Exploring the Effectiveness of Supporting Dietary Weight Loss Interventions with Health Coaching and Telemonitoring: An Integrative Nutrition Approach

1. Introduction

Obesity is still considered a major global burden, where rates are increasing over the past decades as seen in the world health statistics [1]. The WHO estimates that there are around 650 million people that are classified as obese, Furthermore, several health issues are associated with obesity which include diabetes[2], cardiovascular diseases [3] and certain cancers [4], highlighting the importance of conducting sustainable weight loss programs [5]. The main approach in weight loss programs involves dietary interventions, which aim to reduce caloric intakes micronutrition composition and metabolic health while evidence consistently supports the efficiency of dietary interventions in promoting short term weight reductions [6]. While these interventions have been showing effective weight reductions, long-term weight loss remains challenging for many individuals [7]. Numerous studies confirm the efficiency of dietary interventions in achieving initial weight loss. For instance, meta-analysis of randomized controlled trials (RCTs) has demonstrated that both calorie restriction and low carbohydrate diets can lead to clinically significant weight loss over short periods (3 to 6 months) [8,9]. Furthermore, intervention such as intermittent fasting and meal replacement have shown promise in specific populations, such as those with metabolic syndrome and insulin resistance[10]. Studies also show that dietary interventions can improve cardiovascular markers such as cholesterol and blood pressure, blood glucose and overall metabolic health [11]. Thus, limitations and challenges have been defined in such interventions, despite the initial success. Firstly, adherence to dietary interventions often declines over time due to various factors, including lifestyle demands, food environment, and psychological factors such as stress or emotional eating [12]. Many individuals struggle to sustain restrictive diets or maintain weight loss once the intervention period ends [13]. This suggests that without continuous support, even individuals with string motivation may find it difficult to sustain in new eating patterns in long term weight management programs. Given these challenges, new research has been directed towards exploring new strategies to improve effectiveness of dietary interventions, among those strategies, are health coaching and telemonitoring, which have gained evident attention. Health coaching, which involves personalized guidance and motivation aims to facilitate behavior changes by addressing individuals’ barriers and fostering self-efficiency in dietary and lifestyle modifications [14]. Health coaches who may be dietitians, nurse or any trained wellness professional works closely with clients to set achievable goals, monitor progress and offer support as they enhance engagement to the weight loss program [15]. Telemonitoring on the other hand may also be considered a supportive strategy via digital health technologies, such as mobile apps, wearable devices and online platforms to monitor health metrics remotely. The method enables continuous tracking of dietary habits, physical activity and other health indicators allowing both clients and healthcare provides to assess progress and make a positive reflection on weight loss interventions due to continuous monitoring and motivation [16]. The integration of health coaching and telemonitoring into dietary interventions may offer promising approach for enhancing weight loss outcomes [17,18]. This literature examines the current evidence on the effectiveness of these combined strategies in supporting dietary weight loss interventions, with an emphasis on understanding their individual and synergistic impacts. By exploring studies on the standalone and combined roles of health coaching and telemonitoring, this review aims to clarify their potential as tools for facilitating sustained weight loss and improved health outcomes.

2. Materials and Methods

A comprehensive literature search was carried out using the keywords “RCT”, “weight loss”, “Diet”, “health coaching”, and “telemonitoring”. The selected strategy was directed towards defining/describing mechanisms of support systems to dietary interventions, which included health coaching and telemonitoring integrated in weight management intervention for weight loss and improving chronic conditions markers. We also aimed to provide a constructive analysis of (31) previous randomised controlled trials (RCTs) carried on health coaching and/or telemonitoring for weight management. Full texts of published articles were reviewed for the past 10 years (2014-2024) via PubMed and Google Scholar databases and duplicate articles were excluded from the research findings.

3. Results

3.1. Health Coaching as a Support for Weight Loss Interventions

Health coaching is an emerging strategy in healthcare that emphasize a patient-centered, motivational approach to facilitate behaviors change and improve adherence to health-related goals. In the context of dietary weight loss interventions, health coaching services as a form of structures support that helps individuals develop and maintain sustainable dietary habits, overcome barriers to change, and improve their confidence in managing their health. Studies have showing that health coaching has consistently demonstrated positive impact on dietary adherable , weight loss and lifestyles when compared to interventions without health coaching [19]. In the study 44 obese participants have enrolled being randomly divided into two groups health coaching group HC (n = 22) or control (n = 22) groups. By providing personalized guidance, health coaches can significantly enhance the effectiveness of dietary interventions where 15.7% of weight loss was seen in HC group compared to 2.5% seen in control group for a total of 12 weeks. Health Coaching is an effective approach that integrates formal education with health treatment in weight loss journey. Yet more randomized studies are required to confirm its impact on chronic disease markers [20]. In addition to the cost that may encounter hiring health coaches, specifically in low-source settings or for individuals without comprehensive health insurance coverage additionally, the effectiveness of health coaching may vary fur to coaches training and client-coach relationships and individuals differences in motivation and readiness for a change [21,22]. There are several mechanisms that are involved in health coaching which is described in three steps [23];

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Goal setting and personalization enable clients to set realistic, achievable goals that align with improving their lifestyles to be able to lose weight.

