We are pleased to spotlight a new publication in Obesity Facts, the European Journal of Obesity, and are in conversation here with lead authors, Dr Julia Mueller and Dr Rebecca Richards.
The COVID-19 pandemic initiated requirements for physical distancing and sometimes isolation; this has had a significant impact on the physical and mental health and wellbeing among people with obesity.
At the same time, with the rise of digital interventions in health care delivery, there has been increasing interest in identifying effective alternatives to in-person interventions to support weight management and eating and physical activity behaviours. The need for alternate options for delivering health services to vulnerable people became stark during COVID-19. It will be great to learn more about SWiM-C.
Becky and Julia, please tell us a bit about yourselves.
Julia: Hi Sheree, thanks for your interest in our SWiM-C study. I’m a postdoctoral researcher at the MRC Epidemiology Unit, University of Cambridge. I currently lead the quantitative analysis on a research grant that focuses on developing and evaluating scalable behavioural weight management programmes for adults with overweight or obesity.
Becky: I’m Julia’s counterpart on the same grant, as I conduct the qualitative analysis to inform the process evaluations of our trials. I’m also a Practitioner Health Psychologist and was involved in the design and development of the SWiM-C programme.
SWiM-C is a guided self-help programme that was designed to support adults with overweight and obesity to prevent weight gain and support wellbeing during the pandemic. Please tell us more about the programme.
Becky: The SWiM-C programme is based on Acceptance and Commitment Therapy (ACT), which is a type of psychological therapy that helps people to accept and tolerate uncomfortable feelings, like food cravings or physical discomfort. This can help people to behave in ways that are more consistent with their goals and values. To reduce costs and make SWiM-C available to more people, it is delivered remotely. There are 12 weekly online sessions, which can be accessed via a Smartphone, tablet computer or laptop/pc, and contact with a non-specialist coach via telephone and email. The SWiM-C programme was actually adapted from a previous programme that we had developed (called SWiM; Supporting Weight Management) to support adults to maintain their weight loss, following completion of a behavioural weight loss programme. We’ve recently published a paper on the large body of work that fed into the development of this programme, so do read this if you would like further detail. We were about to evaluate SWiM when the pandemic hit. We were inspired by discussions with members of the European Collaboration for People with Obesity to adapt the intervention to support people with obesity during this difficult time.
What was the aim of the study and what research methods did you employ?
Julia: The aim of our study was to find out whether SWiM-C had effects on bodyweight, eating behaviour, physical activity and mental wellbeing compared with a control group. We randomly assigned 388 adults with overweight or obesity to either the SWiM-C programme or to a control group who received a leaflet designed by ECPO with information on diet and physical activity during the pandemic. Participants completed assessments online at the start of the study and after 4 months to see if there were any changes in weight, how people felt in themselves (their mental wellbeing), and other psychological factors related to changes in weight.
Please tell us a bit more about your research
Julia: Overall, we found some evidence that the SWiM-C programme has beneficial effects that could help people manage their weight better during situations like the COVID 19 pandemic involving high levels of stress, reduced access to resources, and/or low levels of mobility.
People lost 0.6kg more weight in the SWiM-C group than in the control group, but based on our statistical tests, we are not sure if this was due to SWiM-C or just random chance. SWiM-C led to improvements in several psychological factors that are determinants of successful weight management. These include reductions in “uncontrolled eating” (the extent to which people feel that they overeat and are not in control of their food intake) and increases in “cognitive restraint” (the extent to which people try to limit their food intake to control their weight). SWiM-C also improved “psychological flexibility”. This suggests that SWiM-C helped participants to relate flexibly to their internal experiences and regulate their behaviour. SWiM-C also had a protective effect on wellbeing during the pandemic – while wellbeing deteriorated in the control group, wellbeing in the SWiM-C group remained stable over the 4 months of follow up.
Improvements in these domains should, according to previous research, lead to better weight management. It is possible that these mechanisms take longer than four months to exert effects on body weight. It is also possible that ACT requires people to learn new skills and techniques, such as ‘cognitive defusion’, that require familiarisation, repeated practice and reflection. We have therefore also followed up our participants after 12 months and are working on analysing those data at the moment (so keep your eyes peeled for the findings!).
Based on these early-phase findings, we will now work to refine and improve the SWiM-C programme and conduct further studies to assess its potential for use in clinical practice.
What are the next steps for this interesting work?
Becky: As I mentioned earlier, we had adapted SWiM-C from our original SWiM programme, which aims to support adults to maintain weight loss following completion of a behavioural weight loss programme. We are now conducting a pilot randomised controlled trial of the original SWiM programme with 60 adults with overweight and obesity who have lost weight on a behavioural weight loss programme. We will use our learnings from this feasibility study and the SWiM-C trial to refine and improve the SWiM programme, with view to conducting a full randomised controlled trial of SWiM in future.