Background Tens of thousands of health-related smartphone applications (apps), including hundreds of weight loss apps, are available but little is known about the effectiveness of these programs. Objective To evaluate the impact of introducing patients to a popular, free smartphone app for weight loss, MyFitnessPal, in a primary care setting. Design Randomized, controlled trial. Setting Two primary care clinics in the University of California Los Angeles Health System. Patients 212 primary care patients with body mass index greater than or equal to 25 kg/m2. Intervention 6 months of usual care (n = 107) or usual care plus research assistant help in downloading the MyFitnessPal app onto the patient’s smartphone (n = 105). Measurements Weight loss at six months (primary outcome), change in systolic blood pressure (SBP), change in behavioral mediators, satisfaction with the app, and frequency of app use (secondary outcomes). Results There was no significant difference between intervention and control groups in weight change (mean between group difference, −0.67 lb [CI, −3.3 to 2.1lb]; p = 0.63) or in SBP (mean between group difference, −1.7 mmHg [CI, −7.1 to 3.8]; p = 0.55). The intervention group exhibited increased use of a personal calorie goal compared to the control group (mean between group difference, 2.0 days per week [CI, 1.1 to 2.9]; p < .001), though changes in other self-reported behaviors did not differ between the groups. Most users reported high satisfaction with MyFitnessPal but logins dropped sharply after the first month. Limitation Despite blinding to the name of the app, fourteen control group participants (16%) used MyFitnessPal. 32% of intervention group participants and 19% of control group participants were lost to follow-up at 6 months. The app was given to patients by research assistants, not by physicians. Conclusion Smartphone apps for weight loss may be useful for individuals who are ready to self-monitor calories. For the average overweight primary care patient, however, introducing a smartphone app is unlikely to produce significant weight change.

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The 15-minute visit does not allow the physician suffi cient time to provide the variety of services expected of primary care. A teamlet (little team) model of care is proposed to extend the 15-minute physician visit. The teamlet consists of 1 clinician and 2 health coaches. A clinical encounter includes 4 parts: a previsit by the coach, a visit by the clinician together with the coach, a postvisit by the coach, and between-visit care by the coach. Medical assistants or other practice personnel would require retraining to assume the health coach role. Some organizations have instituted aspects of the teamlet model. Primary care practices interested in trying out the teamlet concept need to train 2 health coaches for each full-time equivalent clinician to ensure smooth patient fl ow.

Normotensive adults on low-sodium, weight-loss, and control diets recorded preferences and perceived saltiness for sodium chloride (NaCl) added to cream soup at intervals over 1 yr. Reduction in sodium intake and excretion accompanied a shift in preference toward less salt: preferred concentrations by ad libitum salting declined from 0.72% at the onset to 0.33% NaCl at week 24; hedonic scores for high concentrations of NaCl decreased significantly while scores for low concentrations increased. After 3 mo of sodium restriction, NaCl preferences readjusted to a lower level: ad libitum additions of NaCl were similar after 13, 24, and 52 wk. Less hedonic variation was observed among controls than among Na-restricted groups. The weight-loss group showed increased liking for mid-range NaCl levels. Mechanisms underlying preference changes, including physiological, behavioral, and context effects, may provide insights into maintenance of low-sodium diets for treatment and prevention of hypertension.

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