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Motivational support and self-efficiency help clients overcome struggle sand build confidence in their ability to adhere to dietary changes. Coaches use motivational interviewing to encourage clients to expose reasons for wanting to lose weight.

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Behavior reinforming and accountability by providing regular feedback, encouragement, and reinforming, which may help client to adhere to their diet over a longer period of tie.

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Problem solving and coping strategies by addressing obstacles to dietary adherence and finding suitable solutions for clients, which include emotional earing, social pressure or lack of meal planning skills.

3.2. Telemonitoring as a Support for Weight Loss Interventions

Telemonitoring refers to the use of digital health technologies that remotely monitor and manage health status. In weight loss interventions, telemonitoring acts as a tool to provide a continuous assessment for weight measures, dietary adherence and lifestyle changes such as physical activity. This approach is believed to enhance motivation through reflection and continuous monitoring. Numerous studies have examined the impact of telemonitoring on dietary adherence and weight loss outcome. In the Active Body Control Program ABC have shown significant impact on weight loss, which is a telemonitoring based program [24]. A systematic review have examined studies on self-monitoring or so called telemonitoring on diet, exercise and self-weighting from 1993 to 2009 showed that there is a strong link between self-monitoring and weight loss [25]. While Telemonitoring holds promise as a supportive tool in weight loss, it is not without challenges. Main limitation is the technical barrier and digital literacy [26], where it requires a specific level of familiarity with technology, which may be a struggle to the elderly [27], where it requires support of care givers or members of the family. Also access to smartphones or wearable devices may be expensive to be adapted as part of the routine [28]. Thus, engagers and sustainable users are considered major limitation, where literature have shown that clients respond to telemonitoring well at the initial period of the weight loss intervention and then with time, clients lose interest and motivation, where response rate becomes so low[29]. Mechanisms associated with such positive outcome include the following:

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Continuous tracking and real-time feedback which enables clients to track their dietary and exercise behaviors daily as it creates a greater awareness of their eating patterns.

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Data-driven personalization which allows personalized feedback and intervention adjustment. This enables health professionals and health coaches to monitor trends in the day as any changes that happen in physical activity for example results in tailored recommendation as well.

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Support for long-term behaviors change which may establish health habits by making behaviors tracking a routine part of the day to day lives.

3.3. Integrative Approaches: Combining Health Coaching and Telemonitoring

Combining health coaching with telemonitoring represents a promising approach to improving the efficiency of dietary weight loss interventions. Each approach has a unique strength, where health coaching offers personalized guidance and motivational support, while telemonitoring provides continuous feedback and accountability. Together, these methods address both the behaviors and logistical barriers to sustained dietary adherence, making it easier for clients to implement and maintain dietary changes over time. According to previous research, promising outcomes have been revealed showing that an integrative approach supports weight loss for a longer period. A study have aimed to examine adherence to remote monitoring devised and weekly rate of weight loss (RWL) in a 12 week online weight management combined with weekly video based health coaching, showed a significantly greater weight loss compared to the control group [30]. Kepm et al (2019) have compared between the effect of a telemedical coaching (TMC) with or without telemonitoring on weight loss among occupational healthcare professionals in a three-armed randomised controlled trial. Results have showed significant support to weight reduction with an added improvements when both strategies are combined [17].

3.4. Effectiveness of Randomized Controlled Trials (RCT) Supported with Telemonitoring and Health Coaching on Weight Loss and Related Chronic Conditions Risk Factors

Table 1 demonstrates Randomized Controlled Trials (RCT) conducted between 2014-2024 to evaluate the effectiveness of interventions on weight loss and related risk factors. Studies have implemented different models such as telemedical support, mobile apps and self-monitoring tools. While populations across the studies also varied( prediabetic patients, type 2 diabetic patients, hypertension patients and obese patients and specific type of groups, which included pregnant women and young adults that are at higher risks of obesity). Duration times were between 12 weeks and 24 months. Short term interventions have focused on immediate outcomes, such as weight loss, waist circumference and dietary improvements, while long term interventions have measured improvements in chronic conditions such as blood pressure and HbA1c levels. Accordingly, we have divided our data to four categories:

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Weight loss and physical activity, showing significant weight loss and increased physical activity particularly with using video conferencing, telehealth or app-based coaching.

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Health and behavior markers, such as HBA1c, blood pressure and lifestyles factors (dietary adherence and sleep), were reported to be improved.

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Diabetes and gestational health were shown in some studies to support blood glucose control and reduce neonatal complications.

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Mental health and self-efficiency where some interventions showed an enhance life satisfaction, mood and self-efficiency, especially with those incorporating motivational interviewing and coaching support.

5. Conclusions

In Conclusion, this review highlights the efficacy and adaptability of dietary weight loss interventions implemented through randomized controlled trials (RCTs). Interventions incorporating telemonitoring and personalized health coaching have been seen to encounter a significant impact on weight loss, chronic conditions markers and mental health when compared to usual or traditional care. The diverse approaches across studies from shirt term, intensive weight reduction programs to long0term chronic condition management have demonstrated the benefits of tailoring interventions to participants needs, risk profiles, and access to resources. However, the effectiveness of these interventions often varies due to challenges in long term adherence technological access, and participant engagement, suggesting that sustained support is essential for lasting impact.