Abstract P211: Effect Of An Mobile Health Weight Loss Intervention On Healthy Eating Index Diet Quality: The Smarter Randomized Controlled Trial

Abstract

Introduction: Dietary modification is key to standard behavioral treatment for weight loss. However, few studies assess whether diet quality—the overall healthfulness of the diet—is improved over the course of the intervention. As diet quality is relevant to health separate from its effect on weight, it may be an important endpoint to assess. The purpose of this secondary analysis of a randomized mobile health weight loss trial was to assess whether self-monitoring with automated, personalized feedback (SM+FB) compared to self-monitoring alone (SM) resulted in improved diet quality. Methods: Adults (N=502) with overweight/obesity (n=251 in SM+FB; n=251 SM) were provided calorie, fat gram, and physical activity goals and instructed to weigh daily, wear a Fitbit activity tracker, and self-monitor diet. Feedback messages were sent up to three times daily to SM+FB participants and were based on participant reported intake of calories, fat, and sugar but did not specifically target diet quality. Diet data were collected from two dietary recalls at baseline, 6 months, and 12 months using the Automated Self-Administered system (ASA-24). The Simple Scoring method was used to calculate Healthy Eating Index 2015 (HEI-2015) total scores as it aligns with the Dietary Guidelines for Americans. Change in diet quality was assessed using two-way repeated measures analysis of variance. Missing dietary data was imputed using last observation carried forward. Analyses used intention to treat. Results: The overall sample was mostly female (79%), white (82.5%), and middle-aged (mean=45.0 years, SD=14.4 years). Baseline HEI-2015 total scores were similar between SM (mean=54.44, SE=0.78) and SM+FB (mean=55.49, SE=0.82) and did not improve for either group over 6 months (SM: mean=55.64, SE=0.77; SM+FB: mean=56.89, SE=0.88) or 12 months (SM: mean=56.21, SE=0.81; SM+FB: mean=56.10, SE=0.88). Group, time, and group by time interaction effects were all non-significant (p>0.003) after Bonferroni adjustment. Discussion: Given that the HEI-2015 total score ranges from 0 to 100 with 74 meeting Healthy People 2020 goals, the diet quality of participants was less than ideal (grade: F) at baseline. The small improvements over time were likely not clinically significant. Future mHealth interventions might consider ways to increase user engagement, customization of additional features beyond feedback, and the addition of more targeted nutritional education in order to improve diet quality.

Technology‐delivered personalized nutrition intervention on dietary outcomes among adults with overweight and obesity: A systematic review, meta‐analysis, and meta‐regression

“…Tables S4 and S5 reasonably show the lists of excluded full‐text articles and ongoing trials in various clinical trial registries. Eventually, a total of 46 RCTs in 52 articles 52–103 were included in published peer‐review journals ( n = 41) and unpublished theses or dissertations ( n = 5) 58,72,73,82,83,86 . There was substantial and perfect agreement ( κ = 0.83–0.88) between two independent reviewers on article selection, data extraction, risk of bias, and GRADE criteria.…”

“…Table S6 describes the technology‐delivered personalized nutrition intervention. Personalized components included advice only ( n = 1), 71 feedback only ( n = 5), 63,72,78,84,97 or a combination of both ( n = 40). The content included diet alone or diet coupled with physical activity, behavioral change, self‐regulation, social support, lifestyle modification, and/or motivation via mobile apps ( n = 9), websites ( n = 17), web‐based programs ( n = 10), SMS ( n = 6), video calls ( n = 1), 87 emails ( n = 11), telephone calls ( n = 8), FIT displays ( n = 2), 82,86 wearable devices ( n = 7), social media ( n = 2), 65,95 or a combination of these technologies.…”

“…were observed on vegetable (g/day and scores) and fruit (servings/ day, g/day and scores) intakes; this might be due to remote feedback with limited engagement over 12 months, 97,99 limited trials for metaanalyses on vegetable intake (g/day), and fruit intake (g/day and scores). Additionally, the results of the food intake were recorded using the 24-h recall method, which can account for the nonsignificance of the results.…”

“…Table S6 describes the technology-delivered personalized nutrition intervention. Personalized components included advice only (n = 1), 71 feedback only (n = 5), 63,72,78,84,97 or a combination of both (n = 40).…”

“…In this review, three types of fat intake were reported, including kcal/ day in 11 trials, 55,58,62,69,72,73,86,91,92,94,95 % energy/day in 11 trials, 55,58,63,64,69,73,77,81,87,92,98 and fat intake scores in seven trials 60,62,79,85,89,93,97 among 1016-3644 adult participants with overweight and obesity. The meta-analyses revealed that technologydelivered nutrition intervention significantly decreased fat intake (% energy/days) (À1.81%, 95% CI: À3.38, À0.24, t = À2.49, p = 0.027, PI 95% = À7.25, 3.64) with small effect ( g = À0.37) and fat intake scores (SMD = À0.19, 95% À0.40, 0.02, t = À2.63, p = 0.025, PI 95% = À0.46, 0.15), as shown in Figure 3A-C.…”