Discussion
obesity, muscle mass, eating behavior, BP reduction, weight reduction, VHV, weight loss
OBESITY, SECONDARY
To our knowledge, this constitutes the first study, a randomized controlled trial, that assesses the effect of daily self-weighing combined with personalized counseling for weight reduction in a rural community in Thailand. We found that, after twenty weeks of follow-up, there was a statistically significant effect on BW and BMI reduction among participants who received a weight-loss program. Furthermore, the outcome suggested that, at 20 weeks of follow-up, the weight-loss program facilitated a greater reduction in BW and BMI in the intervention group in comparison with the control group. In contrast, the weight-loss program had no effect on the secondary outcome of BP reduction.For 20 weeks, participants in the weight-loss program performed self-weighing twice daily and recorded their weight on the calendar. The program also provides VHV visiting the participants at home once weekly. Therefore, intervention participants could see the trends in their BW over follow-up time which were recorded on the calendar. Furthermore, the VHV home visit may facilitate the maintenance of a hypocaloric diet and daily self-weighing with participants’ records for 20 weeks.Robust evidence confirmed that regular self-weighing was associated with more weight loss [Nevertheless, some related studies revealed that the effect of self-monitoring might decline over time [Our results reported that there was no significant difference in mean change in BP at a twenty-week follow-up from baseline between intervention and control groups. However, a decrease in SBP and DBP over a 20-week follow-up among intervention participants was pinpointed, which is compatible with the related study in Thai patients with NCDs [Being a community-based randomized control trial was one of this study’s advantages. In addition, the participants were adults residing in a rural community. Hence, the results are robust for the adults with obesity in the rural areas, which is the residential area of half of the Thai population.Regarding the study’s drawbacks, the first was its small sample size and uneven randomized allocation (2:1), which might have an impact on the power of study. Second, most study participants were females; thus, the results of our study could not be generalized to males. Third, 14 control participants withdrew from the study, which may affect the balance of baseline characteristics after allocation. However, no statistically significant differences were illustrated between the intervention and control groups regarding all baseline characteristics. Further, we also performed a sensitivity analysis to adjust sex and age in the GEE method; the results were relatively the same as the primary analysis. Fourth, due to a lack of resources, we were unable to examine the blood and urine samples for lipid profiles and plasma glucose as the secondary outcomes; furthermore, urine sodium for assessing sodium consumption which may affect BW and BP also was not evaluated. Fifth, in the present study, the total energy intake and physical activities were not assessed during the study period, which may influence the study outcomes. Further research needs to evaluate whether dietary intake and physical activities improve the actual evaluation of the effect of intervention. Finally, the present study was conducted between November 2020 and March 2021, covering the new year festival, which may affect eating behavior and study outcomes among study participants. Also, the study period coincided with the COVID-19 pandemic which only had an impact on Bangkok and Samut Sakhorn province in Thailand. On the other hand, the rural town of Nayao in Chacheongsao province was unaffected. However, the COVID-19 pandemic may have some impacts on the daily life activities of people. In the future, a more extensive community-based randomized control trial should be investigated to examine the effects of an intervention on the other body compositions, such as muscle mass, visceral fat, and body fat, as well as laboratory results, like lipid profile and plasma glucose.