A significant proportion of the global population is obese, foreshadowing an epidemic of chronic disease. Self-monitoring (of diet, exercise, and body weight), decreasing energy intake, and increasing energy expenditure are robust predictors of successful weight loss. However, few individuals consistently practice these behaviors, making long-term weight loss and maintenance unlikely. Technologies afford unique opportunities to overcome barriers and increase the reach of traditional obesity interventions. In this article, we introduce ENGAGED, a technology-enhanced modification of the Diabetes Prevention Program designed to improve adherence to weight loss behaviors. Using a treatment implementation framework, we suggest how virtual reality technologies might further improve the delivery, receipt, and enactment of ENGAGED to maximize patient impact.
MokdadAHFordESBowmanBADietzWHVinicorFBalesVSMarksJS. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA.2003;289 (1): 76–9.
4.
PoirierPGilesTDBrayGAHongYSternJSPi-SunyerFXEckelRH. Obesity and cardiovascular disease: Pathophysiology, evaluation, and effect on weight loss. Atheroscler Thromb Vasc Biol.2006;26 (5): 968–76.
5.
AlhassanSKimSBersaminAKingACGardnerCD. Dietary adherence and weight loss success among overweight women: Results from the A to Z weight loss study. Int J Obes (Lond).2008;32 (6): 985–91.
6.
BakerRCKirschenbaumDS. Self-monitoring may be necessary for successful weight control. Behav Ther.1993;24: 377–94.
7.
WingRRHammanRFBrayGADelahantyLEdelsteinSLHillJOHortonESHoskinMAKriskaALachinJMayer-DavisEJPi-SunyerXRegensteinerJGVendittiBWylie-RosettJ, Diabetes Prevention Program Research Group. Achieving weight and activity goals among diabetes prevention program lifestyle participants. Obes Res.2004;12 (9): 1426–34.
8.
WingRRPhelanS. Long-term weight loss maintenance. Am J Clin Nutr.2005;82 (1 Suppl): 2225–55.
9.
BurkeLEDunbar-JacobJMHillMN. Compliance with cardiovascular disease prevention strategies: A review of the research. Ann Behav Med.1997;19 (3): 239–63.
10.
DiMatteoMRGiordaniPJLepperHSCroghanTW. Patient adherence outcomes: A meta-analysis. Med Care.2002;40 (9): 794–811.
11.
LewisLBSloaneDCNascimentoLMDiamantALGuinyardJJYanceyAKFlynnG, REACH Coalition of the African Americans Building a Legacy of Health Project. African Americans' access to healthy food options in South Los Angeles restaurants. Am J Public Health.2005;95 (4): 668–73.
12.
BurdetteHLWhitakerRC. Neighborhood playgrounds, fast food restaurants, and crime: Relationships to overweight in low-income preschool children. Prev Med.2004;38 (1): 57–63.
13.
BoutelleKNKirschenbaumDS. Further support for consistent self-monitoring as a vital component of successful weight control. Obes Res.1998;6 (3): 219–24.
14.
ButrynMLPhelanSHillJOWingRR. Consistent self-monitoring of weight: A key component of successful weight loss maintenance. Obesity (Silver Spring).2007;15 (12): 3091–6.
15.
WingRRTateDFGorinAARaynorHAFavaJL. A self-regulation program for maintenance of weight loss. N Engl J Med.2006;355 (15): 1563–71.
16.
StoneAAShiffmanSSchwartzJEBroderickJEHuffordMR. Patient compliance with paper and electronic diaries. Control Clin Trials.2003;24 (2): 182–99.
17.
WilliamsMVBakerDWHonigEGLeeTMNowlanA. Inadequate literacy is a barrier to asthma knowledge and self-care. Chest.1998;114 (4): 1008–15.
18.
Look AHEAD Research Group, Pi-Sunyer X, Blackburn G, Brancati FL, Bray GA, Bright R, Clark JM, Curtis JM, Espeland MA, Foreyt J P, Graves K, Haffner SM, Harrison B, Hill JO, Horton ES, Jakicic J, Jeffery RW, Johnson KC, Kahn S, Kelley DE, Kitabchi AE, Knowler WC, Lewis CE, Maschak-Carey BJ, Montgomery B, Nathan DM, Patricio J, Peters A, Redmon JB, Reeves RS, Ryan DH, Safford M, Van Dorsten B, Wadden TA, Wagenknecht L, Wesche-Thobaben J, Wing RR, Yanovski SZ. Reduction in weight in cardiovascular risk factors in individuals with type 2 diabetes: One-year results of the Look AHEAD trial. Diabetes Care.2007;30 (6): 1374–83.
