eHealth for health behavior change: Design, evaluation and implementation of a digital self-management intervention for weight loss maintenance in adults living with obesity

Successful weight loss maintenance is challenging. Even though weight loss can be obtained through effective interventions, few people living with obesity are able to maintain the new weight after weight loss. With the rapid increase in the prevalence of obesity, there is an urgent need for innovative approaches to support individuals living with obesity to maintain weight after weight loss.
Digital technologies, also called eHealth, are promising in optimizing and improving health outcomes and healthcare delivery through supporting self-management and inducing relief for healthcare systems. eHealth interventions also have the potential to support individual needs for sustained lifestyle and behavior change and might be a “missing link” to facilitate weight loss maintenance long-term. This thesis therefore aimed to explore how an eHealth-based intervention can facilitate weight maintenance after weight loss in adults living with obesity.
Several studies were performed (e.g., a scoping review, interviews, focus groups, co-design, prototyping, feasibility pilot study) to investigate how evidence-informed eHealth interventions can support weight loss maintenance. A systematic, iterative and holistic approach, guided by the CeHRes Roadmap and the Double Diamond, led to the design, development, feasibility testing and technology transfer of an app-based self-management intervention called eCHANGE. Multiple methods, frameworks, theories and models were combined, resulting in a novel approach to design, evaluation and implementation of a digital self-management intervention for weight loss maintenance.
This thesis identified values and needs of adults living with obesity aiming to maintain weight after weight loss, as well as persuasive system design (PSD) principles and behavior change techniques (BCTs) matching the identified values and needs. The thesis also shows how eHealth interventions, combining PSD principles and BCTs, can support self-management and maintenance of health behaviors to prevent weight regain. Findings indicate that a shift in focus from weight to improvement of health and wellbeing might be required as a motivator for change, and points to the potential of eHealth interventions to improve outreach and support weight loss maintenance long-term.

This thesis can inspire future research and development of personalized, evidence-informed eHealth-based interventions aiming to support self-management and health behavior change to maintain weight, improve health and healthcare.