Assessment of the Efficacy, Safety, and Effectiveness of Weight Control and Obesity Management Mobile Health Interventions: Systematic Review.

Elisa Puigdomenech Puig,Mariona Balfegó,Alberto Zamora,Montse Moharra,Noemí Robles,Carme Carrion,Guillem Cuatrecasas Cambra,Francesc Saigí-Rubió,Guillermo Paluzie,Pilar Garcia-Lorda

doi:10.2196/12612

Abstract

BackgroundThe use of apps to tackle overweight and obesity by tracking physical and dietary patterns and providing recommendations and motivation strategies to achieve personalized goals has increased over recent years. However, evidence of the efficacy, effectiveness, and safety of these apps is severely lacking.ObjectiveThe aim of this study was to identify efficacy, safety, and effectiveness criteria used to assess weight control, overweight, and obesity management in mobile health (mHealth) interventions through a systematic review.MethodsPubMed, PsycINFO, Scopus, UK Trial Database, ClinicalTrials.gov, and the Cochrane Library were surveyed up to May 2018. All types of clinical studies were considered. A total of 2 independent reviewers assessed quality using Scottish Intercollegiate Guidelines Network (SIGN) criteria. Ratings were used to provide an overall score for each study (low, moderate, or high). Data were synthesized in evidence tables.ResultsFrom 233 potentially relevant publications, only 28 studies were included. Of these, 13 (46%) were randomized control trials, 11 were single-arm studies (39%), 3 were nonrandomized controlled trials (11%), and 1 study was a cluster randomized trial (4%). The studies were classified as low (15), high (7), and moderate (6) quality according to SIGN criteria. All studies focused on efficacy, with only 1 trial mentioning safety and another 1 effectiveness. In 11 studies, the apps were used as stand-alone interventions, the others were multicomponent studies that included other tools for support such as sensors or websites. The main management tool included in the apps was feedback messaging (24), followed by goal-setting mechanisms (20) and self-monitoring (19). The majority of studies took weight or body mass index loss as the main outcome (22) followed by changes in physical activity (14) and diet (12). Regarding outputs, usability, adherence, and engagement (17) were the most reported, followed by satisfaction (7) and acceptability (4).ConclusionsThere is a remarkable heterogeneity among these studies and the majority have methodological limitations that leave considerable room for improvement. Further research is required to identify all relevant criteria for assessing the efficacy of mHealth interventions in the management of overweight and obesity.Trial RegistrationPROSPERO CRD42017056761; https://tinyurl.com/y2zhxtjx

Highlights

BackgroundObesity and overweight are considered major public health concerns because of their high prevalence and association with various health complications including cardiovascular disease, type 2 diabetes, and cancer [1,2]
Further research is required to identify all relevant criteria for assessing the efficacy of mobile health (mHealth) interventions in the management of overweight and obesity
The aim of this paper was to undertake a systematic review of efficacy, safety, and effectiveness assessment criteria in use, including both outputs and outcomes, to assess weight control, overweight, and obesity management in mHealth interventions

Summary

Introduction

BackgroundObesity and overweight are considered major public health concerns because of their high prevalence and association with various health complications including cardiovascular disease, type 2 diabetes, and cancer [1,2]. Mobile health (mHealth) can play an important adjuvant role in the prevention and treatment of overweight and obesity by tracking physical activity (PA), enabling self-reporting of dietary patterns, providing recommendations to achieve healthier habits, guidance, advice, tips, and motivational strategies to achieve personalized goals; all are relevant aspects for the prevention and treatment of obesity, as recognized in numerous guidelines [3,4]. Numerous efforts to address this challenging issue are underway and some aspects that may be linked to a lack of efficacy have been identified These are, among others, the poor quality of many apps, a lack of guidance on the usefulness of an app, and a low level of support from health professionals [12,13]. The use of apps to tackle overweight and obesity by tracking physical and dietary patterns and providing recommendations and motivation strategies to achieve personalized goals has increased over recent years. Evidence of the efficacy, effectiveness, and safety of these apps is severely lacking

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