Drivers of weight loss in a CDC-recognized digital diabetes prevention program

Abstract

<jats:sec><jats:title>Introduction</jats:title><jats:p>To investigate the impact of the digital Livongo Diabetes Prevention Program (DPP) on weight at 12 months, understand participants’ self-monitoring behaviors associated with greater weight loss, and evaluate the impact of coaching interactions on more frequent self-monitoring behaviors.</jats:p></jats:sec><jats:sec><jats:title>Research design and methods</jats:title><jats:p>A retrospective analysis was performed using data from 2037 participants enrolled in the Livongo DPP who completed lesson 1 and recorded a starting weight during 2016–2017. Self-monitoring behaviors, including weigh-ins, food logging, activity, and coach–participant interactions, were analyzed at 6 and 12 months. Subgroup analysis was conducted based on those who were highly engaged versus those minimally engaged. Multiple regression analysis was performed using demographic, self-monitoring, and lesson attendance data to determine predictors of weight loss at 12 months and coaching impact on self-monitoring.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Participants had a mean age of 50 years (SD ±12), with a starting weight of 94 kg (SD ±21), were college-educated (78%), and were female (74%). Overall, participants lost on average 5.1% of their starting weight. Highly engaged participants lost 6.6% of starting body weight, with 25% losing ≥10% at 12 months. Logistic regression analysis showed each submitted food log was associated with 0.23 kg (p&lt;0.05) weight loss, each lesson completed was associated with 0.14 kg (p&lt;0.05) weight loss, and a week of 150 active minutes was associated with 0.1 kg (p&lt;0.01) weight loss. One additional coach–participant message each week was associated with 1.4 more food logs per week, 1.6% increase in weeks with four or more weigh-ins, and a 2.7% increase in weeks with 150 min of activity.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Food logging had the largest impact on weight loss, followed by lesson engagement and physical activity. Future studies should examine further opportunities to deliver nutrition-based content to increase and sustain weight loss for DPP.</jats:p></jats:sec>

Self‐Monitoring via Digital Health in Weight Loss Interventions: A Systematic Review Among Adults with Overweight or Obesity

“…Longer intervention duration tempered this relationship, however, suggesting that self-monitoring may be less effective for weight loss over time either because engagement declines or because rates of weight loss slow despite similar degrees of engagement. This primary finding supports the conclusions from prior reviews that focused predominantly on paper-based selfmonitoring methods (26,27) and is also consistent with large-scale retrospective studies from industry platforms that used self-monitoring (85)(86)(87)(88)(89).…”

Free-Living Energy Balance Behaviors Are Associated With Greater Weight Loss During a Weight Loss Program

“…The current findings showing that the amount of PA is related to WL align with previous research which found that higher PA prior to engaging in an aerobic exercise intervention (41) and greater PA levels during a WL program were associated with greater WL (42,43). Research examining whether energy balance behaviors (i.e., movement and eating behaviors), early in the intervention, and the change in those behaviors during an intervention, are predictive of WL success following a WL program primarily focused on diet is lacking.…”

Preference, Expected Burden, and Willingness to Use Digital and Traditional Methods to Assess Food and Alcohol Intake

“…The small difference between methods along with the relatively high willingness ratings across all methods (≥6.0 points for food intake and ≥5.7 points for alcohol consumption) suggests that participants generally seem willing to use all four methods for study/research purposes, even if they rate one method to be relatively more burdensome and less preferred than another. This is encouraging as more frequent engagement with (digital) food logging methods in behavioral interventions has been reported to be associated with greater weight loss over 3 [25] and 12 [26] months. Nonetheless, the actual usage of self-report methods to assess food intake decreases over time, even when efforts are made to reduce burden by, for example, using photographic food records [27].…”

“…The following are available online at https://www.mdpi.com/article/10 .3390/nu13103340/s1, Supplementary Methods: Food Intake Assessment Preference Questionnaire, Alcohol Consumption Assessment Preference Questionnaire; Supplementary Figure S1: Percentage of participants who rated each method as their preferred method of food intake assessment in those <25 years (Panel A), [25][26][27][28][29][30][31][32][33][34]…”