Effect of a mobile app intervention on vegetable consumption in overweight adults: a randomized controlled trial

Sarah Mummah, Thomas N Robinson, Maya Mathur, Sarah Farzinkhou, Stephen Sutton, Christopher D Gardner, Sarah Mummah, Thomas N Robinson, Maya Mathur, Sarah Farzinkhou, Stephen Sutton, Christopher D Gardner

Abstract

Background: Mobile applications (apps) have been heralded as transformative tools to deliver behavioral health interventions at scale, but few have been tested in rigorous randomized controlled trials. We tested the effect of a mobile app to increase vegetable consumption among overweight adults attempting weight loss maintenance.

Methods: Overweight adults (n=135) aged 18-50 years with BMI=28-40 kg/m2 near Stanford, CA were recruited from an ongoing 12-month weight loss trial (parent trial) and randomly assigned to either the stand-alone, theory-based Vegethon mobile app (enabling goal setting, self-monitoring, and feedback and using "process motivators" including fun, surprise, choice, control, social comparison, and competition) or a wait-listed control condition. The primary outcome was daily vegetables servings, measured by an adapted Harvard food frequency questionnaire (FFQ) 8 weeks post-randomization. Daily vegetable servings from 24-hour dietary recalls, administered by trained, certified, and blinded interviewers 5 weeks post-randomization, was included as a secondary outcome. All analyses were conducted according to principles of intention-to-treat.

Results: Daily vegetable consumption was significantly greater in the intervention versus control condition for both measures (adjusted mean difference: 2.0 servings; 95% CI: 0.1, 3.8, p=0.04 for FFQ; and 1.0 servings; 95% CI: 0.2, 1.9; p=0.02 for 24-hour recalls). Baseline vegetable consumption was a significant moderator of intervention effects (p=0.002) in which effects increased as baseline consumption increased.

Conclusions: These results demonstrate the efficacy of a mobile app to increase vegetable consumption among overweight adults. Theory-based mobile interventions may present a low-cost, scalable, and effective approach to improving dietary behaviors and preventing associated chronic diseases.

Trial registration: ClinicalTrials.gov NCT01826591. Registered 27 March 2013.

Keywords: Behavior change; Design thinking; Diet; Digital; Mobile; Nutrition; Smartphone; User-centered design; Vegetables; mHealth.

Conflict of interest statement

Ethics approval and consent to participate

This research was approved by the Panel on Human Subjects in Medical Research (#22305) at Stanford University, Stanford, CA, USA. All participants provided written informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
CONSORT flow diagram
Fig. 2
Fig. 2
Changes in daily vegetable consumption. Mean ± SE, n = 135. Measured by FFQ (baseline to 8 weeks, solid lines) and 24-h recalls (baseline to 5 weeks, dashed lines)
Fig. 3
Fig. 3
Frequency of vegetable logging among intervention condition. n = 511. Participants sorted in decreasing order of logging frequency. 1Figure excludes 17 participants who did not log

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