Effects of an abbreviated obesity intervention supported by mobile technology: The ENGAGED randomized clinical trial

Bonnie Spring, Christine A Pellegrini, Angela Pfammatter, Jennifer M Duncan, Alex Pictor, H Gene McFadden, Juned Siddique, Donald Hedeker, Bonnie Spring, Christine A Pellegrini, Angela Pfammatter, Jennifer M Duncan, Alex Pictor, H Gene McFadden, Juned Siddique, Donald Hedeker

Abstract

Objective: To determine the effects on weight loss of three abbreviated behavioral weight loss interventions with and without coaching and mobile technology.

Methods: A randomized controlled efficacy study of three 6-month weight loss treatments was conducted in 96 adults with obesity: 1) self-guided (SELF), 2) standard (STND), or 3) technology-supported (TECH). STND and TECH received eight in-person group treatment sessions. SELF and STND used paper diaries to self-monitor diet, activity, and weight; TECH used a smartphone application with social networking features and wireless accelerometer.

Results: Weight loss was greater for TECH and STND than SELF at 6 months (-5.7 kg [95% confidence interval: -7.2 to -4.1] vs. -2.7 kg [95% confidence interval: -5.1 to -0.3], P < 0.05) but not 12 months. TECH and STND did not differ except that more STND (59%) than TECH (34%) achieved ≥ 5% weight loss at 6 months (P < 0.05). Self-monitoring adherence was greater in TECH than STND (P < 0.001), greater in both interventions than SELF (P < 0.001), and covaried with weight loss (r(84) = 0.36-0.51, P < 0.001).

Conclusions: Abbreviated behavioral counseling can produce clinically meaningful weight loss regardless of whether self-monitoring is performed on paper or smartphone, but long-term superiority over standard of care self-guided treatment is challenging to maintain.

Trial registration: ClinicalTrials.gov NCT01051713.

Conflict of interest statement

Disclosures: BS serves on scientific advisory boards for Actigraph and Arivale. The other authors declare that they have no conflicts of interest to disclose.

© 2017 The Obesity Society.

Figures

Figure 1
Figure 1
Flow of Participants Through the ENGAGED Study
Figure 2
Figure 2
ENGAGED Intervention and Assessment Timeline
Figure 3
Figure 3
Percent Weight Change at 3, 6, and 12 Months by Intervention Condition

