Weight Loss Using a Feedback Device in Obese People With the Metabolic Syndrome

October 22, 2018 updated by: Jeanne Walker, Rockefeller University

What is the Effect of a Feedback Device on Weight Loss and Metabolic Measurements in Obese People With the Metabolic Syndrome?

The purpose of this study is to determine if a weight loss app (VA MOVE!® Coach App) along with regularly scheduled telephone counseling, will motivate obese people with metabolic syndrome to lose weight and improve the symptoms of the metabolic syndrome, compared to usual weight loss approaches. This study will randomly assign participants to one of two groups, interventional or control. The interventional group will use the app with phone coaching and standard of care for weight loss. The control group will receive standard weight loss care without the app and phone coaching. Weight loss motivation to adopt life-style changes to maintain weight loss and quality of life between the two groups will be compared. The metabolic syndrome (MetS) is a cluster of disorders including high blood pressure, pre-diabetes, the tendency to carry body weight around the waist, and increased fat in the blood. When these problems happen together, there is an increased risk for heart attack, stroke, diabetes and certain cancers.

Although the metabolic syndrome is a serious condition, it can be treated with diet, weight loss and increased activity. It can even be reversed using these lifestyle changes. Due to poor success with routine short-term weight loss treatment (group and one-on-one counseling), it is time to address the problem by a different method. Studies have shown feedback devices and weight loss apps have been successful in weight loss and weight maintenance. They are economical (many apps are free), and convenient to use, without attendance at group sessions. Since weight loss is the corner stone for improvement in the symptoms of the MetS, this study will offer a unique approach to support individuals who are committed to losing weight and adopting a healthier lifestyle.

Numerous studies demonstrated that feedback via text messaging, and interaction through social networking support groups, in addition to iPhone apps, are all more effective in weight loss measures than group sessions at a hospital site. (Duncan et al., 2011; Greene, Sacks, Piniewski, Kil, & Hahn, 2012; Shaw et al., 2013; Spring et al., 2013). The benefit of these various methods is that they appear to accelerate weight loss and prevent weight re-gain if employed long-term. With technology changing daily, these approaches must be considered an essential adjunct to, or replacement for, traditional group counselling sessions.

Study Overview

Status

Withdrawn

Conditions

Intervention / Treatment

Detailed Description

Obesity rates in the United States have steadily increased since the 1980's, doubling between 1980 and 2010 from 15.0% to 36.1% (Cefalu et al., 2015). The prevalence rate of obesity in adults in the U.S. in 2014 was 37.7%, according to the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics (Ogden, Carroll, Fryar, & Flegal, 2015) resulting in a rising incidence of type 2 diabetes, heart disease, hypertension, and some cancers (American Society of Clinical Oncology, 2014). Many contributors to the rise in obesity rates are cited in the literature: socio-economic, urbanization, sedentary behavior (Hruby & Hu, 2015), psychological and motivational factors (Byrne, Cooper, & Fairburn, 2003), and ethnicity and gender (Ogden et al., 2015). ). According to research done by The Pew Research Center (DeSilver, 2016), daily caloric intake by the average American in 2010 was 2,481 calories, about 23% more than in 1970.

As research into obesity continues, contributing factors include more than excessive dietary intake and decreased physical activity. Obesity scientists and medical specialists view the disorder as a systemic dynamic involving the brain, gut, liver, adipose tissue, hormones, inflammation, and heredity (Cefalu et al., 2015). The condition, recognized by the American Medical Association as a disease in 2011, resulted in obesity specialists and medical board certification (American Board of Obesity Medicine, ABOM, 2013).

Though considered a disease in itself, obesity is a major contributor to preventable morbidity and mortality, as well as to enormous health care costs (American Nurse Practitioner Foundation, 2013). The estimated cost of obesity and the resultant co-morbidities in the U.S. in 2015 was $190 billion. This figure represented 21% of total U.S. healthcare costs (Hruby & Hu, 2015). Furthermore, the excess cost incurred by obese individuals annually over the non-obese was $1,152 for obese men (for prescription drugs and hospitalizations), and $3,613 for obese women (Hruby & Hu, 2015).

