mHealth Journal Club
Article Name: Integrating Technology Into Standard Weight Loss Treatment
Authors: Bonnie Spring, Jennifer M. Duncan, Amy Janke, Andrea T. Kozak, et al.
Journal Published: Archives of Internal Medicine
Date Published: December 10, 2012 (Online First)
Spring B, Duncan JM, Janke EA, et al. Integrating Technology Into Standard Weight Loss Treatment: A Randomized Controlled Trial. Arch Intern Med. 2012;:1-7.
The US Preventative Services Task Force recommends intensive behavioral treatment for obese adults due to evidence demonstrating that weight loss is more profound within the first year.
That being the case, the logistics of providing behavioral treatment is time consuming for primary providers and has been supplanted by additional help from interprofessional care. Taking this further, evidence is becoming apparent that technology can also be utilized to reduce the logistical hamper of face-to-face treatment in favor of treatment at the point-of-time care (e.g. during meals and exercise).
That being the case, the question becomes whether technology supported weight loss interventions, as a supplement to standard-of-care, is any better.
To determine whether a ‘connective mobile technology system, telephone coaching, and the standard-of-care obesity treatment improved weight loss’ when compared to standard-of-care alone.
- Conducted from October 1, 2007 through September 31, 2010 at a Midwestern Hospital
- Inclusion Criteria: BMI between 25 and 40, weight less than 181.4kg (about 400Lbs), and able to perform moderate-intensity physical exercise.
- Exclusion Criteria: recent psychiatric hospitalization, current substance abuse, binge eating disorder, or severe mood disorder.
- Randomization was accomplished by pre-screening candidates fluency in technology and their ability to record personal data via a PDA for 2 weeks. Those who demonstrated a level of adherence were then detailed the pros and cons of both arms of the trial to determine interest in final participation.
- Computer generated randomization was then conducted to place in 1 of 2 groups:
- Standard-of-Care using the VA Hospitals MOVE! (Group 1)
- Standard-of-Care plus connective mobile technology system (Group 2)
- 6-month intervention
- Group 1 attended biweekly MOVE! session with goal 5-10% weight loss and educated on weight loss through diet and exercise.
- Group 2 did the same as Group 1 plus recorded food intake with caloric ‘Thermometer’ to self-regulate intake recorded via PDA. Professional coach also telephoned participants every 2 weeks for personalized care. PDA also detailed physical goals for participants to also meet along with caloric goals personalized based on individual baseline characteristics.
- Maintenance phase of 7-12 months following intervention phase where both groups attended MOVE! sessions but Group 2 still transmitted data.
- 1371 assessed and contacted for eligibility for inclusion in the study. 70 participants were randomized, and 1 withdrew consent.
- Of the 69 participants, 59 were men (85.5%), and a mean age of 57.7 (range 28-86 years; median 60 years)
- Men Baseline mean weight of 114.3 kg with mean BMI of 36.3. No difference in weight between either participant group.
- Group 2 lost a mean of 3.9kg (3.1%) more than Group 2 (95% CI, 2.2-5.5kg) over all contact times measurements.
- At 12 months, Group 2 still had lost more weight than Group 1 (Group 2: 2.9 kg; 95% CI, 0.5 to 6.2 kg; Group 1: −0.02 kg; 95% CI, −2.1 to 2.1 kg).
- Results demonstrated that Group 2 had an increased odds of losing 5% than Group 1 over all time points (odds ratio, 6.5; 95% CI, 2.5-18.6).
- Individuals that attended MOVE! had a greater likelihood of losing weight than others in the same groups
The authors concluded that the study “highlights the use of mobile technology as a scalable, cost-effective means to augment physician-directed weight loss treatment.”
Commentary & Implication to mHealth
This study, while small, has large implications for the movement of mHealth and management of chronic conditions. Concentrating specifically in weight loss, this study demonstrated that the integration of mobile technology allowed practitioners to set patient-specific goals to be followed by patients and then related back to practitioners to make guided therapeutic decisions.
While the study concentrated on two mechanics (1) PDA caloric intake and activity guide, (2) Phone call directed care, this can all be conducted vial modern smartphones. This leads me to then wonder if similar results would be seen if a mobile app was constructed around these premises that does both functions.
However, several limitations must be emphasized for developers and researchers seeking to test this idea. This study was conducted within the VA system, renowned for their large support network already in place. The study also screened for users ability to use mobile technology and did not educate users specifically in use to be integrated in the study. Both arms of the trial were engaged with the MOVE! Program, and had outside support. Future researchers need to address how to integrate a similar program within an app or some form of supplemental support outside of just using an app to drive goals for a patient to achieve without a means of letting them know how and why.