Low Carb Program Health App Within a Hospital-Based Obesity Setting: Observational Service Evaluation

Abstract

Background Obesity underlies much chronic disease. Digitalization of obesity management provides an opportunity to innovate our traditional model of health care delivery within this setting, and to transform its scalability potentially to the population level. Objective The objective was to assess the feasibility and effectiveness of the Low Carb Program app for weight loss, applied within our hospital-based (tier 3) obesity service. Due to the disrupting effects of the COVID-19 pandemic on our obesity service, we compared the clinical outcomes from the Low Carb Program app applied in the context of remote patient appointments over the telephone with the prepandemic traditional standard of care. Methods We invited patients who attended our hospital-based obesity service to engage with the Low Carb Program smartphone app. We combined this approach with remote delivery (over the telephone) of obesity management from medical and psychology members of our obesity team during the COVID-19 pandemic. Outcome variables included changes in body weight and changes in HbA1c as a marker of glycemic control. We compared data from the Low Carb Program group with a retrospective control group (n=126) that had received traditional face-to-face obesity management from our team without concomitant use of the Low Carb Program app in the pre–COVID-19 era. T test comparisons were employed, with P<.05 considered significant. Results The mean weight of participants (n=105) was 130.2 kg, with 59% (n=62) females and a mean age of 48.8 years. Most participants (90/105, 86%) completed the Low Carb Program app registration process and engaged with the Low Carb Program app program; at follow-up, most participants (88/105, 84%) had actively engaged with the Low Carb Program app within the prior 30 days. The majority of participants (58/105, 55%) self-reported outcomes within the app. Mean duration of clinical follow-up for recruited participants who received the app was 7.4 months. Paired data were available for 48 participants for body weight and 41 participants for HbA1c. Paired sample t test analysis revealed a statistically significant mean loss of body weight of 2.7 kg (P=.001) and improvement in HbA1c of 3.3 mmol/mol (P=.01). The mean weight of control group patients (n=126) was 137.1 kg, with 74% (93/126) females and a mean age of 44.4 years. The mean follow-up for this group was 6 months. Data comparisons between the app user group and the pre–COVID-19 retrospective control group revealed equivalence for loss of body weight and change in HbA1c between the two groups. Conclusions We provide evidence to support the feasibility of implementing the Low Carb Program app combined with remote management; this is the first proof of concept for digitalized management within a hospital-based (tier 3) obesity service. We demonstrate the potential clinical efficacy of the approach in terms of improvements in body weight and glycemic control.

Implementation of a digital health tool for patients awaiting input from a specialist weight management team (Preprint)

“…Indeed, at least in the short term (less than 6 months), such interventions result in greater weight loss than more traditional face-to-face interventions [ 6 ], with apparent equivalence in the overall effectiveness between these 2 approaches in the long term (12 months) [ 3 ]. Similar findings were observed in a feasibility study of the Low Carb Program app in our obesity service at UHCW, whereby digital tool interventions for diet combined with medical appointments resulted in a similar weight loss to that from a traditionally delivered obesity service [ 7 ]. Interestingly, there are no studies that explore the feasibility of offering digital tools to patients on a waiting list for a specialist weight management service, defined as a service comprising specialist dietitians, physicians, and psychologists.…”

Knowledge, Attitudes, and Behaviors towards Proper Nutrition and Lifestyles in Italian Diabetic Patients during the COVID-19 Pandemic

“…In fact, although one might think that a lockdown must necessarily reduce physical activity levels while increasing calorie intake, in fact, a relevant part of the population was able to take advantage of the lockdown to pay more attention to proper nutrition at home as opposed to for example, consuming frugal and unbalanced meals during work breaks outside the home in non-pandemic times. Conversely, others suffered greatly from social distancing and home isolation by compensating with food for their discomfort, indulging in sedentary living, and sometimes interrupting the daily physical activity they had previously partaken in [ 57 , 58 , 59 , 60 ].…”

The Potential of a Digital Weight Management Program to Support Specialist Weight Management Services in the UK National Health Service: Retrospective Analysis

“…Previous systematic reviews have shown that DWMIs can be as effective as in-person interventions for weight loss and related outcomes for people with obesity [ 19 - 21 ], and the COVID-19 pandemic provided further evidence that existing intensive, in-person programs could be effectively transformed to deliver care remotely and effectively using technology [ 22 - 24 ]. Furthermore, 2 studies have shown that remote delivery of a weight management program in the UK can be as effective as usual face-to-face support in a tier 3 weight management service [ 18 , 25 ]. For example, a dietetic weight loss app program was found to be as effective and feasible when delivered remotely from a hospital-based SWMS to their usual face-to-face care [ 25 ].…”

“…Furthermore, 2 studies have shown that remote delivery of a weight management program in the UK can be as effective as usual face-to-face support in a tier 3 weight management service [ 18 , 25 ]. For example, a dietetic weight loss app program was found to be as effective and feasible when delivered remotely from a hospital-based SWMS to their usual face-to-face care [ 25 ]. However, real-world evidence of the potential for digital intervention to support SWMS in the UK National Health Service (NHS) remains limited [ 26 ].…”