Lifestyle coaching improves health perceptions, behaviors, and weight during COVID-19

By Tarun Sai LomteReviewed by Benedette Cuffari, M.Sc.Mar 14 2023

In a recent study under review at the BMC Public Health journal and currently posted to the Research Square* preprint server, researchers examine the perceptive, behavioral, and anthropometric changes in Coaching on Lifestyle (CooL) participants.

Study: The combined lifestyle intervention CooL in times of COVID-19: a descriptive case series study. Image Credit: Motortion Films / Shutterstock.com

*Important notice: Research Square publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Supporting weight loss in the Netherlands

In 2021, half of the Dutch population aged 18 or older were considered overweight, with nearly 14% considered obese.

In the Netherlands, combined lifestyle interventions (CLIs) were part of the primary health insurance for overweight/obese people. CLIs are intended to stimulate weight reduction and promote healthier behaviors.

CooL is one of six CLIs and is implemented in two phases that consist of an eight-month behavioral change and 16-month behavioral maintenance phase.

About the study

In the present study, researchers examine the effect of the coronavirus disease 2019 (COVID-19) pandemic on changes in health perceptions, anthropometry, and behaviors among CooL participants during the behavioral change phase. Dutch-speaking individuals in the Netherlands were recruited between November 2018 and October 2021.

Some participants completed their first phase of CooL before the COVID-19 pandemic began in the Netherlands, while others participated during the period when COVID-19 restrictions were enforced. A cut-off date of April 1, 2020, was used to distinguish participants impacted by the pandemic and those who were not.

There were some changes in how CooL was offered to participants during the pandemic, which included the addition of COVID-19-related queries to existing outcome measures. CooL was an open CLI without a strict protocol, thereby allowing the coaches to adapt interventions to the target audience.

The researchers used anthropometric measurements and a questionnaire to collect data. Outcome measures were grouped into anthropometrics, physical activity, control and support, perceived fitness, diet attentiveness, smoking and alcohol use, stress, and sleep. Data collection occurred at baseline (T0), after 32 weeks (T1), and after 24 months (T2).

T1 represented completion of the first CooL phase, while T2 was the end of the second phase. Data from T2 were unavailable for analysis in this study.

Demographic characteristics, including age, gender, education, occupation, and marital status, were reported by participants at baseline. CooL coaches measured anthropometrics using professional equipment.

Perceived support of close people was examined to identify social support. A short version of the Pearlin Mastery Scale was used to assess self-mastery.

A brief questionnaire for coaches was used to understand how the CooL interventions differed during the pandemic. To assess physical activity, the team queried sedentary behavior on the least and most active days, as well as the average minutes/day participants were physically active.

Study findings

Overall, 1,824 adult individuals participated in the CooL CLI. About 95% of participants were born in the Netherlands, with 72% of the study cohort identifying as female. Over 70% of the study cohort lived with a partner, two-thirds had intermediate/lower education, and a quarter did not have a stable job.

Around 24% of participants provided information on how CooL was offered during the pandemic. Over 80% of participants started CooL with physical face-to-face sessions, while 20% joined remotely.

Almost all participants were part of the combined physical and digital sessions. More participants received face-to-face than digital sessions throughout the study period.

Before April 1, 2020, 120 participants completed their first phase of the CooL CLI; however, 1,667 completed the first phase after this date. Weight, waist circumference, and body mass index (BMI) decreased at T1 relative to T0, with an average loss of 1.15 BMI points and 3.2% weight loss.

Anthropometric measurements did not significantly differ between those who joined before and during the COVID-19 pandemic. Self-mastery declined at T1 as compared to baseline; however, support remained unchanged. There were differences in self-mastery between CooL participation before and during the pandemic, with a much larger effect for pre-COVID-19 participants.

At T1, sedentary time was reduced for the least and most active days. The average daily minutes of physical activity at T1 was 108 minutes, which increased from 94 minutes at T0.

CooL participants enrolled during the COVID-19 period reported reductions in sedentary time relative to baseline, while pre-COVID-19 participants showed a slight increase.

Over time, participants increased attentiveness to food consumption, meal composition, and food quantity while also reducing alcohol intake. There were no differences between pre-COVID-19 and COVID-19 participants in diet-related outcomes.

Stress perceptions were significantly reduced in pre-COVID-19 participants as compared to those who joined after the COVID-19 pandemic began. There were no differences in sleep between the two groups.

Conclusions

The current study assessed changes in outcomes after eight months of the first phase of the CooL CLI and reported positive changes relative to the baseline. Importantly, the COVID-19 pandemic had a negative impact on self-mastery, stress, and perceived fitness but not on diet, social support, sleep, or anthropometric outcomes.

Taken together, these findings indicate that minor changes in different lifestyle behaviors can synergistically contribute to better health.

*Important notice: Research Square publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.