Abstract
BackgroundSome guidelines state that in-person weight management interventions are more efficacious than those delivered digitally. However, digital programs are more scalable and accessible. We hypothesized that one-on-one health coaching via app-based video chat would simulate an in-person experience and help achieve outcomes comparable to those of in-person interventions.MethodsA 12-month digital weight management intervention was provided to overweight or obese adults recruited from a large technology company. One-on-one health coaching sessions were offered during a 24-week intensive phase as well as subsequent maintenance phase. Focused on sustainable changes in activity and diet, the intervention incorporates SMART goals, in-app food and activity logs, Fitbit integration, as well as optional sleep and stress modules. Self-Determination Theory and the Transtheoretical Model are incorporated to drive behavior change. Multilevel mixed-effects models were used to analyze weight changes retrospectively.ResultsSix hundred eighty-three participants reported 29,051 weights. At 12 months, mean percent changes in body weight were -7.2% and -7.6% for overweight and obese groups, respectively. A weight change of -5% is commonly targeted for in-person weight management interventions. Observed weight loss exceeded this target by 2.2% (95% CI, 0.7% to 3.8%; P < .01) for the overweight group and 2.6% (95% CI, 1.4% to 3.9%; P < .01) for the obese group.ConclusionsFurther research is needed with randomization to in-person or digital interventions. Though limited by an observational, retrospective design, preliminary results suggest that some digital weight management programs with one-on-one coaching may achieve outcomes comparable to those of robust, in-person interventions.
Highlights
Obesity continues to show epidemic prevalence levels in the United States; estimates using non-self-reported data from 2015–16 suggest that 40% of U.S adults are living with obesity, while 32% are overweight [1,2]
A weight change of -5% is commonly targeted for in-person weight management interventions
Observed weight loss exceeded this target by 2.2% for the overweight group and 2.6% for the obese group
Summary
Obesity continues to show epidemic prevalence levels in the United States; estimates using non-self-reported data from 2015–16 suggest that 40% of U.S adults are living with obesity, while 32% are overweight [1,2]. Innovative, scalable intervention strategies are needed to treat and prevent obesity in the United States population. Evidence-based digital health interventions (DHIs) are one tool that has received increased attention recently as a population health management strategy to help control the obesity epidemic [7]. Often delivered through smartphone apps, web platforms, or both, DHIs can incorporate a variety of program components that may support patients’ efforts to achieve sustained behavior changes and manage chronic conditions. DHI components can include food logs, physical activity tracking tools, evidence-based goal setting exercises, educational activities, and integration with devices (activity trackers, sleep trackers, glucometers, etc.), to name a few. Some guidelines state that in-person weight management interventions are more efficacious than those delivered digitally. We hypothesized that one-on-one health coaching via app-based video chat would simulate an in-person experience and help achieve outcomes comparable to those of in-person interventions
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