The SMARTER pilot study: Testing feasibility of real-time feedback for dietary self-monitoring

Abstract

Self-monitoring (SM) of food intake is central to weight loss treatment. Technology makes it possible to reinforce this behavior change strategy by providing real-time feedback (FB) tailored to the diary entry. To test the feasibility of providing 1–4 daily FB messages tailored to dietary recordings via a smartphone, we conducted a 12-week pilot randomized clinical trial in Pittsburgh, PA in US in 2015. We compared 3 groups: SM using the Lose It! smartphone app (Group 1); SM + FB (Group 2); and SM + FB + attending three in-person group sessions (Group 3). The sample (N = 39) was mostly white and female with a mean body mass index of 33.76 kg/m2. Adherence to dietary SM was recorded daily, weight was assessed at baseline and 12 weeks. The mean percentage of days adherent to dietary SM was similar among Groups 1, 2, and 3 (p = 0.66) at 53.50% vs. 55.86% vs. 65.33%, respectively. At 12 weeks, all groups had a significant percent weight loss (p < 0.05), with no differences among groups (− 2.85% vs. − 3.14% vs. − 3.37%) (p = 0.95); 26% of the participants lost ≥ 5% of their baseline weight. Mean retention was 74% with no differences among groups (p = 0.37). All groups adhered to SM at levels comparable to or better than other weight loss studies and lost acceptable amounts of weight, with minimal intervention contact over 12 weeks. These preliminary findings suggest this 3-group approach testing SM alone vs. SM with real-time FB messages alone or supplemented with limited in-person group sessions warrants further testing in a larger, more diverse sample and for a longer intervention period.

The effectiveness of app‐based mobile interventions on nutrition behaviours and nutrition‐related health outcomes: A systematic review and meta‐analysis

“…Studies were excluded for multiple reasons, such as not having an intervention component (see Data S3 for a list of the excluded studies). In total, 41 studies had investigated the effectiveness of app‐based mobile interventions for improving nutrition behaviours or nutrition‐related health outcomes and met all four eligibility criteria. These 41 studies were then included in the systematic review and quantitative meta‐analysis.…”

“…Of the 41 studies, 29 included an app‐based assessment of the total nutrition intake, nine an assessment of specific foods such as vegetables or specific food consumption patterns (eg, adherence to specific guideline‐based recommendations), one assessed meal replacements, and two did not provide further information . Twenty one of the 32 studies that provided information about the features implemented for nutrition assessment included a database that participants could search to select the food items and meals they had consumed.…”

“…The overall effectiveness of the interventions did not significantly vary in dependence of whether the interventions were based on apps as stand‐alone or they were combined with additional intervention components. Eighteen of the 41 intervention studies (44%) used an app as a stand‐alone intervention delivery method, while a larger proportion of interventions used an app in combination with other intervention strategies such as groups sessions, weekly meetings and online tools, coaching calls, text messages, and emails, or face‐to‐face contact (see Data S8 for a detailed study description). Also, the 11 most successful intervention studies, which demonstrated a significant and positive overall pooled effect size, included four intervention studies using an app as stand‐alone strategy (36%).…”

“…Eighteen of the 41 intervention studies (44%) used an app as a stand‐alone intervention delivery method, while a larger proportion of interventions used an app in combination with other intervention strategies such as groups sessions, weekly meetings and online tools, coaching calls, text messages, and emails, or face‐to‐face contact (see Data S8 for a detailed study description). Also, the 11 most successful intervention studies, which demonstrated a significant and positive overall pooled effect size, included four intervention studies using an app as stand‐alone strategy (36%). Comparing the effect sizes between these “success models” shows an overall comparable result pattern for stand‐alone interventions (range: Hedges' g = 0.58 to Hedges' g = 0.76) compared with combined interventions (range: Hedges' g = 0.28 to Hedges' g = 1.19 …”

Early weight loss in a standalone mHealth intervention predicting treatment success

“…Behavioural weight loss treatment delivered via mobile technology is efficacious (1,2), with roughly 25-44% of participants achieving clinically significant weight loss of 5% in interventions that are standalone (i.e. those without a counselling component) (3)(4)(5). Early weight loss is a robust predictor of clinically meaningful weight loss (6)(7)(8) and has been used as a trigger in stepped-care behavioural interventions to implement rescue efforts for individuals not responding early to obesity treatment (6,(9)(10)(11).…”