References

    1. Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA. 2012;307(5):491–497.
    1. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403.
    1. Cramer JS, Sibley RF, Bartlett DP, Kahn LS, Loffredo L. An adaptation of the diabetes prevention program for use with high-risk, minority patients with type 2 diabetes. Diabetes Educ. 2007;33(3):503–508.
    1. ter Bogt NC, Bemelmans WJ, Beltman FW, Broer J, Smit AJ, van der Meer K. Preventing weight gain: one-year results of a randomized lifestyle intervention. Am J Prev Med. 2009;37(4):270–277.
    1. Pellegrini CA, Duncan JM, Moller AC, et al. A smartphone-supported weight loss program: design of the ENGAGED randomized controlled trial. BMC public health. 2012;12(1):1041.
    1. Spring B, Gotsis M, Paiva A, Spruijt-Metz D. Healthy apps: mobile devices for continuous monitoring and intervention. IEEE pulse. 2013;4(6):34–40.
    1. Smith A. Pew Research Center: US Smartphone Use in 2015. . Accessed June 27, 2016.
    1. Coons MJ, DeMott A, Buscemi J, et al. Technology interventions to curb obesity: a systematic review of the current literature. Curr Cardiovasc Risk Rep. 2012;6:120–134.
    1. Appel LJ, Clark JM, Yeh HC, et al. Comparative effectiveness of weight-loss interventions in clinical practice. N Engl J Med. 2011;365(21):1959–1968.
    1. Carver C, Scheier M. Attention and Self-Regulation: A Control Theory Approach to Human Behavior. New York: Springer-Verlag; 1981.
    1. Spring B, Duncan JM, Janke EA, et al. Integrating technology into standard weight loss treatment: a randomized controlled trial. JAMA Intern Med. 2013;173(2):105–111.
    1. Spring B, Schneider K, McFadden HG, et al. Multiple behavior changes in diet and activity: a randomized controlled trial using mobile technology. Arch Intern Med. 2012;172(10):789–796.
    1. Marsch LA, Lord SE, Dallery J. Behavioral Healthcare and Technology. New York, NY: Oxford University Press; 2014.
    1. Kullgren JT, Troxel AB, Loewenstein G, et al. Individual- versus group-based financial incentives for weight loss: a Randomized, Controlled Trial. Ann Intern Med. 2013;158(7):505–514.
    1. Ashrafian H, Toma T, Harling L, Kerr K, Athanasiou T, Darzi A. Social networking strategies that aim to reduce obesity have achieved significant although modest results. Health Aff. 2014;33(9):1641.
    1. Poncela-Casasnovas J, Spring B, McClary D, et al. Social embeddedness in an online weight management programme is linked to greater weight loss. J Roy Soc Interface. 2015;12:20140686.
    1. Ma J, Yank V, Xiao L, et al. Translating the Diabetes Prevention Program lifestyle intervention for weight loss into primary care: a randomized trial. JAMA Intern Med. 2013;173(2):113–121.
    1. Rao G, Kirley K. The future of obesity treatment: comment on “integrating technology into standard weight loss treatment: a randomized controlled trial”. JAMA Intern Med. 2013;173(2):111–112.
    1. U.S. Preventive Services Task Force. Final update summary. Obesity in Adults: Screening and Management. 2016 . Accessed September 12, 2016.
    1. Wing RR. Behavioral weight control. In: Wadden TA, Stunkard AJ, editors. Handbook of Obesity Treatment. New York: Guilford Press; 2002. pp. 301–316.
    1. Burke LE, Conroy MB, Sereika SM, et al. The effect of electronic self-monitoring on weight loss and dietary intake: a randomized behavioral weight loss trial. Obesity (Silver Spring) 2011;19(2):338–344.
    1. Goldberg JH, Kiernan M. Innovative techniques to address retention in a behavioral weight-loss trial. Health Educ Res. 2005;20(4):439–447.
    1. Netzer C. The complete book of food counts. 7th. New York: Dell Pub; 2006.
    1. Kramer MK, Kriska AM, Venditti EM, et al. Translating the Diabetes Prevention Program: a comprehensive model for prevention training and program delivery. Am J Prev Med. 2009;37(6):505–511.
    1. Eaglehouse YL, Schafer GL, Arena VC, Kramer MK, Miller RG, Kriska AM. Impact of a community-based lifestyle intervention program on health-related quality of life. Qual Life Res. 2016;25(8):1903–1912.
    1. Ryan D, Heaner M. Guidelines (2013) for managing overweight and obesity in adults. Preface to the full report. Obesity. 2014;22(Suppl 2):S1–3.
    1. Hedeker D, Gibbons RD. Longitudinal Data Analysis. New York: Wiley; 2006.
    1. Hernan WH, Brandle M, Zhang P, et al. Costs associated with the primary prevention of type 2 diabetes mellitus in the diabetes prevention program. Diabetes Care. 2003;26(1):36–47.
    1. Ross KM, Wing RR. Impact of newer self-monitoring technology and brief phone-based intervention on weight loss: A randomized pilot study. Obesity. 2016;24(8):1653–1659.
    1. Wing RR, Lang W, Wadden TA, et al. Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes Care. 2011;34(7):1481–1486.
    1. Pi-Sunyer X, Blackburn G, Brancati FL, et al. Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the look AHEAD trial. Diabetes Care. 2007;30(6):1374–1383.
    1. Finkelstein E, Haaland B, Bilger M, et al. Effectiveness of activity trackers with and without incentives to increase physical activity (TRIPPA): a randomised controlled trial. Lancet Diabetes Endocrinol. 2016;4(12):983–995.
    1. Elfhag K, Rössner S. Who succeeds in maintaining weight loss? A conceptual review of factors associated with weight loss maintenance and weight regain. Obes Rev. 2005;6(1):67–85.
    1. Jakicic JM, Davis KK, Rogers RJ, et al. Effect of wearable technology combined with a lifestyle intervention on long-term weight loss: the idea randomized clinical trial. JAMA. 2016;316(11):1161–1171.
    1. Hutchesson MJ, Rollo ME, Callister R, Collins CE. Self-monitoring of dietary intake by young women: online food records completed on computer or smartphone are as accurate as paper-based food records but more acceptable. J Acad Nutr Diet. 2015;115(1):87–94.
    1. Young MD, Morgan PJ, Plotnikoff RC, Callister R, Collins CE. Effectiveness of male-only weight loss and weight loss maintenance interventions: a systematic review with meta-analysis. Obes Rev. 2012;13(5):393–408.
    1. Pellegrini CA, Verba SD, Otto AD, Helsel DL, Davis KK, Jakicic JM. The comparison of a technology-based system and an in-person behavioral weight loss intervention. Obesity. 2012;20(2):356–363.
    1. Turner-McGrievy GM, Beets MW, Moore JB, Kaczynski AT, Barr-Anderson DJ, Tate DF. Comparison of traditional versus mobile app self-monitoring of physical activity and dietary intake among overweight adults participating in an mHealth weight loss program. J Am Med Inform Assoc. 2013;20(3):513–518.
    1. Allen JK, Stephens J, Patel A. Technology-assisted weight management interventions: systematic review of clinical trials. Telemed J E Health. 2014;20(12):1103–1120.
    1. Svetkey LP, Batch BC, Lin P-H, et al. Cell phone intervention for you (CITY): A randomized, controlled trial of behavioral weight loss intervention for young adults using mobile technology. Obesity. 2015;23(11):2133–2141.

Source: PubMed

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