A randomised controlled trial to investigate the feasibility and acceptability of a small change approach to prevent weight gain.

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• A key take home message is that through small changes it is possible to prevent weight gain, which could be seen as a more attainable and positive goal than focussing on weight loss.
• Often individuals find it hard to make changes on their own, since this study was delivered remotely it could help to encourage people wanting to improve their health to use online resources and apps for motivation and guidance.

Introduction

• To explore strategies for addressing the global obesity crisis, this feasibility trial aimed to determine whether small, incremental reductions in calorie intake alongside gentle increases in energy expenditure, could promote weight loss over time.
• Unlike earlier studies, this approach was intentionally designed without post-intervention support to assess whether participants could achieve weight loss independently.
• If successful, this would demonstrate the potential for the method to be implemented effectively in broader public health initiatives.

Methods

• The study was a randomised controlled trial. Participants were aged ≥ 18 with a Body Mass Index between 20 and 30kg/m2.
• The intervention lasted 12 weeks and participants were encouraged to make 1 small change each day to decrease calorie intake or increase energy expenditure by 100-200 kcal a day.
• The program was delivered remotely with an initial 10-minute video followed by 33 texts over the period – encouraging self-regulation, being motivational or collecting adherence data.
• A total of 122 participants were recruited, with 80 randomly assigned to the intervention group and 42 to the control group

Results

• The primary feasibility and acceptability outcomes, assessed by recruitment (122), retention (91%) and adherence (<60%) showed that intervention is feasible and acceptable.
• One primary outcome of the study was that 62% of the intervention group reported the small change approach as helpful.
• The intervention group lost significantly more weight than the control group- 1.1kg (95% CI: -1.7 to -0.4).
• The intervention group had favourable mean difference scores for cognitive restraint of eating (1.6, 95% CI: 0.5 – 2.8) and self-regulation (5.0, 95% CI: 0.8 – 9.3).
• Self-efficacy for dietary behaviour and physical activity were the same for both groups.

Conclusion

• The results of this randomised controlled trial suggest that a small change approach may be an effective, sustainable strategy for preventing weight gain.
• The approach's feasibility and acceptability highlight its potential for broader public health application, as a scalable intervention to combat the obesity epidemic.
• Future research should explore long-term effects of this approach and its effectiveness in diverse populations.

• These findings suggest that small, consistent changes, combined with digital support tools and a focus on self-regulation, can be effective strategies for preventing weight gain in clinical and nutritional settings.
• Incorporating self-regulation techniques into client consultations, like goal setting and self-monitoring could improve results in managing diet and physical activity.
• Promoting gradual daily changes to diet and physical exercise is an effective strategy to help adherence to health programmes.

• The participants of the study were mainly white females, and this may have impacted results, Future studies would be advised to recruit a more diverse sample group.
• To increase the success of any potential public health programmes, follow up studies could benefit on making changes to those aspects of the intervention which participants reported as not finding as helpful.
• Changes in behaviour were self-reported, processes to gain real time results, whilst not adding additional support to participants might be a consideration to ensure more accurate reporting.
• Review the method for assessing adherence to understand if additional measures are required e.g. gamification or support.