Technology-based Weight Loss Intervention Research Articles

Impact of EASO/ESPEN-Defined Sarcopenic Obesity Following a Technology-Based Weight Loss Intervention.

Sarcopenic Obesity is the co-existence of increased adipose tissue (obesity) and decreased muscle mass or strength (sarcopenia) and is associated with worse outcomes than obesity alone. The new EASO/ESPEN consensus provides a framework to standardize its definition. This study sought to evaluate whether there are preliminary differences observed in weight loss or physical function in older adults with and without sarcopenic obesity taking part in a multicomponent weight loss intervention using these new definitions. A 6-month, non-randomized, non-blinded, single-arm pilot study was conducted from 2018 to 2020 in adults ≥ 65years with a body mass index (BMI) ≥ 30kg/m2. Weekly dietitian visits and twice-weekly physical therapist-led exercise classes were delivered using telemedicine. We conducted a secondary retrospective analysis of the parent study (n = 53 enrolled, n = 44 completers) that investigated the feasibility of a technology-based weight management intervention in rural older adults with obesity. Herein, we applied five definitions of sarcopenic obesity (outlined in the consensus) to ascertain whether the response to the intervention differed among those with and without sarcopenic obesity. Primary outcomes evaluated included weight loss and physical function (30-s sit-to-stand). In the parent study, mean weight loss was - 4.6kg (95% CI - 3.6, - 5.6; p < 0.001). Physical function measures of 30-s sit-to-stand showed a mean increase of 3.1 in sit-to-stand repetitions (+ 1.9, + 4.3; p < 0.001). In this current analysis, there was a significant decrease in weight and an increase in repetitions between baseline and follow-up within each group of individuals with and without sarcopenia for each of the proposed definitions. However, we did not observe any significant differences in the changes between groups from baseline to follow-up. The potential lack of significant differences in weight loss or physical function between older adults with and without sarcopenic obesity participating in a weight loss intervention may suggest that well-designed, multicomponent interventions can lead to similar outcomes irrespective of sarcopenia status in persons with obesity. Fully powered randomized clinical trials are critically needed to confirm these preliminary results.

Design of experiments with sequential randomizations on multiple timescales: the hybrid experimental design.

Psychological interventions, especially those leveraging mobile and wireless technologies, often include multiple components that are delivered and adapted on multiple timescales (e.g., coaching sessions adapted monthly based on clinical progress, combined with motivational messages from a mobile device adapted daily based on the person's daily emotional state). The hybrid experimental design (HED) is a new experimental approach that enables researchers to answer scientific questions about the construction of psychological interventions in which components are delivered and adapted on different timescales. These designs involve sequential randomizations of study participants to intervention components, each at an appropriate timescale (e.g., monthly randomization to different intensities of coaching sessions and daily randomization to different forms of motivational messages). The goal of the current manuscript is twofold. The first is to highlight the flexibility of the HED by conceptualizing this experimental approach as a special form of a factorial design in which different factors are introduced at multiple timescales. We also discuss how the structure of the HED can vary depending on the scientific question(s) motivating the study. The second goal is to explain how data from various types of HEDs can be analyzed to answer a variety of scientific questions about the development of multicomponent psychological interventions. For illustration, we use a completed HED to inform the development of a technology-based weight loss intervention that integrates components that are delivered and adapted on multiple timescales.

Social Mobile Approaches to Reducing Weight (SMART) 2.0: protocol of a randomized controlled trial among young adults in university settings

