Abstract
BACKGROUND: Mental health problems and adverse health behaviors are enriched in individuals with obesity and need to be considered in weight loss interventions. Regarding weight loss, hybrid interventions combining digital and in-person elements have proven superior to eHealth-only interventions. However, it remains unclear whether minimal group or individual enhancement could bring additional benefits to the mental health and health behavior domains in individuals with obesity. OBJECTIVE: This study aimed to explore whether minimal group or individual enhancements could offer additional benefits to an eHealth intervention in relation to mental health, perceived work ability, and health behavior in a sample of occupational health patients with obesity. In addition, the study sought to examine the overall effects of the health behavior-focused intervention across these domains. METHODS: This study was a randomized controlled trial with a 12-month intervention (March 2021-2022), with selected variables followed for another 12 months without additional support. Recruited from occupational health care, 111 working-age adults with BMI 30-40 kg/m2 were randomized to one of the 3 treatment arms, such as eHealth, eHealth+Group, or eHealth+Individual. All treatment arms received a web-administered, coach-assisted eHealth program based on acceptance and commitment therapy, and, in addition, the eHealth+Group and eHealth+Individual arms received 3 remotely facilitated group or individual meetings. The overall intervention effects were evaluated quasi-experimentally by combining the 3 treatment arms into a single eHealth arm. Participants were assessed for depression (the Beck Depression Index 21 [BDI-21]), burnout (Bergen Burnout Inventory 18 [BBI-15]), perceived work ability, eating behavior (ecSatter 2.0, Three Factor Eating Questionnaire [TFEQ], and Binge Eating Scale [BES]), and physical activity (Baecke Habitual Physical Activity Questionnaire, BHPAQ). RESULTS: We observed inconsistent fluctuations between the treatment arms in depression and burnout scores, indicating a lack of meaningful intervention effects despite statistical significance. Therefore, none of the treatment arms showed superiority over another. Across all participants, depression showed an estimated mean decrease of 2.5 BDI-21 points, with older participants experiencing a greater reduction in depressive symptoms. Furthermore, binge eating tendency decreased by 4.9 BES points during the 12-month intervention. We also observed increases in eating competence, controlled restraint, and physical activity. However, the 24-month measurements showed an adverse effect on eating competence, especially on attitudes toward eating and food, during the follow-up period without further support. CONCLUSIONS: Minimal enhancement through either group or individual video-conference meetings did not provide additional benefits in the mental health or eating habit domains compared with the eHealth intervention alone. Nevertheless, our results indicate that eHealth interventions for weight loss have the potential to reduce depression symptoms and binge-eating tendencies, while also improving eating competence and physical activity across the study population. Continued support may be necessary to sustain positive changes.