The Karma system is currently undergoing maintenance (Monday, January 29, 2018).
The maintenance period has been extended to 8PM EST.

Karma Credits will not be available for redeeming during maintenance.

Journal of Medical Internet Research


Citing this Article

Right click to copy or hit: ctrl+c (cmd+c on mac)

Published on 24.07.14 in Vol 16, No 7 (2014): July

Preprints (earlier versions) of this paper are available at, first published Apr 17, 2014.

This paper is in the following e-collection/theme issue:

    Letter to the Editor

    Response to: Self-Directed Interventions to Promote Weight Loss: A Systematic Review of Reviews

    1School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia

    2Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia

    3School of Education, Faculty of Education and Arts, University of Newcastle, Callaghan, Australia

    4SP Health Pty Ltd, North Sydney, Australia

    Corresponding Author:

    Melinda J Hutchesson, PhD

    School of Health Sciences

    Faculty of Health and Medicine

    University of Newcastle

    Hunter Building HA12 University Drive

    Callaghan, 2298


    Phone: 61 49215405

    Fax:61 2 49217053


    In the February issue of the Journal of Medical Internet Research, Tang et al reported a systematic review of reviews examining the effectiveness of self-directed interventions to promote weight loss [1]. They reviewed 20 systematic reviews which incorporated 99 primary studies relevant to their review question. They concluded that self-directed interventions promote weight loss both independently and when provided as an adjunct to personal contact interventions.

    We agree that the evidence presented in this systematic review of reviews provides some support for the use of self-directed interventions for weight loss; however we believe the data provided does not specifically support the use of self-directed interventions alone and when used in combination with other delivery modes. We wish to point out that this is because the majority of reviews included do not have inclusion criteria or present results in a way that considers whether the intervention was delivered solely in a self-directed format or in combination with other delivery modes (eg, face-to-face). In most of the reviews, these two types of self-directed interventions are grouped together when results are presented in a narrative summary or meta-analysis. We believe that as part of their recommendation for a comprehensive review of primary evaluations, the authors should have recommended that future systematic reviews of self-directed interventions should consider results separately for interventions that are delivered solely using self-directed modes, and those that use self-directed modes in combination with other delivery modes. Furthermore, we believe that authors should be encouraged to describe the components of self-directed modes in sufficient detail to enable such a classification.

    We are also concerned about the accuracy of the methodological quality review of Tang et al. For example, the review incorrectly states that Neve et al [2] “did not use quality assessment”. However, the methods section of this review reports that “included studies were assessed by two independent reviewers for methodological validity using a standardized critical appraisal instrument from the JBI Meta-Analysis of Statistics Assessment and Review Instrument” (p 307) and the tool is provided as an Appendix to the paper [2]. Furthermore, the results include a description of the critical appraisal findings (subheading “Quality of Included Studies” p 310)[2]. As the results of the review of methodological quality are only presented as an overall score, and not by the individual criteria, it is difficult to determine how this influences the results of the quality evaluation within the review by Tang et al [1].

    We agree with the authors that meta-analyses of self-directed weight loss interventions should be undertaken to help identify what intervention techniques and delivery formats are most effective. However, as an author of one of the included systematic reviews, we are aware that the absence of such meta-analyses from the included reviews is likely due to inadequate descriptions of intervention techniques and delivery formats currently being published. Therefore, we believe a more important recommendation is that researchers who are currently evaluating self-directed interventions should provide more robust descriptions of their interventions, as recommended by the CONSORT-EHEALTH statement [3].  Furthermore, this may be achieved by specifically publishing study protocols (eg, [4,5]), or descriptions of the intervention development methods (eg, [6]). 


    1. Tang J, Abraham C, Greaves C, Yates T. Self-directed interventions to promote weight loss: a systematic review of reviews. J Med Internet Res 2014;16(2):e58 [FREE Full text] [CrossRef] [Medline]
    2. Neve M, Morgan PJ, Jones PR, Collins CE. Effectiveness of Web-based interventions in achieving weight loss and weight loss maintenance in overweight and obese adults: a systematic review with meta-analysis. Obes Rev 2010 Apr;11(4):306-321. [CrossRef] [Medline]
    3. Eysenbach G, CONSORT-EHEALTH Group. CONSORT-EHEALTH: improving and standardizing evaluation reports of Web-based and mobile health interventions. J Med Internet Res 2011;13(4):e126 [FREE Full text] [CrossRef] [Medline]
    4. JMIR Research Protocols. E-collection: Randomized Controlled Trials - Protocols/Proposals (eHealth)   URL: [accessed 2014-07-24] [WebCite Cache]
    5. JMIR Research Protocols. E-collection: Randomized Controlled Trials - Protocols/Proposals (funded, already peer-reviewed)   URL: [accessed 2014-07-24] [WebCite Cache]
    6. JMIR Research Protocols. E-collection: Formative Studies and eHealth/mHealth Development   URL: [WebCite Cache]

    Edited by G Eysenbach; submitted 17.04.14; peer-reviewed by R Kok; accepted 24.07.14; published 24.07.14

    ©Melinda J Hutchesson, Philip J Morgan, Penelope McCoy, Clare E Collins. Originally published in the Journal of Medical Internet Research (, 24.07.2014.

    This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.