Nearly 35% of all adults and 50% of those over 60 years of age in the United States, have the Metabolic Syndrome (MetS) (Aguilar et al 2015). This is especially disturbing since the population over 60 years of age increases annually, due to the aging of America. Obesity and the MetS are the underlying factors in most of the chronic illnesses prevalent today: diabetes, cancer, inflammatory diseases, reduced immunity, heart disease, stroke, and disability. It is clear that new, pragmatic, cost effective treatment to control the risk factors and resultant morbidity and mortality, caused by this epidemic, must be aggressively investigated. Employing apps developed for mobile phones is an obvious choice, if the data can show evidence that this approach is effective. This is a prime area for nurse practitioners to initiate research and to add to the scientific knowledge of obesity and its sequelae (American Nurse Practitioner Foundation, 2013).

This will be the first study of its kind to examine changes in the metabolic markers of the MetS, body composition and biometrics using a feedback device in the form of a weight loss app. As such, it has the potential to provide clinicians with evidence based, adjunctive treatment for this population. This study will provide the seeds for a longer study to determine the feasibility of using feedback devices to reinforce healthy life styles and continue or maintain the weight loss. In this way, the participant will be able to achieve true health benefits and reduced risks of co-morbidities due to obesity and the MetS. Comparison with a control group will determine if the treatment is more effective than standard of care for this population.

Motivation and readiness to change:

It is important to assess motivation and readiness to change in individuals who wish to achieve significant life style behavior changes (Ceccarini, M., et al., (2015). Studies have shown that risk of disease development can motivate people to adopt new habits. In a randomized study of weight loss in women at high risk for breast cancer, Hartman, et al (2016) found that women at risk of developing breast cancer were motivated to improve health through weight loss. Using weight loss technology (My Fitness Pal) and phone contact, this intervention resulted in greater weight loss that that of the control group. They concluded that combining technology supported by phone counselling was effective in weight loss as a treatment for women at increased risk for breast cancer. There are no current studies of the effect of motivation on weight loss in people with the metabolic syndrome. However, it is plausible that given the risks of developing diabetes or heart disease, these people may be more motivated to use the app and pursue weight loss to prevent complications of the MetS.

Study Type

Interventional

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • New York
      • New York, New York, United States, 10065
        • Rockefeller University

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

40 years to 70 years (Adult, Older Adult)

Accepts Healthy Volunteers

Yes

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • BMI≥30 kg/m2;
  • fasting glucose ≥ 100mg/dl
  • Access to IPhone or Android phone;
  • Willing/able to travel to Rockefeller for all study visits;
  • Able to speak and understand English;
  • Willing to receive weekly phone coaching calls from investigator;
  • Willing to monitor and record daily weight and steps in provided notebook.

At least 2 of the following for women:

  • waist circumference ≥88 cm;
  • Serum triglycerides ≥150mg/dl to ≤ 500mg/dl;
  • HDL cholesterol <50mg/dl;
  • Hypertension: treated or >130/85 mm/hg untreated during screening

At least 2 of the following for men:

  • Waist circumference ≥ 102 cm;
  • Serum triglycerides ≥150mg/dl to ≤ 500mg/dl;
  • HDL cholesterol <40mg/dl;
  • Hypertension: treated or >130/85 mm/hg untreated during screening;

Exclusion Criteria:

  • Diabetes except history of gestational diabetes
  • HgA1C greater than 6.5% at screening;
  • Pregnancy or intent to become pregnant during study participation (women);
  • hypo/hyperthyroidism (based on fasting screening labs);
  • currently on steroid therapy;
  • currently on weight loss medication;
  • history of bariatric weight loss surgery;
  • currently on statin therapy;
  • participation in a formal weight loss program or using another weight loss app;
  • any medical, social or psychological condition that, in the opinion of the investigator, would jeopardize the health or well being of the participant or the integrity of the data.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Health Services Research
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Interventional Cohort

VA MOVE! Coach app: Weight loss using the VA MOVE! Coach weight loss app which presents positive feedback, education in nutrition and portion sizes, coping mechanisms, charts and graphs. App will be used for three months.

Telephone Coaching: Weekly phone coaching will provide further support and assist with problem solving and goal setting for a three month period.

