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Smartphone-based weight-loss program appears as effective as group intervention
Attempting to lose weight with the help of a smartphone-based behavioral program may be just as effective as more intensive group-based therapies for adults with obesity, according to findings published in Obesity.
“Innovative approaches are needed to make behavioral obesity treatment more accessible and less costly,” J. Graham Thomas, PhD, associate professor in the department of psychiatry and human behavior at the Warren Alpert Medical School of Brown University in Providence, Rhode Island, and colleagues wrote. “A mobile health approach has potential to fill the need by combining the internet with mobile devices such as smartphones to deliver behavioral treatment with fewer clinic visits.”
Thomas and colleagues recruited 276 adults with obesity from January 2013 and January 2015 for a randomized clinical trial comparing the previously established Self-Monitoring and Recording Using Technology (SMART) program, a group-based intervention and a control group during an 18-month period. All participants (mean age, 55.1 years; 83% women; mean BMI, 35.2 kg/m2) were randomly assigned to one of the three treatment groups at a ratio of 2:2:1.
In the SMART program, participants were provided with a smartphone if they did not already have one. In the first 6 months, participants received three 5-minute dietary education and skills training videos on their smartphone, with the frequency lowering to two videos per week and one per week during the next 6-month segments, respectively. Participants in this group used the MyFitnessPal app to self-report dietary intake, daily weight and physical activity while undergoing a monthly weigh-in with study interventionists.
Dietary education and skills training in stimulus control and meal planning were provided in the group intervention, which included weekly group sessions for the first 6 months, then biweekly for 6 months and once per month during the final 6 months of the trial. Diet, weight status and physical activity were recorded in paper diaries by all participants, who were also weighed at each group session.
The final group, which was considered the control arm, was weighed once per month and asked to record dietary intake, weight and physical activity level each day.
After 18 months, the participants in the SMART group (n = 114) averaged weight loss of 5.5 kg compared with loss of 5.9 kg in the group intervention (n = 106) and 6.4 kg in the control group (n = 56). In terms of percentage of weight loss, participants in the SMART group averaged a loss of 5.7%, whereas the group treatment yielded an average loss of 6.2% and the control group lost an average of 6.7%.
“The positive outcomes obtained in CONTROL suggest that self-monitoring, feedback, and whatever accountability and support can be obtained from a brief weigh-in may be sufficient to produce clinically significant weight loss for motivated treatment-seeking individuals and that more complex interventions such as GROUP and SMART may not always be necessary,” the researchers wrote, adding that no statistical significance was found among the three groups, including between the SMART and the group programs.
Besides weight-loss outcomes, the researchers evaluated adherence across the three groups. A higher percentage of participants in the SMART (81%) and group intervention (83%) cohorts completed the 18-month trial compared with the control group (66%). Participants in the group intervention self-reported weight status less often (21.2%; 95% CI, 17.9-25.9) than the SMART (30.7%; 95% CI, 26.2-37.2) and control (29.7%; 95% CI, 21.7-37.7) groups. Days when diet was self-monitored were more frequent in the SMART program (37.9%; 95% CI, 32.6-43.2) compared with the group intervention (27.5%; 95% CI, 23.6-31.4), but not significantly so in comparison with the control group (32%; 95% CI, 24-40).
“The SMART intervention could be considered a model for relying primarily on technology for behavioral intervention delivery while capitalizing on occasional brief contacts with human interventionists to provide supplementary accountability and support,” the researchers wrote. “Despite efforts to compensate physicians and other highly skilled providers for providing behavioral obesity treatment, this treatment was shown to be uncommon in the United States because of the infeasibility of the clinical and financial model and lack of training.” – by Phil Neuffer
Disclosures: The authors report no relevant financial disclosures.