Using a mobile device to track food consumption and get feedback from a weight loss coach helped patients lose more weight than a traditional weight loss program, according to a study published in the Archives of Internal Medicine today.
Intensive weight loss programs that include goal setting, self monitoring, and frequent contacts with clinicians have a good track record of success. But having to attend frequent meetings may be inconvenient or difficult for patients, and clinicians may find they do not have the time or resources to provide intensive face-to-face weight loss coaching. A multi-institution team of researchers hypothesized, however, that mobile technology might make such frequent contacts more feasible for both physicians and patients. To test this, the team conducted a randomized trial comparing a standard intensive weight loss program with a standard treatment program augmented with use of a personal digital assistant (PDA) for tracking and feedback from a clinician. They found that the group that used the PDAs lost 3.1% (on average 3.9-kg) more weight than the standard weight loss program group over the course of the 12-month–long study and were more likely to achieve the goal of losing 5% of their baseline weight over the course of the study.
Bonnie Spring, PhD, professor of preventive medicine at Northwestern University and director of the Center for Behavior and Health, discussed the team’s findings with news@JAMA.
news@JAMA: Why do you think the PDA-assisted group lost more weight?
Dr Spring: I don’t think it’s magic; it just gives us a platform to deliver effective care. One of the most effective ways to lose weight is self-tracking, but people hate to do it. We know that immediate reinforcement helps you to do it. In a typical weight loss program, you basically have to wait a week to go to the dietician to get feedback. With this technology, you enter the information and it gives you feedback right away. It makes it reinforcing to track what you are doing. Another huge part of a successful weight loss program is supportive accountability. We all know what we are supposed to be doing, but we need support to do it. One of the most important parts of the digital intervention is that people know their data is going to be uploaded to a coach.
news@JAMA: Is some of the personal element lost in this approach?
Dr Spring: Something that is really important and unusual about what we do is that we don’t use the technology alone. We help people self monitor and help them connect with a support person about how to get back on track when they are falling off the wagon.
news@JAMA: How clinically relevant is the weight loss difference between the 2 groups?
Dr Spring: The patients using the technology who attended 80% of the in-person sessions had about a 15-pound weight loss. We like to say a weight loss of about 5% of starting body weight is meaningful. In the mobile group, your odds of losing 5% of your body weight were about 6 times greater than if you were in the comparison group.
news@JAMA: The study participants were primarily older men with less than a college degree who received care within the Veterans Administration health system. Do you think the results would be generalizable to other groups?
Dr Spring: What is remarkable is that we have almost no literature on weight loss in men. We think it is difficult for men to lose weight, and we tend to think older people are hesitant to use technology. These are not people who had PalmPilots at the time of study enrollment; in fact, only 1 of the participants had ever seen one. These were older folks, and not particularly technologically literate, and they did just fine.
news@JAMA: Do you think a similar approach could be used in a private primary care setting?
Dr Spring: Absolutely. And it would help physicians to have a positive impact on the weight of more of their patients.
news@JAMA: How do you think this study helps advance our understanding of what makes a successful weight loss intervention?
Dr Spring: One thing that is quite important is that now we have a clinical trial that gives the kind of evidence we want to see for a digital health application. Apps for weight loss are proliferating, but we don’t have any evidence they work. I don’t know whether the app alone without the connectivity to clinicians would work. But linking the app with in-person education and clinicians works.