19.
PerriMGNezuAMPattiETMcCannKL. Effect of length of treatment on weight loss. J Consult Clin Psychol.1989;57 (3): 450–2.
20.
LichsteinKLRiedelBWGrieveR. Fair tests of clinical trials: A treatment implementation model. Adv Behav Res Ther.1994;16 (1): 1–29.
21.
SpringBRoehrigMPagotoSMollerASnyderHMacTavishTRussellSSularzADuncanJ. Development of a theory-guided, mobile technology to enhance adherence and weight loss in obese patients: The ENGAGED study. Presented at: The mHealth Summit, November 2010. Washington DC: Foundation for the National Institutes of Health.
22.
SpringBRoehrigMMollerACoonsMJDuncanJ. Handheld technologies to improve adherence to diet and activity intervention. Ann Behav Med. Forthcoming 2011.
23.
CarverCSScheierMF. On the self-regulation of behavior. New York: Cambridge University Press; 1998.
24.
ChristakisNAflowlerJH. The spread of obesity in a large social network over 32 years. N Engl J Med.2007;357 (4): 370–9.
25.
KnowlerWCBarrett-ConnorEflowlerSEHammanRFLachinJMWalkerEANathanDM; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med.2002;346 (6): 393–403.
26.
SchultheisMTRizzoAA. The application of virtual reality technology in rehabilitation. Rehab Psych.2001;46 (3): 296–311.
27.
GerardiMCukorJDifedeJRizzoARothbaumBO. Virtual reality exposure therapy for post-traumatic stress disorder and other anxiety disorders. Curr Psychiatry Rep.2010;12 (4): 298–305.
28.
ParsonsTDRizzoAA. Affective outcomes of virtual reality exposure therapy for anxiety and specific phobias: A meta-analysis. J Behav Ther Exp Psychiatry.2008;39 (3): 250–61.
29.
ManzoniGMPagniniFGoriniAPreziosaACastelnuovoGMolinariERivaG. Can relaxation training reduce emotional eating in women with obesity? An exploratory study with 3 months of follow-up. J Am Diet Assoc.2009;109 (8): 1427–32.
30.
RivaGBacchettaMBaruffMMolinariE. Virtual reality-based multidimensional therapy for the treatment of body image disturbances in obesity: A controlled study. Cyberpsychol Behav.2001;4 (4): 511–26.
31.
RivaGBacchettaMCesaGContiSCastelnuovoGMontovaniFMolinariE. Is severe obesity a form of addiction? Rationale, clinical approach, and controlled clinical trial. Cyberpsychol Behav.2006;9 (4): 457–79.
32.
RivaGManzoniMVillaniDGaggioliAMolinariE. Why you really eat? Virtual reality in the treatment of obese emotional eaters. Stud Health Technol Inform.2008;132: 417–9.
33.
FoxJBailensonJN. Virtual self-modeling: The effects of vicarious reinforcement and identification on exercise behaviors. Media Psych.2009;12: 1–25.
34.
FoggBJ. Persuasive technology: Using computers to change what we think and do. San Francisco: Morgan Kaufmann; 2003.
35.
JackoJASearsAE, eds. The human-computer interaction handbook: Fundamentals, evolving technologies and emerging applications. Hillsale: Lawrence Erlbaum; 2003.
36.
StrecherVWangCDerryHWildenhausKJohnsonC. Tailored interventions for multiple risk behaviors. Health Educ Res.2002;17 (5): 619–26.
37.
RivaGWaterworthJAWaterworthELMantovaniF. From intention to action: The role of presence. New Ideas Psychol.2009;29 (1): 24–37.
38.
JacobRGirouardAHirshfeldLHornMShaerOSoloveyEZigelbaumJ. Reality-based interaction: A framework for post-WIMP interfaces. CHI '08: Proceedings of the Twenty-Sixth Annual SIGCHI Conference on Human Factors in Computing Systems. Florence: ACM; 2008.
39.
Falk-KrzesinskiHJBörnerBContractorNFioreSMHallKLKeytonJSpringBStokolsDTrochimWUzziB. Advancing the science of team science. Clin Transl Sci.2010;3 (5): 263–6.
40.
StokolsDHallKLTaylorBKMoserRP. The science of team science: Overview of the field and introduction to the supplement. Am J Prev Med.2008;35 (2 Suppl): S77–89.
