Introduction: Obesity treatment is less successful for socioeconomically disadvantaged populations, particularly when delivered in primary care. Digital health strategies can extend the reach of clinical obesity treatments to care settings serving patients at highest risk. Methods: Track was an effectiveness RCT of a 12-month digital weight-loss intervention, embedded within a community health center system. Participants were 351 adult patients (aged 21–65 years) with obesity and hypertension, diabetes, and hyperlipidemia. Patients were randomized to usual care (n = 175) or an intervention (n = 176) comprising app-based self-monitoring of behavior change goals with tailored feedback, a smart scale, dietitian-delivered counseling calls, and clinician counseling informed by app-generated recommendations, delivered via electronic health record. The primary outcome was 12-month weight change. Randomization began on June 18, 2013, final assessments were completed on September 10, 2015. Data analysis was conducted in 2016 and 2017. The trial retained 92% of usual care and 96% of intervention participants at 12 months. Results: The Track intervention produced larger weight losses relative to usual care at 6 months (net effect: −4.4 kg, 95% CI = −5.5, −3.3, p < 0.001) and 12 months (net effect: −3.8 kg, 95% CI = −5.0, −2.5, p < 0.001). Intervention participants were more likely to lose ≥ 5% of their baseline weight at 6 months (43% vs 6%, p < 0.001) and 12 months (40% vs 17%, p < 0.001). Intervention participants completing ≥ 80% of expected self-monitoring episodes (−3.5 kg); counseling calls (−3.0 kg); or self-weighing days (−4.4 kg) lost significantly more weight than less engaged intervention participants (all p < 0.01). Conclusions: A digital obesity treatment, integrated with health system resources, can produce clinically meaningful weight-loss outcomes among socioeconomically disadvantaged primary care patients with elevated cardiovascular disease risk. Trial registration: This study is registered at www.clinicaltrials.gov, NCT01827800.

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Background:The International Physical Activity Questionnaire-Short Form (IPAQ-S) has been evaluated against accelerometer-determined physical activity measures in small homogenous samples of adults in the United States. There is limited information about the validity of the IPAQ-S in diverse US samples. Methods: 142 Blacks residing in low-income housing completed the IPAQ-S and wore an accelerometer for up to 6 days. Both 1-and 10-minute accelerometer bouts were used to define time spent in light, moderate, and vigorous physical activity. Results: We found fair agreement between the IPAQ-S and accelerometerdetermined physical activity (r = .26 for 10-minute bout, r = .36 for 1-minute bout). Correlations were higher among men than women. When we classified participants as meeting physical activity recommendations, agreement was low (kappa = .04, 10-minute; kappa = .21, 1-minute); only 25% of individuals were classified the same by both instruments (10-minute bout). Conclusions: In one of the few studies to assess the validity of a self-reported physical activity measure among Blacks, we found moderate correlations with accelerometer data, though correlations were weaker for women. Correlations were smaller when IPAQ-S data were compared using a 10-versus a 1-minute bout definition. There was limited evidence for agreement between the instruments when classifying participants as meeting physical activity recommendations.

BackgroundDaily self-monitoring of diet and physical activity behaviors is a strong predictor of weight loss success. Text messaging holds promise as a viable self-monitoring modality, particularly among racial/ethnic minority populations.ObjectiveThis pilot study evaluated the feasibility of a text messaging intervention for weight loss among predominantly black women.MethodsFifty obese women were randomized to either a 6-month intervention using a fully automated system that included daily text messages for self-monitoring tailored behavioral goals (eg, 10,000 steps per day, no sugary drinks) along with brief feedback and tips (n=26) or to an education control arm (n=24). Weight was objectively measured at baseline and at 6 months. Adherence was defined as the proportion of text messages received in response to self-monitoring prompts.ResultsThe average daily text messaging adherence rate was 49% (SD 27.9) with 85% (22/26) texting self-monitored behavioral goals 2 or more days per week. Approximately 70% (16/23) strongly agreed that daily texting was easy and helpful and 76% (16/21) felt the frequency of texting was appropriate. At 6 months, the intervention arm lost a mean of 1.27 kg (SD 6.51), and the control arm gained a mean of 1.14 kg (SD 2.53; mean difference –2.41 kg, 95% CI –5.22 to 0.39; P=.09). There was a trend toward greater text messaging adherence being associated with greater percent weight loss (r=–.36; P=.08), but this did not reach statistical significance. There was no significant association between goal attainment and text messaging adherence and no significant predictors of adherence.ConclusionsGiven the increasing penetration of mobile devices, text messaging may be a useful self-monitoring tool for weight control, particularly among populations most in need of intervention.Trial RegistrationClinicaltrials.gov: NCT00939081; http://clinicaltrials.gov/show/NCT00939081 (Archived by WebCite at http://www.webcitation.org/6KiIIcnk1).