Comparison of Smartphone-Based Behavioral Obesity Treatment With Gold Standard Group Treatment and Control: A Randomized Trial
J Graham Thomas, Dale S Bond, Hollie A Raynor, George D Papandonatos, Rena R Wing, J Graham Thomas, Dale S Bond, Hollie A Raynor, George D Papandonatos, Rena R Wing
Abstract
Objective: This study aimed to determine whether weight losses from a primarily smartphone-based behavioral obesity treatment (SMART) differed from those of a more intensive group-based behavioral obesity treatment (GROUP) and a control condition (CONTROL).
Methods: A total of 276 adults with overweight/obesity were randomly assigned to 18 months of GROUP-based treatment with meetings weekly for 6 months, meetings biweekly for 6 months, and meetings monthly for 6 months and self-monitoring via paper diaries with written feedback; SMART-based treatment with online lessons, self-monitoring, and feedback plus monthly weigh-ins; or a CONTROL condition with self-monitoring via paper diaries with written feedback and monthly weigh-ins.
Results: Among the 276 participants (17% men; 7.2% minority; mean [SD] age: 55.1 [9.9] years; weight: 95.9 [17.0] kg; BMI: 35.2 [5.0] kg/m2 ), 18-month retention was significantly higher in both GROUP (83%) and SMART (81%) compared with CONTROL (66%). Estimated mean (95% CI) weight change over 18 months did not differ across the three conditions: 5.9 kg (95% CI: 4.5-7.4) in GROUP, 5.5 kg (95% CI: 3.9-7.1) in SMART, and 6.4 kg (95% CI: 3.7-9.2) in CONTROL.
Conclusions: Mobile online delivery of behavioral obesity treatment can achieve weight loss outcomes that are at least as good as those obtained via the more intensive gold standard group-based approach.
Trial registration: ClinicalTrials.gov NCT01724632.
Conflict of interest statement
Disclosure: The authors declare no conflict of interest.
© 2019 The Obesity Society.
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References
- Alamuddin N, Wadden TA. Behavioral treatment of the patient with obesity. Endocrinol Metab Clin North Am 2016;45:565–80.
- Magkos F, Fraterrigo G, Yoshino J, et al. Effects of moderate and subsequent progressive weight loss on metabolic function and adipose tissue biology in humans with obesity. Cell Metab 2016;23(4):591–601.
- Font-Burgada J, Sun B, Karin M. Obesity and cancer: The oil that feeds the flame. Cell Metab 2016;23(1):48–62.
- 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):1481–6.
- Tate DF, Finkelstein EA, Khavjou O, Gustafson A. Cost effectiveness of Internet interventions: Review and recommendations. Ann Behav Med 2009;38(1):40–5.
- Tsai AG, Asch DA, Wadden TA. Insurance coverage for obesity treatment. J Am Diet Assoc 2006;106(10):1651–5.
- Manzoni GM, Pagnini F, Corti S, Molinari E, Castelnuovo G. Internet-based behavioral interventions for obesity: an updated systematic review. Clin Pract Epidemiol Ment Health 2011;7:19–28.
- Nguyen B, Kornman KP, Baur LA. A review of electronic interventions for prevention and treatment of overweight and obesity in young people. Obes Rev 2011;12:e298–314.
- Stephens J, Allen J. Mobile phone interventions to increase physical activity and reduce weight: a systematic review. J Cardiovasc Nurs 2013;28:320–9.
- Harvey-Berino J, West D, Krukowski R, et al. Internet delivered behavioral obesity treatment. Prev Med 2010;51:123–8.
- Baker RC, Kirschenbaum DS. Self-monitoring may be necessary for successful weight control. Behav Ther 1993;24(3):377–94.
- Burke LE, Wang J, Sevick MA. Self-monitoring in weight loss: A systematic review of the literature. J Am Diet Assoc 2011;111(1):92–102.
- Lieffers JR, Hanning RM. Dietary assessment and self-monitoring with nutrition applications for mobile devices. Can J Diet Pract Res 2012;73(3):e253–60.
- Burke LE, Styn MA, Sereika SM, et al. Using mHealth technology to enhance self-monitoring for weight loss: a randomized trial. Am J Prev Med 2012;43:20–6.
- Thomas S, Reading J, Shephard RJ. Revision of the Physical Activity Readiness Questionnaire (PAR-Q). Can J Sport Sci 1992;17(4):338–45.
- Diabetes Prevention Program (DPP) Research Group. The Diabetes Prevention Program (DPP): Description of lifestyle intervention. Diabetes Care 2002;25(12):2165–71.
- Look AHEAD Research Group. The Look AHEAD study: A description of the lifestyle intervention and the evidence supporting it. Obesity 2006;14(5):737–52.
- Thomas GJ, Wing RR. Health-E-Call, a smartphone-assisted behavioral obesity treatment: pilot study. JMIR Mhealth Uhealth 2013;1:e3.
- Radloff LS. The CES-D scale: A self-report depression scale for research in the general population. Appl Psychol Meas 1977;1(3):385–401.
- Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983;24(4):385–96.
- Stunkard AJ, Messick S. The Three-Factor Eating Questionnaire to measure dietary restraint, disinhibition and hunger. J Psychosom Res 1985;29(1):71–83.
- Gormally J, Black S, Daston S, Rardin D. The assessment of binge eating severity among obese persons. Addict Behav 1982;7(1):47–55.
- Lowe MR, Butryn ML, Didie ER, et al. The Power of Food Scale. A new measure of the psychological influence of the food environment. Appetite 2009;53(1):114–8.
- Paffenbarger RS Jr., Blair SN, Lee IM, Hyde RT. Measurement of physical activity to assess health effects in free-living populations. Med Sci Sports Exer 1993;25(1):60–70.
- Meuter ML, Ostrom AL, Bitner MJ, Roundtree R. The influence of technology anxiety on consumer use and experiences with self-service technologies. J Bus Res 2003;56(11):899–906.
- Hogan JW, Roy J, Korkontzelou C. Handling drop-out in longitudinal studies. Stat Med 2004;23(9):1455–97.
- Ridgeway G Generalized boosted regression models: GBM 2.1 package manual 2014.
- Halekoh U, Højsgaard S, Yan J. The R package geepack for generalized estimating equations. J Stat Softw 2006;15(2):1–11.
- Tate DF, Jackvony EH, Wing RR. A randomized trial comparing human e-mail counseling, computer-automated tailored counseling, and no counseling in an Internet weight loss program. Arch Intern Med 2006;166:1620–5.
- Batsis JA, Bynum JP. Uptake of the centers for medicare and medicaid obesity benefit: 2012–2013. Obesity 2016;24(9):1983–8.
- Grumbach K, Bodenheimer T. Can health care teams improve primary care practice? JAMA 2004;291(10):1246–51.
- Kelly MP, Barker M. Why is changing health-related behaviour so difficult? Public Health 2016;136:109–16.
Source: PubMed