BackgroundExcess weight gain in young adulthood is associated with future weight gain and increased risk of chronic disease. Although multimodal, technology-based weight-loss interventions have the potential to promote weight loss among young adults, many interventions have limited personalization, and few have been deployed and evaluated for longer than a year. We aim to assess the effects of a highly personalized, 2-year intervention that uses popular mobile and social technologies to promote weight loss among young adults.MethodsThe Social Mobile Approaches to Reducing Weight (SMART) 2.0 Study is a 24-month parallel-group randomized controlled trial that will include 642 overweight or obese participants, aged 18–35 years, from universities and community colleges in San Diego, CA. All participants receive a wearable activity tracker, connected scale, and corresponding app. Participants randomized to one intervention group receive evidence-based information about weight loss and behavior change techniques via personalized daily text messaging (i.e., SMS/MMS), posts on social media platforms, and online groups. Participants in a second intervention group receive the aforementioned elements in addition to brief, technology-mediated health coaching. Participants in the control group receive a wearable activity tracker, connected scale, and corresponding app alone. The primary outcome is objectively measured weight in kilograms over 24 months. Secondary outcomes include anthropometric measurements; physiological measures; physical activity, diet, sleep, and psychosocial measures; and engagement with intervention modalities. Outcomes are assessed at baseline and 6, 12, 18, and 24 months. Differences between the randomized groups will be analyzed using a mixed model of repeated measures and will be based on the intent-to-treat principle.DiscussionWe hypothesize that both SMART 2.0 intervention groups will significantly improve weight loss compared to the control group, and the group receiving health coaching will experience the greatest improvement. We further hypothesize that differences in secondary outcomes will favor the intervention groups. There is a critical need to advance understanding of the effectiveness of multimodal, technology-based weight-loss interventions that have the potential for long-term effects and widespread dissemination among young adults. Our findings should inform the implementation of low-cost and scalable interventions for weight loss and risk-reducing health behaviors.Trial registrationClinicalTrials.govNCT03907462. Registered on April 9, 2019

Changes in Body Composition in Older Adults after a Technology-Based Weight Loss Intervention.

We conducted a post-hoc analysis of a pre/post, single-arm, nonrandomized, multicomponent weight loss intervention in older adults. Fifty-three older adults aged ≥65 with a body mass index ≥ 30 kg/m2 were recruited to participate in a six-month, remote monitoring and video-conferencing delivered, prescriptive intervention consisting of individual and group-led registered dietitian nutrition and physical therapy sessions. We assessed weight, height, and body composition using a SECA 514 bioelectrical impedance analyzer. Mean age was 72.9±3.9 years (70% female) and all had ≥2 chronic conditions. Of those with complete data (n=30), we observed a 4.6±3.5kg loss in weight, 6.1±14.3kg (1.9%) loss in fat mass, and 0.78±1.69L loss in visceral fat (all p<0.05). Fat-free mass (−3.4kg±6.8, p=0.19), appendicular lean mass (−0.25±1.83, p=0.22), and grip strength (+3.46±7.89, p=0.56) did not significantly change. These variables were preserved after stratifying by 5% weight loss. Our intervention led to significant body and visceral fat loss while maintaining fat-free and appendicular lean muscle mass.Electronic Supplementary MaterialSupplementary material is available for this article at 10.14283/jfa.2022.15 and is accessible for authorized users.

Counselor Efficiency at Providing Feedback in a Technology-Based Behavioral Weight Loss Intervention: Longitudinal Analysis.

BackgroundFeedback for participants’ self-monitoring is a crucial and costly component of technology-based weight loss interventions. Detailed examination of interventionist time when reviewing and providing feedback for online self-monitoring data is lacking.ObjectiveThe aim of this study was to longitudinally examine the time counselors spent providing feedback on participant self-monitoring data (ie, diet, physical activity, weight) in a 12-month technology-based weight loss intervention. We hypothesized that counselors would compose feedback for participants more quickly over time.MethodsThe time the lay counselors (N=10) spent reviewing self-monitoring records and providing feedback to participants via email was longitudinally examined for all counselors across the three years of study implementation. Descriptives were observed for counselor feedback duration across counselors by 12 annual quarters (ie, 3-month periods). Differences in overall duration times by each consecutive annual quarter were analyzed using Wilcoxon-Mann-Whitney tests.ResultsThere was a decrease in counselor feedback duration from the first to second quarter (mean 53 to 46 minutes; P<.001), and from the second to third (mean 46 to 30 minutes; P<.001). A trend suggested a decrease from the third to fourth quarter (mean 30 to 26 minutes; P=.053), but no changes were found in subsequent quarters. Consistent with the hypothesis, counselors may be increasing their efficiency in providing feedback; across 12 months, counselors spent less time reviewing participant self-monitoring and composing feedback (decreasing from mean 53 to 26 minutes).ConclusionsCounselors used increasingly less time to review online self-monitoring data and compose feedback after the initial 9 months of study implementation. Results inform counselor costs for future technology-based behavioral weight loss interventions. For example, regardless of increasing counselor efficiency, 25-30 minutes per feedback message is a high cost for interventions. One possibility for reducing costs would be generating computer-automated feedback.Trial RegistrationClinicalTrials.gov NCT02063178; https://clinicaltrials.gov/ct2/show/NCT02063178

