A randomized controlled trial of an innovative, user‐friendly, interactive smartphone app‐based lifestyle intervention for weight loss

Abstract

Objectives Most electronically delivered lifestyle interventions are labor intensive, requiring logging onto websites and manually recording activity and diet. Cumbersome technology and lack of a human coach may have contributed to the limitations of prior interventions. In response, the current program of research created a comprehensive electronically delivered lifestyle intervention using a user‐friendly, interactive, smartphone app‐based model, and evaluated it in a randomized controlled trial. Methods Twenty‐eight adults, body mass index 25–42 kg/m2, with smartphones and sedentary jobs, were randomized to the intervention, along with conventional outpatient weight‐management visits every 3 months, or to a wait‐listed control group that received only weight‐management visits. The intervention included wearable activity trackers, smartscales, food photography logs, physician‐driven app‐based behavioral coaching, and peer support via the app. The prespecified primary outcome was a comparison of change in weight in kilograms, in the intervention versus control group at 6 months. Results At 6 months, the intervention group experienced a statistically significant weight change of −7.16 ± 1.78 kg (mean ± SE, 95% CI −11.05 to −3.26, p < 0.01), which differed from the weight change in controls by −4.16 ± 2.01 kg (95% CI −8.29 to −0.02, p < 0.05, prespecified primary outcome). Weight change in the control group was −3.00 ± 1.05 kg (95% CI −5.27 to −0.73, p < 0.05). Waist circumference and hemoglobin A1c significantly improved (intervention vs. control: p < 0.01, p < 0.05, respectively, prespecified secondary outcomes). Weight change in the intervention group correlated with numbers of food photographs participants shared (rho = −0.86, p < 0.01), numbers of their text messages (rho = −0.80, p < 0.01), number of times and days each participant stepped on the smartscale (rho = −0.73, p < 0.01; rho = −0.608, p < 0.05, respectively), and mean daily step counts (rho = −0.55, p < 0.05). Conclusion This app‐based electronically delivered lifestyle intervention produced statistically significant, clinically meaningful weight loss and improved metabolic health. Engagement with the intervention correlated strongly with weight loss. Given the limited sample size, larger and longer studies of this intervention are needed.

Engaging primary care patients with existing online tools for weight loss: A pilot trial

“…Food photography is one method that has shown potential promise to simplify dietary tracking in the context of a provider-supported weight loss intervention. 73 The weight change results observed in the present study support the potential of the intervention for population impact. The feasibility of the trial approach was supported by the successful recruitment and retention of patients in this study.…”

“…With enhanced training and ongoing materials, more patients may engage with these tools. Food photography is one method that has shown potential promise to simplify dietary tracking in the context of a provider‐supported weight loss intervention 73 …”

“…Food photography is one method that has shown potential promise to simplify dietary tracking in the context of a provider‐supported weight loss intervention. 73 …”

Obesity in South and Southeast Asia—A new consensus on care and management

“…For those who are comfortable with technology, electronically delivered behavioral interventions may provide additional support beyond what the primary care clinician can offer. Electronic tools include websites and apps for smartphones and tablets, which allow the user to track and report their daily meals and exercise, and receive automatic or, in some cases, personal coaching 164,165 . Those who continue to log in or interact with these tools show corresponding success in weight loss over 6 months, as well as WC and glycemic control 165 .…”

“…164,165 Those who continue to log in or interact with these tools show corresponding success in weight loss over 6 months, as well as WC and glycemic control. 165 However, attrition is common as the tools lose their novelty. 164 Behavioral interventions should continue to be offered to patients on pharmacotherapy 166 and after bariatric surgery, 167 to support improved habits and adherence to a healthful lifestyle, as well as for mental health and QoL benefits.…”