Abstract
This study evaluated feasibility and acceptability of adding energy balance modeling displayed on weight graphs combined with a wrist-worn bite counting sensor against a traditional online behavioral weight loss program. Adults with a BMI of 27–45 kg/m2 (83.3% women) were randomized to receive a 12-week online behavioral weight loss program with 12 weeks of continued contact (n = 9; base program), the base program plus a graph of their actual and predicted weight change based on individualized physiological parameters (n = 7), or the base program, graph, and a Bite Counter device for monitoring and limiting eating (n = 8). Participants attended weekly clinic weigh-ins plus baseline, midway (12 weeks), and study culmination (24 weeks) assessments of feasibility, acceptability, weight, and behavioral outcomes. In terms of feasibility, participants completed online lessons (M = 7.04 of 12 possible lessons, SD = 4.02) and attended weigh-ins (M = 16.81 visits, SD = 7.24). Six-month retention appears highest among nomogram participants, and weigh-in attendance and lesson completion appear highest in Bite Counter participants. Acceptability was sufficient across groups. Bite Counter use (days with ≥ 2 eating episodes) was moderate (47.8%) and comparable to other studies. Participants lost 4.6% ± 4.5 of their initial body weight at 12 weeks and 4.5% ± 5.8 at 24 weeks. All conditions increased their total physical activity minutes and use of weight control strategies (behavioral outcomes). Although all groups lost weight and the study procedures were feasible, acceptability can be improved with advances in the technology. Participants were satisfied with the online program and nomograms, and future research on engagement, adherence, and integration with other owned devices is needed. ClinicalTrials.gov Identifier: NCT02857595
Highlights
Online behavioral weight loss programs, while not always as efficacious as gold standard in-person treatment, often produce clinically relevant weight losses and are increasingly utilized as a scalable means of intervention (Neve et al 2010)
Utilized as a scalable means of intervention (Neve et al 2010). Participants completing these programs may be susceptible to suboptimal weight loss if they fail to adhere to recommendations for a reduced-calorie diet, physical activity, and self-monitoring
This study found that both the Bite Counter and manual tracking via app produced clinically significant weight loss when combined with educational podcasts, though participants that received the Bite Counter lost less weight than the smartphone app group but achieved greater physical activity (Turner-McGrievy et al 2017b)
Summary
Online behavioral weight loss programs, while not always as efficacious as gold standard in-person treatment, often produce clinically relevant weight losses and are increasingly. One strategy to harness data visualization as a more powerful behavior change tool is to involve nomograms (i.e., graphs) that depict expected weight change produced via caloric restriction (Martin et al 2016; Martin et al 2015) These nomograms are shaped by a validated dynamic mathematical model that predicts weight change based on an individual’s personalized parameters including age, sex, and daily calorie goals (Martin et al 2015; Thomas 2013). The DIET Mobile study provides preliminary evidence that the Bite Counter, combined with personalized bite goals, may support clinically meaningful weight loss across the typical length of an effective behavioral weight loss program. The combination of the nomogram and Bite Counter has potential to provide timely, personalized feedback It is unknown if combining these strategies is feasible and acceptable to individuals participating in online weight loss programs. We present descriptive information of our primary and secondary outcomes across all three study conditions
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