Self-Administered Auricular Acupressure Integrated With a Smartphone App for Weight Reduction: Randomized Feasibility Trial

Abstract

BackgroundObesity is a common global health problem and increases the risk of many chronic illnesses. Given the adverse effects of antiobesity agents and bariatric surgeries, the exploration of noninvasive and nonpharmacological complementary methods for weight reduction is warranted.ObjectiveThe study aimed to determine whether self-administered auricular acupressure (AA) integrated with a smartphone app was more effective than using AA alone or the controls for weight reduction.MethodsThis study is a 3-arm randomized waitlist-controlled feasibility trial. A total of 59 eligible participants were randomly divided into either group 1 (AA group, n=19), group 2 (AA plus smartphone app, n=19), or group 3 (waitlist control, n=21). A total of 6 reflective zones or acupoints for weight reduction were chosen. The smartphone app could send out daily messages to the subjects to remind them to perform self-pressing on the 6 ear acupoints. A “date picker” of the 8-week treatment course was used to enable the users to input the compliance of pressing and the number of bowel movement daily instead of using the booklet for recordings. The app also served as a reminder for the subjects regarding the dates for returning to the center for acupoint changing and assessments. Treatment was delivered 2 times a week, for 8 weeks. Generalized estimating equations were used to examine the interactions among the groups before and after intervention.ResultsSubjects in group 2 expressed that the smartphone app was useful (7.41 out of 10). The most popular features were the daily reminders for performing self-pressing (88%), the ear diagram indicating the locations and functions of the 6 ear points (71%), and ear pressing method demonstrated in the video scripts (47%). Nearly 90% of the participants completed the 8-week intervention, with a high satisfaction toward the overall arrangement (8.37 out of 10). The subjects in group 1 and 2 achieved better therapeutic effects in terms of body weight, body mass index (BMI), waist circumference, and hip circumference and perceived more fullness before meals than the waitlist controls. Although no significant differences in the pairwise comparisons between the 2 groups were detected (P>.05), the decrease in body weight, BMI, body fat, visceral fat rating and leptin level, and increase in adiponectin level were notable in group 2 before and after the intervention.ConclusionsThe high compliance rate and high satisfaction toward the trial arrangement indicate that AA can be used to achieve weight reduction and applied in future large-scale studies. AA integrated with the smartphone app has a more notable effect than using AA alone for weight reduction. Larger sample size should be considered in future trials to determine the causal relationship between treatment and effect.Trial RegistrationClinicalTrials.gov NCT03442712; https://clinicaltrials.gov/ct2/show/NCT03442712 (Archived by WebCite at http://www.webcitation.org/78L2tO8Ql)

Efficacy of Interventions That Incorporate Mobile Apps in Facilitating Weight Loss and Health Behavior Change in the Asian Population: Systematic Review and Meta-analysis

“…Intervention characteristics and descriptions of the studies included in this review are summarized in Table 1 and Table 2 , respectively. Of the 21 papers, 17 (81%) were RCTs and 4 (19%) were non-RCTs, with study locations in China [ 25 , 37 - 39 , 48 ], Hong Kong [ 34 ], India [ 26 , 31 ], Japan [ 35 ], Singapore [ 30 ], South Korea [ 27 - 29 , 32 , 33 , 36 , 40 , 50 ], Taiwan [ 41 , 49 ], and the United States [ 47 ]. The total number of participants across the 21 studies was 21,173 (RCTs: 4090 and non-RCTs: 17,083), with a mean age of 45.9 (SD 9.84, range 25.8-60.5) years; on average, 45.1% (SD 20.1) of the participants were women.…”

“…The average attrition rate was 11.5% (SD 8.53, range 0%-28%). Of the 21 studies, 2 (10%) consisted of single-component interventions using a mobile app exclusively [ 35 , 39 ], whereas 19 (90%) were multicomponent interventions incorporating additional components such as face-to-face consultations [ 25 - 30 , 32 - 34 , 36 - 38 , 47 - 50 ], reviews through phone calls or emails [ 26 , 27 , 29 , 31 , 32 , 36 , 40 , 48 ], supporting webpage [ 41 ], or financial incentives [ 33 ]. Of the 16 studies with face-to-face consultations, 4 (25%) also included tutorials to familiarize users on app use [ 29 , 30 , 36 , 41 ].…”

“…Across interventions, of the 21 studies, 12 (57%) used a researcher-designed app [ 27 , 28 , 30 - 34 , 36 , 40 , 41 , 49 , 50 ], whereas 9 (43%) used a commercially available app [ 25 , 26 , 29 , 35 , 37 - 39 , 47 , 48 ]. All studies had either used a culturally adapted app or had an app that was locally developed, except for 2 (10%) studies [ 29 , 47 ] that used a generic app developed in the United States.…”

“…Of the 17 RCTs, 1 (6%) was rated high risk for random sequence generation because of errors in patient randomization [ 27 ] and 5 (29%) were rated unclear risk for allocation concealment because of insufficient details reported by the authors [ 27 - 29 , 37 , 38 ]. Performance bias was rated high risk for 53% (9/17) of the studies [ 26 - 30 , 32 , 33 , 35 , 38 ], whereas 29% (5/17) of the studies scored unclear risk [ 25 , 31 , 34 , 36 , 37 ]. Of the 17 studies, detection bias was rated unclear for most, except for 3 (18%) that were rated low risk [ 25 , 34 , 35 ].…”

“…Performance bias was rated high risk for 53% (9/17) of the studies [ 26 - 30 , 32 , 33 , 35 , 38 ], whereas 29% (5/17) of the studies scored unclear risk [ 25 , 31 , 34 , 36 , 37 ]. Of the 17 studies, detection bias was rated unclear for most, except for 3 (18%) that were rated low risk [ 25 , 34 , 35 ]. Of the 17 studies, 3 (18%) were rated high risk for attrition bias, with attrition rates between 21% and 24% [ 27 , 28 , 31 ]; 2 (12%) were rated unclear risk [ 32 , 38 ]; and 1 (6%) was rated high risk for reporting bias because the authors did not report the primary outcome registered in the trial registration [ 31 ].…”