Feasibility and efficacy of a technology-based weight loss intervention program through public-private partnerships in Japan

Feasibility and efficacy of a technology-based weight loss intervention program through public-private partnerships in Japan

Efficacy of A Technology-Based Weight Loss Intervention Program with Public-Private Partnerships − Feasibility to apply functional food ingredients to health promotion measures−

Efficacy of A Technology-Based Weight Loss Intervention Program with Public-Private Partnerships − Feasibility to apply functional food ingredients to health promotion measures−

SMART 2.0: A Multimodal Weight Loss Intervention for Young Adults.

A significant number of young Americans are vulnerable to excess weight gain, especially during the college years. While technology-based weight loss interventions have the potential to be very engaging, short-term approaches showed limited success. In our work we aim to better understand the impact of long-term, multimodal, technology-based weight loss interventions, and study their potential for greater effect among college students. In this paper we lay the basis for our approach towards a multimodal health intervention for young adults: we present formative work based on interviews and a design workshop with 26 young adults. We discuss our intervention at the intersection of user feedback, empirical evidence from previous work, and behavior change theory.

A Randomized, Controlled, Multicenter Study of Technology-Based Weight Loss Interventions among Endometrial Cancer Survivors.

The aim of this study was to test the efficacy of technology-based weight loss interventions for endometrial cancer (EC) survivors with obesity. EC survivors with obesity (n = 196) from three medical centers completed assessments for knowledge of obesity as a risk for EC and interest in weight management. Forty-one women were randomized to a 6-month intervention: telemedicine with Wi-Fi scales, text messaging (texting), or enhanced usual care (EUC). Changes in anthropometrics and psychosocial measures were analyzed. One-third of survey participants lacked awareness that obesity increased the risk of EC, and 40% misclassified their body mass. There were no significant differences in weight loss across interventions (mean = -4.4 kg, SD = 6.5 kg). Telemedicine showed improvements in physical health and cancer-related body image (Ps = 0.04) compared to texting and in sexual functioning compared to EUC (P = 0.03). Total physical activity was increased in EUC compared with telemedicine (P = 0.01), and vigorous physical activity was increased in EUC compared with both interventions (P = 0.01-0.03); walking significantly increased in texting compared with telemedicine (P = 0.02). Technology-based lifestyle interventions in EC survivors with obesity were accessible and resulted in weight loss and improved quality of life. EUC also produced weight loss, demonstrating a potential for beginning weight management with information on specific diet and exercise goals.

Obesity and Endometrial Cancer: A Lack of Knowledge but Opportunity for Intervention

ABSTRACTObjective: The causal link between obesity and endometrial cancer is well established; however obese women's knowledge of this relationship is unknown. Our objective was to explore patients' understanding of this relationship and assess the acceptability of a technology-based weight loss intervention. Methods/materials: Obese women with Type I endometrial cancer/hyperplasia were surveyed about their assessment of their body mass, knowledge of the relationship of obesity and endometrial cancer, and eating and activity habits. Interest in participation in an intervention also was assessed. Results: Eighty-one women with early stage (71.6% stage I) and grade (41.7% grade 1) disease completed the survey. The median BMI was 35.4 kg/m2 (IQR 32.2–43.5 kg/m2) and the average age was 59.3 (SD 11.1) yr. 76.25% of women were unable to categorize their BMI correctly and 86.9% of those incorrectly underestimated their BMI category. One-third (35.9%) were unaware of any association between obesity and endometrial cancer and 33.3% responded that obesity decreased or did not significantly increase the risk of endometrial cancer. 59% expressed interest in a weight loss intervention. Conclusions: Endometrial cancer survivors with obesity underestimated their obesity and lacked knowledge regarding the link between obesity and endometrial cancer. However, the majority expressed interest in electronically delivered weight loss interventions.