Standard of care for weight loss (the 2013 AHA/ACC/TOS guidelines). Followed for three months.

Pre and post weight loss metabolic measurements will be obtained.
Device: VA MOVE! Coach app
The VA MOVE! Coach app promotes weight loss through positive feedback, nutritional education, calorie counts, graphs, charts, and encourages increased activity. Efforts will be supported through weekly phone coaching.
Behavioral: Telephone Coaching
Weekly Telephone Coaching
Behavioral: Standard of Care for weight loss.

Standard of Care for weight loss (2013 American College of Cardiology/American Heart Association Task Force and The Obesity Society (AHA/ACC/TOS) Report,PubMed Identification: 24222017).

To include:

  • Vioscreen food frequency assessment and bionutritionist consult.
  • Healthy eating nutritional pamphlets (during consult)
  • Decrease daily caloric intake by 500 cal/day
  • Increase in physical activity (goal: 10,000 steps per day - measured by pedometer.)
  • Dietary counseling by Clinician (monthly)
Active Comparator: Control Cohort

Standard of care for weight loss (2013 AHA/ACC/TOS guidelines). Followed for three months.

Pre and post weight loss metabolic measurements will be obtained.
Behavioral: Standard of Care for weight loss.

Standard of Care for weight loss (2013 American College of Cardiology/American Heart Association Task Force and The Obesity Society (AHA/ACC/TOS) Report,PubMed Identification: 24222017).

To include:

  • Vioscreen food frequency assessment and bionutritionist consult.
  • Healthy eating nutritional pamphlets (during consult)
  • Decrease daily caloric intake by 500 cal/day
  • Increase in physical activity (goal: 10,000 steps per day - measured by pedometer.)
  • Dietary counseling by Clinician (monthly)

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in weight
Time Frame: Baseline up to 3 months
Change in weight measured from baseline to end of study participation (3 months). Weight loss app with compliance is expected to result in 2-3 kg loss.
Baseline up to 3 months

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Retention
Time Frame: Baseline up to 3 months
Compare the number of drop outs in each group to determine if there is a difference in motivation to lose weight with the app vs standard of care
Baseline up to 3 months
Change in waist circumference
Time Frame: Baseline up to 3 months
Weight loss is expected to reduce central obesity
Baseline up to 3 months
Change in BMI
Time Frame: Baseline up to 3 months
Weight loss is expected to result in decreased BMI
Baseline up to 3 months
Change in body composition by Bod Pod
Time Frame: Baseline up to 3 months
Weight loss is expected to reduce total fat percentage
Baseline up to 3 months
Change in metabolic parameters
Time Frame: Baseline up to 3 months
Improvement in metabolic markers: serum glucose, triglycerides, lipids, White Blood Count,erythrocyte sedimentation rate
Baseline up to 3 months
Change in blood pressure
Time Frame: Baseline up to 3 months
Reduction in systolic BP
Baseline up to 3 months
Change in hemoglobin-A1C %
Time Frame: Baseline up to 3 months
Weight loss and increased activity is expected to reduce Hemoglobin A1C, and indicator of diabetes
Baseline up to 3 months
Change in motivation to lose weight and adopt healthier lifestyle
Time Frame: Baseline up to 6 months
URICA motivation questionnaire will monitor motivation at baseline, 3, and 6 months
Baseline up to 6 months
Change in quality of life by "SF-12v2" questionnaire
Time Frame: Baseline up to 3 months
Monitor change in perception of quality of life while losing weight
Baseline up to 3 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Rockefeller University

Collaborators

Molloy College

Investigators

  • Principal Investigator: Jeanne Walker, NP, Rockefeller University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Anticipated)

June 1, 2018

Primary Completion (Anticipated)

August 1, 2018

Study Completion (Anticipated)

December 1, 2018

Study Registration Dates

First Submitted

April 2, 2018

First Submitted That Met QC Criteria

April 2, 2018

First Posted (Actual)

April 9, 2018

Study Record Updates

Last Update Posted (Actual)

October 24, 2018

Last Update Submitted That Met QC Criteria

October 22, 2018

Last Verified

October 1, 2018

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • JWA-0967

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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