Integrating technology into standard weight loss treatment: a randomized controlled trial

Abstract

Background: A challenge in intensive obesity treatment is making care scalable. Little is known about whether the outcome of physician-directed weight loss treatment can be improved by adding mobile technology.

Methods: We conducted a 2-arm, 12-month study (October 1, 2007, through September 31, 2010). Seventy adults (body mass index >25 and ≤40 [calculated as weight in kilograms divided by height in meters squared]) were randomly assigned either to standard-of-care group treatment alone (standard group) or to the standard and connective mobile technology system (+mobile group). Participants attended biweekly weight loss groups held by the Veterans Affairs outpatient clinic. The +mobile group was provided personal digital assistants to self-monitor diet and physical activity; they also received biweekly coaching calls for 6 months. Weight was measured at baseline and at 3-, 6-, 9-, and 12-month follow-up.

Results: Sixty-nine adults received intervention (mean age, 57.7 years; 85.5% were men). A longitudinal intent-to-treat analysis indicated that the +mobile group lost a mean of 3.9 kg more (representing 3.1% more weight loss relative to the control group; 95% CI, 2.2-5.5 kg) than the standard group at each postbaseline time point. Compared with the standard group, the +mobile group had significantly greater odds of having lost 5% or more of their baseline weight at each postbaseline time point (odds ratio, 6.5; 95% CI, 2.5-18.6).

Conclusions: The addition of a personal digital assistant and telephone coaching can enhance short-term weight loss in combination with an existing system of care. Mobile connective technology holds promise as a scalable mechanism for augmenting the effect of physician-directed weight loss treatment.

Trial registration: clinicaltrials.gov Identifier: NCT00371462.

Figure 1. Trial phases

PDA indicates personal digital assistant.

Figure 2. Participant flow

BMI indicates body mass index and VA, Veterans Affairs. Chronic pain was eliminated as a study entry criterion 1 year after the study began.

Figure 3. Weight Change over Time for +Mobile versus Standard Treatment

Weight loss plotted over time for the connective mobile technology (+mobile) and standard groups. Weight loss was significantly greater for the +mobile group at 3, 6, and 9 months.

Figure 4. Weight Loss over Time as a function of Treatment Assignment and MOVE! Adherence*

Participants in the connective mobile technology (+mobile) group who were adherent to MOVE! treatment (ie, attended 80% of treatment sessions) lost significantly more weight than less adherent +mobile participants and either adherent or nonadherent standard-of-care participants. Data were available from the following: standard adherers, 15 participants at baseline and 13 at month 12; standard nonadherers, 20 at baseline and 14 at month 12; +mobile adherers, 21 at baseline and 18 at month 12; and +mobile nonadherers, 13 at baseline and 9 at month 12.