptoms was associated with subsequent weight (0.045kg weight per unit of depression severity, 95% CI 0.021 to 0.069), but we did not find evidence for associations in between-individual analysis, or in analyses of stress and anxiety. In subgroup analyses, we found evidence of a dose-dependent moderation effect of baseline BMI on the within-individual association between depressive symptoms and subsequent weight (baseline BMI 25-29.9 kg/m2: 0.052kg weight per unit of depression severity, 95% CI 0.010-0.094kg;baseline BMI>30 kg/m2: 0.071kg weight per unit of depression severity, 95% CI 0.013-0.129kg). We did not find evidence for reverse causality. Conclusions: In this study, individuals with overweight or obesity were more vulnerable to weight gain following higher-than-usual (for that individual) depressive symptoms than individuals with a healthy BMI. Although causality cannot be inferred, our analysis meets the Bradford-Hill criteria of biological gradient and temporality. Our results suggest that targeting depressive symptoms in individuals with overweight may aid weight management strategies.

Participants' experiences of mental health during a COVID-19 tailored ACT-based behavioural weight management intervention: a qualitative study.

PURPOSE: We aimed to explore participants' experiences of mental health during an acceptance and commitment therapy (ACT)-based guided self-help intervention to support weight management in adults with overweight or obesity during the COVID-19 pandemic (SWiM-C: Supporting Weight Management during COVID-19). METHODS: We conducted semi-structured telephone interviews with twenty participants and used reflexive thematic analysis to identify patterns of meaning across the dataset relevant to mental health. RESULTS: Four themes were conceptualized: i) Mental health changes associated with SWiM-C, ii) External factors negatively impacted mental health and intervention engagement, iii) Use and impact of coping responses, and iv) Intervention preferences based on psychological needs. CONCLUSIONS: Findings suggest that participants were exposed to multiple factors, both related to and external to the intervention, that negatively impact their mental health, yet ACT-based aspects of the SWiM-C intervention appeared to support participants to adaptively manage the decline in their mental health. The findings can be used to inform the development of future weight management interventions, such as through intervention personalization and the inclusion of more strategies that target emotional regulation.Trial registration: ISRCTN 12107048, https://www.isrctn.com/ISRCTN12107048.

Perceived weight-related stigma, loneliness, and mental wellbeing during COVID-19 in people with obesity: A cross-sectional study from ten European countries.

BACKGROUND: Increased weight-related stigma during the COVID-19 pandemic has amplified the need to minimise the impacts on mental wellbeing. We investigated the relationship between the perceived changes in the representation of obesity in the media and mental wellbeing during the pandemic in a sample of people with obesity across 10 European countries. We also investigated the potential moderating effect of loneliness. METHODS: Between September to December 2020 during the COVID-19 pandemic, participants reported data on demographics, mental wellbeing (measured by World Health Organisation Five Wellbeing Index and Patient Health Questionaire-4), loneliness (measured by De Jong Gierveld short scale), and perceived change in the representation of obesity in media (measured by a study-specific question) using the online, cross-sectional EURopean Obesity PatiEnt pANdemic Survey (EUROPEANS). Data were analysed using linear mixed-effects models, controlling for age, gender, body mass index, and shielding status, with random incept for country. RESULTS: The survey was completed by 2882 respondents. Most identified as female (56%) and reported their ethnicity as White or White-mix (92%). The total sample had a mean age of 41 years and a BMI of 35.4 kg/m2. During the peak of the pandemic, compared to pre-pandemic, perceiving more negative representation of people with obesity on social media was associated with worse psychological distress, depression, and wellbeing. Perceiving more positive representation, compared to no change in representation, of people with obesity on television was associated with greater wellbeing, yet also higher psychological distress and anxiety. Loneliness, as a moderator, explained ≤0.3% of the variance in outcomes in any of the models. CONCLUSIONS: Perceiving negative representation of obesity on social media was associated with poorer mental wellbeing outcomes during the pandemic; positive representation on television was associated with both positive and negative mental wellbeing outcomes. We encourage greater media accountability when representing people with obesity.

Supporting Weight Management during COVID-19: A Randomized Controlled Trial of a Web-Based, ACT-Based, Guided Self-Help Intervention.

INTRODUCTION: Adults with overweight and obesity are vulnerable to weight gain and mental health deterioration during the COVID-19 pandemic. We developed a web-based, guided self-help intervention based on Acceptance and Commitment Therapy (ACT) that aims to support adults with overweight and obesity to prevent weight gain by helping them to manage their eating behaviours, be more physically active, and protect their emotional wellbeing ("SWiM-C"). SWiM-C is a guided self-help programme using non-specialist guides to enhance scalability and population reach while minimizing cost. This study evaluated the effect of SWiM-C on bodyweight, eating behaviour, physical activity, and mental wellbeing in adults with overweight and obesity over 4 months during the COVID-19 pandemic in the UK. METHODS: We randomized adults (BMI ≥25 kg/m2) to SWiM-C or to a wait-list standard advice group. Participants completed outcome assessments online at baseline and 4 months. The primary outcome was self-measured weight; secondary outcomes were eating behaviour, physical activity, experiential avoidance/psychological flexibility, depression, anxiety, stress, and wellbeing. We estimated differences between study groups in change in outcomes from baseline to 4 months using linear regression, adjusted for outcome at baseline and the randomization stratifiers (BMI, sex). The trial was pre-registered (ISRCTN12107048). RESULTS: 486 participants were assessed for eligibility; 388 participants were randomized (196 standard advice, 192 SWiM-C), and 324 were analysed. The adjusted difference in weight between SWiM-C and standard advice was -0.60 kg (-1.67 to 0.47, p = 0.27). SWiM-C led to improvements in uncontrolled eating (-3.61 [-5.94 to -1.28]), cognitive restraint (5.28 [2.81-7.75]), experiential avoidance (-3.39 [-5.55 to -1.23]), and wellbeing (0.13 [0.07-0.18]). CONCLUSIONS: SWiM-C improved several psychological determinants of successful weight management and had a protective effect on wellbeing during the pandemic. However, differences in weight and some other outcomes were compatible with no effect of the intervention, suggesting further refinement of the intervention is needed.

Effects of a group-based weight management programme on anxiety and depression: A randomised controlled trial (RCT).

OBJECTIVES: The aim was to investigate the impact of a group-based weight management programme on symptoms of depression and anxiety compared with self-help in a randomised controlled trial (RCT). METHOD: People with overweight (Body Mass Index [BMI]≥28kg/m2) were randomly allocated self-help (n = 211) or a group-based weight management programme for 12 weeks (n = 528) or 52 weeks (n = 528) between 18/10/2012 and 10/02/2014. Symptoms were assessed using the Hospital Anxiety and Depression Scale, at baseline, 3, 12 and 24 months. Linear regression modelling examined changes in Hospital Anxiety and Depression Scale between trial arms. RESULTS: At 3 months, there was a -0.6 point difference (95% confidence interval [CI], -1.1, -0.1) in depression score and -0.1 difference (95% CI, -0.7, 0.4) in anxiety score between group-based weight management programme and self-help. At subsequent time points there was no consistent evidence of a difference in depression or anxiety scores between trial arms. There was no evidence that depression or anxiety worsened at any time point. CONCLUSIONS: There was no evidence of harm to depression or anxiety symptoms as a result of attending a group-based weight loss programme. There was a transient reduction in symptoms of depression, but not anxiety, compared to self-help. This effect equates to less than 1 point out of 21 on the Hospital Anxiety and Depression Scale and is not clinically significant.