Behavioral Interventions, mHealth Self-Monitoring Tools Cut Obesity

Behavioral interventions using mHealth self-monitoring tools lead to significant weight loss among overweight or obese patients, according to a research review published online in The Obesity Society's flagship journal, Obesity.

Researchers reviewed randomized controlled studies among overweight or obese adults, ultimately concluding that digital self-monitoring lead to weight loss in 74 percent of interventions across three major behaviors tracked (diet, physical activity, and body weight).

"Digital health tools have flourished in the past decade," said Michele L. Patel, PhD, corresponding author of the study and post-doctoral research fellow at the Stanford Prevention Research Center in the Stanford University School of Medicine. "What this paper sought out to explore was whether tracking via these digital tools is effective at producing greater weight loss."

Researchers searched six databases—PubMed, EMBASE, Scopus, PsycInfo, CINAHL and ProQuest Dissertations & Theses—for studies that included self-monitoring interventions for weight loss that were 12 weeks or longer in duration and provided patient outcomes at least six months post-intervention. The studies were published between January 2009 and September 2019.

mHealth self-monitoring tools lead to higher rates of weight loss than paper-based journal interventions in 21 out of 34 comparisons. This may be because digital tools are highly portable and may make tracking quicker and less burdensome than traditional paper-based self-monitoring practices, Patel explained.

Websites were the most common self-monitoring digital tool used for behavioral intervention in the studies, followed by apps, wearables, electronic scales, and SMS messaging.

Only a few interventions had digital self-monitoring engagement rates greater than 75 percent of days. Further research may look at how these digital tools can be improved to encourage greater patient engagement.

"Given that previous reviews conducted before the emergence of these newer tools have established that self-monitoring also plays a key role in the maintenance of weight loss (i.e. preventing weight regain), a critical next step for our field is to examine how we can help sustain engagement with these tools longer term, after the initial novelty wears off," said Kathryn M. Ross, PhD, MPH, Clinical and Health Psychology Assistant Professor at the University of Florida.

Ross was not associated with the research.

Previous reviews have found that behavioral interventions using technology like SMS, apps, websites, and wearables often lead to weight loss similar to or less than that of in-person interventions. However, this is the first comprehensive systematic review of interventions to focus on digital self-monitoring.

This review comes as America’s obesity problem continues to worsen. Thirteen percent of people worldwide are obese, compared to 42 percent of US adults.

America’s obesity rates have risen 11 percent in the past two decades, and rates of severe obesity have nearly doubled from 4.7 percent to 9.2 percent. To address America’s obesity crisis, effective and accessible treatment options must be developed. This review suggests mHealth digital self-monitoring tools may be an appropriate strategy.

The Obesity Medicine Association (OMA), an organization focused on improving the lives of patients affected by obesity, updated its Obesity Algorithm in January 2021 to include practice guidelines for using digital health tools.

The guidelines encourage providers to use mHealth apps and telehealth technology to tailor care programs to meet individual patients’ needs, provide more opportunities for interventions, and ultimately improve patient outcomes.  

“With COVID, and even without COVID, many patients are less inclined to seek medical care (for obesity care) if it means meeting with a healthcare provider,” said Harold Bays, MD, a trustee and chief science officer of the OMA and medical director and president of the Louisville Metabolic and Atherosclerosis Research Center. “Telehealth provides a much more convenient and accessible option.”