Abstract
Mobile health (mHealth) interventions are ubiquitous and effective treatment options for obesity. There is a widespread assumption that the mHealth interventions will be equally effective in other locations. In an initial test of this assumption, this retrospective study assesses weight loss and engagement with an mHealth behavior change weight loss intervention developed in the United States (US) in four English-speaking regions: the US, Australia and New Zealand (AU/NZ), Canada (CA), and the United Kingdom and Ireland (UK/IE). Data for 18,459 participants were extracted from the database of Noom's Healthy Weight Program. Self-reported weight was collected every week until program end (week 16). Engagement was measured using user-logged and automatically recorded actions. Linear mixed models were used to evaluate change in weight over time, and ANOVAs evaluated differences in engagement. In all regions, 27.2–33.2% of participants achieved at least 5% weight loss by week 16, with an average of 3–3.7% weight loss. Linear mixed models revealed similar weight outcomes in each region compared to the US, with a few differences. Engagement, however, significantly differed across regions (P < 0.001 on 5 of 6 factors). Depending on the level of engagement, the rate of weight loss over time differed for AU/NZ and UK/IE compared to the US. Our findings have important implications for the use and understanding of digital weight loss interventions worldwide. Future research should investigate the determinants of cross-country engagement differences and their long-term effects on intervention outcomes.
Highlights
While initially concentrated in the United States, obesity has become a pervasive health concern for countries around the world [1]
Baseline body mass index (BMI) differed across regions (P < 0.001), ranging from a mean BMI of 30.27 (SD = 4.59) in the United States (US) and 30.14 (SD = 4.56) in Canada to 29.46 (SD = 3.62) in AU/NZ and 29.47 (SD = 4.13) in United Kingdom and Ireland (UK/IE)
As hypothesized, our findings showed that the Noom program generated comparable significant weight loss in the United States, the United Kingdom and Ireland, Canada, and Australia and New Zealand
Summary
While initially concentrated in the United States, obesity has become a pervasive health concern for countries around the world [1]. There are, significant barriers limiting the success of traditional inperson interventions Because they are timeintensive and costly, they face declining attendance rates, adherence, and decreased weight loss outcomes [6]. To overcome these barriers, mobile health (mHealth) interventions are commonly delivered via mobile platforms. MHealth interventions save time and travel costs with textbased messaging and in-app education and features They have been found to induce significant weight loss, as well as other beneficial outcomes such as increased physical activity and improved biomarkers for risk factors of obesity [7, 8]. They have been found to induce significant weight loss, as well as other beneficial outcomes such as increased physical activity and improved biomarkers for risk factors of obesity [7, 8]. mHealth interventions use technology to increase adherence and improve outcomes in ways that traditional in-person care cannot, such as text message support at the time that best suits individuals [9]
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