Weight Reduction Interventions Using Digital Health for Employees with Obesity: A Systematic Review

Figures & data

Figure 1 PRISMA Flow Diagram for Systematic Review.

Notes: PRISMA figure adapted from Moher D, Liberati A, Altman D, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Journal of clinical epidemiology. 2009;62(10). Creative Commons.²⁴

Figure 2 Risk of Bias Results of the Included Studies.

Table 1 Characteristics of the Included Studies

Author (Year)	Country	Population	Interventions	Results
		Characteristics Mean Age Sample Size	Contents Theoretical Background Intervention Length	Outcome Variables Follow Up Major Results
Abdi et al (2015)^Citation29	Iran	Governmental Employees with obesity Web = 42.5 years, Telephone = 41.1 years IG: Web = 135, Telephone = 135, CG: 135	Nutrition, Physical activity, Behavioral change, Incentive Social cognitive theory 6m	BW, WC, BP, Physical activity, Nutrition Baseline, 12m, 15m A weight reduction of 1.92 in the telephone-assisted intervention groups (p<0.001) and 1.08 kg in the web-assisted intervention groups(p<0.001)
Almeida et al (2015)^Citation38	USA	Employees with obesity in multiple industries 46.9 years IG: 789, CG: 1001	Nutrition, Physical activity, Incentive Social cognitive theory 12m	BW, BMI, Physical activity behavior, Dietary behavior Baseline, 18m All groups reduced weight and BMI (p<0.001), but without significant difference between groups.
Balk-Moller et al (2017)^Citation39	Denmark	Employees with obesity in Social Welfare Sector 47 years IG: 355, CG: 211	Nutrition, Physical activity, Behavioral change N/A 16wk	BW, WC, BMI, BP, Total cholesterol Baseline, 16wk, 38wk IG lost more weight than CG (−1.01 kg, p=0.03)
Carnie et al (2013)^Citation30	USA	Female employees with overweight 47 years IG: 99, CG: 100	Nutrition, Physical activity, Incentive N/A 6m	BW, WC, HC, BMI, Glucose, Insulin, Lipid, Total fat mass, Percent truncal fat, Exercise performance, peak VO2, Insulin sensitivity, Pedometer Baseline, 3m, 6m IG lost more weight than CG at 3 months (−2.2±2.8 vs −1.0±3.0 kg, p<0.001). Weight reduction at 6 months was significant in both IG and CG, but without significant difference between groups
Day et al (2019)^Citation31	USA	Employees with overweight or obesity 37.1 years IG: 221, CG: 200	Nutrition, Physical activity, Behavioral change N/A 6m	BW, BMI, Intent to treat Baseline, 6m A weight reduction from 1.04 to 1.41 kg in IG, and an weight gain in CG
Kempf et al (2019)^Citation32	Germany	Employees with obesity in Pharmaceutical company 51 years IG: 34, CG 1: 34, CG 2: 36	Nutrition, Physical activity, Behavioral change, Motivation N/A 12m	BW, BMI, WC, BP, Triglyceride, HbA1c, Fast blood glucose, Adiponectin, C-reactive protein, Eating behavior, Physical activity, Quality of life Baseline, 3m, 6m, 9m, 12m, 36m All groups reduced weight after 12 months (all p<0.01) and sustained it during the 36 months follow-up (all p<0.01), without significant difference between groups.
Ozaki et al (2018)^Citation33	Japan	Employees with obesity in multiple industries 34.2 years IG: Standard = 24, Enhanced = 25, CG: 22	Nutrition, Physical activity, Behavioral change N/A 12wk	BW, WC, BMI, Physical activity, Energy intake, Diet History Questionnaire, Self-efficacy, Perceived health competence scale Baseline, 12wk Enhanced IG lost more weight than standard IG and CG (p<0.001), and standard IG lost more weight than CG (p=0.033)
Petersen et al (2008)^Citation34	USA	Employees with obesity in multiple healthcare center N/A IG: 7743, CG 1: 128, CG 2: 188	Nutrition, Physical activity, Behavioral change, Motivation N/A At least 18wk	BW, BMI, Health risk behavior (Smoking, Physical inactivity, high stress, high cholesterol), Eating habit Baseline, 6m, 12m The percentage of participants in the normal weight category had increased from 27.0% to 29.8% (p< 0.05). Increased website usage was associated with increased weight reduction and stage of change improvements.
Pressler et al (2010)^Citation35	Germany	Employees with obesity in Automobile Manufacturer N/A(Median age 48 years) IG: 84, CG: 56	Physical activity N/A 12wk	BW, WC, BMI, Body fat composition, BP, HDL, Triglycerides, FBG, peak VO2, Peak ergometer performance (Pmax/Kg), Heart rate during ergometry, Acceptance of the intervention questionnaire Baseline, 12wk Weight reduction at 12 weeks was significant in both IG and CG, but without significant difference between groups
Sakane et al (2013)^Citation36	Japan	Employees with obesity in multiple healthcare center N/A IG: Web+Visceral fat measurement = 88, Web = 95, CG: 68	Nutrition, Physical activity Social cognitive theory 12wk	BW, BMI, WC, Assessment of Lifestyle improvement Baseline, 12wk Reduction of weight, waist circumference, and BMI and improvements of health behaviors were the largest in Web and Visceral fat measurement group, with the significant differences between groups.
Van Wier et al (2012)^Citation37	Netherlands	Employees with obesity in multiple industries 43.3 years IG: Phone = 462, Internet 464, CG: 460	Nutrition, Physical activity, Behavioral change Social cognitive theory 6m	BW, WC, Dietary intake, Physical activity Baseline, 24m Weight reduction at 24 months was significant in both IG and CG, but without significant difference between groups

Abbreviations: IG, intervention group; CG, comparison group; wk, week; m, month; BW, body weight; WC, waist circumference; BP, blood pressure; BMI, body mass index; HC, hip circumference; HDL, high-density lipoprotein; FBG, fasting blood glucose.

Table 2 Use of Digital Health

Author (Year)	Delivering Method				Intervention Strategies
	E-mail	Website	Mobile App	Tele-Monitoring Device	Tele-Counseling	Patient-Tailored Advice	Telemonitoring of Patient’s Generated Health Related Data	Providing Online Resources	Online Social Support
Abdi et al (2015)^Citation29		√			√			√	√
Almeida et al (2015)^Citation38	√				√	√		√
Balk-Moller et al (2017)^Citation39		√	√		√	√	√	√	√
Carnie et al (2013)^Citation30		√				√	√
Day et al (2019)^Citation31		√			√	√	√	√
Kempf et al (2019)^Citation32				√	√		√	√
Ozaki et al (2018)^Citation33		√				√	√	√	√
Petersen et al (2008)^Citation34		√			√	√	√	√	√
Pressler et al (2010)^Citation35		√				√	√	√
Sakane et al (2013)^Citation36		√			√	√		√
Van Wier et al (2012)^Citation37		√			√	√		√

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