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

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Richards, R 
Jones, RA 
Woolston, J 

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 minimising 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 randomised adults (BMI≥25kg/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 randomisation stratifiers (BMI, sex). The trial was pre-registered (ISRCTN12107048). Results: 486 participants were assessed for eligibility; 388 participants were randomised (196 standard advice, 192 SWiM-C) and 324 were analysed. The adjusted difference in weight between SWiM-C and standard advice was -0.60kg (-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 to 7.75]), experiential avoidance (-3.39 [-5.55 to -1.23]), and wellbeing (0.13 [0.07 to 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.

Acceptance and Commitment Therapy, COVID-19, Obesity, Overweight, Acceptance and Commitment Therapy, Adult, COVID-19, Humans, Internet, Obesity, Overweight, Pandemics, Weight Gain
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Obesity Facts: the European journal of obesity
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S. Karger AG
Department of Health (via National Institute for Health Research (NIHR)) (RP-PG-0216-20010)
MRC (MC_UU_00006/6)
Medical Research Council (MC_UU_12015/4)
This work was supported by the Medical Research Council [grant number MC_UU_00006/6], National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (RP-PG-0216-20010), and by the European Association for the Study of Obesity (EASO). The views expressed are those of the author(s) and not necessarily those of EASO, the NIHR or the Department of Health and Social Care. The University of Cambridge has received salary support in respect of SJG from the NHS in the East of England through the Clinical Academic Reserve. The funder had no role in study design, collection, analysis, interpretation of data, or writing of the report.