The use of novel technology-based weight loss interventions for obese women with endometrial hyperplasia and cancer

ObjectiveObesity significantly increases the risk of the development of both endometrial hyperplasia and cancer. Our objective was to assess the feasibility of two technology-based weight loss interventions in this patient population. MethodsWomen with obesity (BMI≥30kg/m2) and endometrial hyperplasia or Type I endometrial cancer were randomized 1:1 to a technology-based 6month lifestyle intervention via either telemedicine or text messaging. The telemedicine arm received weekly phone calls, with weights tracked online using Withings© Wi-Fi scales. The text arm received 3–5 personalized messages daily via Text4Diet™. Participants maintained a 1200–1800calorie/day diet, self-monitored food intake and received exercise goals. Biomarkers (IGFBP-1, adiponectin, VEGF, IL1-beta, IL2, IL6, and IL7) were assessed pre- and post-treatment. ResultsTwenty women were randomized (Telemedicine: n=10, Text4Diet: n=10), and 90% lost weight. Many were early stage (70%) and grade (43.8%) disease with a median age of 60.5years. We observed a statistically greater weight loss in the Telemedicine arm [median loss: 9.7kg (range: 1.6–22.9kg)] versus 3.9kg (range: 0.3–11.4kg) in the Text4Diet arm (p=0.0231). Similarly, percent weight loss was greater in the Telemedicine (7.6%) as compared to the Text4Diet arm (4.1%, p=0.014). Mean serum levels of IL-2 were significantly (27.15pg/mL vs. 5.18pg/mL, p=0.0495) lower at intervention end as compared to baseline. ConclusionsA technology-based weight loss intervention is feasible in women with Type I endometrial cancer/hyperplasia. Both interventions produced weight loss, although more person-to-person contact produced more significant outcomes. Reductions in expression of IL-2 were related to weight loss.

Weight change after participation in a technology-based weight loss intervention for endometrial cancer survivors with obesity

Weight change after participation in a technology-based weight loss intervention for endometrial cancer survivors with obesity

Using technology to promote postpartum weight loss in urban, low-income mothers: a pilot randomized controlled trial.

To examine the feasibility, acceptability, and initial efficacy of a technology-based weight loss intervention for urban, low-income mothers. Eighteen obese, ethnic minority, socioeconomically disadvantaged mothers in the first year after childbirth were randomly assigned to either: 1) technology-based intervention, which included empirically supported behavior-change strategies, daily skills, and self-monitoring text messages with personalized feedback, biweekly counseling calls from a health coach, and access to a Facebook support group, or 2) usual-care control. After 14 weeks of treatment, the technology-based intervention participants had significantly greater weight loss (-2.9 ± 3.6 kg) than usual care (0.5 ± 2.3 kg; adjusted mean difference: -3.2 kg, 95% confidence interval -6.2 to -0.1 kg, P = .04). One-third of intervention participants (3 of 9) and no control participants lost > 5% of their initial body weight at follow up. Results suggest the potential for using technology to deliver a postpartum weight loss intervention among low-income racial/ethnic minorities.

The Feasibility and Acceptability of a Technology-based Lifestyle Intervention for College Students

