Abstract
Objectives
Most electronically delivered lifestyle interventions are labor‐intensive, requiring logging onto websites and manually recording activity and diet. Cumbersome technology and lack of a human coach may have contributed to the limitations of prior interventions. In response, the current program of research created a comprehensive electronically delivered lifestyle intervention using a user‐friendly, interactive, smartphone app‐based model and evaluated it in a randomized controlled trial.
Methods
Twenty‐eight adults, BMI 25‐42 kg/m2, with smartphones and sedentary jobs, were randomized to the intervention, along with conventional outpatient weight‐management visits every three months, or to a wait‐listed control group that received only weight‐management visits. The intervention included wearable activity trackers, smartscales, food photography logs, physician‐driven app‐based behavioral coaching, and peer support via the app. The pre‐specified primary outcome was a comparison of change in weight in kg, in the intervention versus control group at six months.
Results
At six months, the intervention group experienced a statistically significant weight change of ‐7.16±1.78 kg (mean±SE, 95% CI ‐11.05 to ‐3.26, p<0.01), which differed from the weight change in controls by ‐4.16±2.01 kg (95% CI ‐8.29 to ‐0.02, p<0.05, pre‐specified primary outcome). Weight change in the control group was ‐3.00±1.05 kg (95% CI ‐5.27 to ‐0.73, p<0.05). Waist circumference and hemoglobin A1c significantly improved (intervention vs. control: p<0.01, p<0.05, respectively, pre‐specified secondary outcomes). Weight change in the intervention group correlated with numbers of food photographs participants shared (rho=‐0.86, p<0.01), numbers of their text messages (rho=‐0.80, p<0.01), number of times and days each participant stepped on the smartscale (rho= ‐0.73, p<0.01; rho= ‐0.608, p<0.05, respectively), and mean daily step counts (rho=‐0.55, p<0.05).
Conclusion
This app‐based electronically delivered lifestyle intervention produced statistically significant, clinically meaningful weight loss and improved metabolic health. Engagement with the intervention correlated strongly with weight loss. Given the limited sample size, larger and longer studies of this intervention are needed.
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