Objective: To investigate the feasibility, acceptability, and effectiveness of a 2-month technology-based weight loss intervention to reduce overweight and obesity in undergraduate students. Study Design, Setting, Participants, and Intervention: Twenty students (90% female, age 20.4 1.4 years, BMI 32.1 4.6 kg/m2) were randomized to either: (1) a technology-based intervention group or (2) an email education group. The technology-based group had access to the study website with nutrition lessons, YouTube exercise videos, a forum for social support, smartphone applications for self-monitoring, and social media including Pinterest and Facebook. Students were sent regular text message updates. The email education group received emails with the nutrition lessons and YouTube links. Outcome, Measures and Analysis: Height, weight, 24hour dietary recalls, and surveys were collected at baseline and 2months. Web-based focus groups were conducted after the intervention. Results: 95% of students completed the study. Over half the respondents in the technology-based group indicated that textmessaging wasmost helpful as well as the website, videos, nutrition facts, and smartphone applications. There were mixed responses about the forum, which was underutilized. Participants in the technology-based intervention group expressed a desire for additional accountability, support, and motivation and suggested using group Skype chats and mobile accessibility to further facilitate interaction on the forum. Conclusions and Implications: The findings support the potential for using technology to reach college students for weight loss programs. Findings will be used to improve a larger trial. Funding: None

The use of technology-based weight loss intervention for endometrial cancer survivors with obesity

Objectives: Presently, more than one third of women in the United State are obese (BMI ≥30). Obesity significantly increases the relative risk of the development of both endometrial hyperplasia and cancer. However, once diagnosed, quality of survivorship of obese women is worse than that for nonobese patients. Our objective was to assess the feasibility of technology-based weight loss interventions in this patient population.

B-38 Free Communication/Poster - Physical Activity and Mental Health

Technology-based interventions that rely on minimal contact with an interventionist have been shown to be effective for weight loss in obese adults. These technology systems that are used have evolved to include wearable monitors and web interfaces that provide feedback to patients on goal achievement for weight loss and key lifestyle factors that include diet and physical activity. PURPOSE: To examine the association between weight loss and patient engagement with technology components that includes an activity monitor and a web interface to self-report dietary intake and self-weighing. METHODS: 25 Class II and III obese adults (age: 40.0±9.4 years, BMI: 39.5±3.0 kg/m2) participated in a technology-based weight loss intervention. Diet was prescribed at 1500 – 2100 kcal/day and physical activity was prescribed to progress to 200 min/wk. The technology intervention included a wearable device to provide feedback on physical activity and energy expenditure, and a web interface to self-report weight and dietary intake. Weight was also measured objectively by the investigators at 0 and 12 weeks. RESULTS: 21 of the 25 subjects (84%) provided an objective measure of weight at both 0 and 12 weeks. These subjects significantly changed their body weight from baseline (110.8±12.4 kg) to 12 weeks (105.8±13.6 kg) (p<.001). Change in weight was significantly correlated with days per week of monitor wear (r=.559; p=.0047) and days per week of self-weighing (r=.559; p=.004), with days per week of self-reported dietary intake not significantly correlated (r=.165; p=.237). Step-wise linear regression indicated that monitor wear remained as a significant predictor of weight change (R2=.312, p=.008); however, days of self-reported dietary intake and days of reported self-weighing were not significant predicators of weight change. CONCLUSIONS: Within a technology-based intervention, encouraging the use of a monitor for physical activity and energy expenditure and self-report of weight appear to be associated with improved short-term weight loss in Class II and III obese adults. However, encouraging regular use of a monitor for physical activity and energy expenditure may be of particular importance for improving weight loss. These findings warrant replication in longer-term interventions of severely obese adults.

A Review of Efficacious Technology-Based Weight-Loss Interventions: Five Key Components

Obesity is highly prevalent among American adults and has negative health and psychosocial consequences. The purpose of this article was to qualitatively review studies that used technology-based interventions for weight loss and to identify specific components of these interventions that are effective in facilitating weight loss. We conducted a narrow, qualitative review, focusing on articles published in the last 10 years that used an experimental or pre/posttest design and used a technology-based intervention for weight loss. Among the 21 studies reviewed, we identified the following five components that we consider to be crucial in technology-based weight-loss interventions that are successful in facilitating weight loss: self monitoring, counselor feedback and communication, social support, use of a structured program, and use of an individually tailored program. Short-term results of technologically driven weight-loss interventions using these components have been promising, but long-term results have been mixed. Although more longitudinal studies are needed for interventions implementing these five components, the interface of technology and behavior change is an effective foundation of a successful, short-term weight-loss program and may prove to be the basis of long-term weight loss.