Study Smartphone Based Weight Loss Program As Effective As Other Options

Researchers at Northwestern University in Chicago today published a study in the journal Obesity showing that a new smartphone-app-based program that focuses on healthy diet plus regular exercise helped participants lose 13.4 pounds in six months. It’s encouraging news, because the new program is cheaper than existing ones, and doesn’t require the in-person counseling and classes that make other programs tougher for people to start and stick with, according to the researchers. “With an app on a smartphone and a coach who sees the results, you get the help you need,” says the lead researcher, Bonnie Spring, PhD, a professor of preventive medicine, psychiatry, psychology, and public health and the director of the Institute for Public Health and Medicine at the Northwestern University Feinberg School of Medicine. “There’s no need to take public transportation or drive to a class or pay for parking and childcare. It makes healthy weight loss accessible for people in rural areas, those who work at night, those who have mobility issues, or those who just can’t get out to classes.” RELATED: Why It’s Harder to Lose Weight With Age The new program, currently referred to as Optimization of Remotely Delivered Intensive Lifestyle Treatment for Obesity (Opt-IN), is facilitated via a smartphone app, with which users learn about healthy weight loss and log their daily food and exercise. A weight loss coach gets regular reports from the app, including daily weigh-in information from the user’s digital scale. The program includes personal coaching every two weeks, plus support from a weight loss buddy (someone designated by the user and trained via webinar) and progress reports sent to each user’s primary care provider. RELATED: How to Lose 1 Pound of Fat

Study Finds Accountability Is Key to Weight Loss Success, Meal Replacement Bars Are Not

For the Opt-IN study, 562 overweight and obese adults all received personalized diet, exercise, and weight loss goals plus weight loss education via the Opt-IN smartphone app. They were divided into 32 small groups, each receiving a different combination of add-on support options. For example, some met with a health coach by phone for 10 to 15 minutes every week, others every other week. Everyone had a friend or relative designated as a weight loss buddy for extra support; half the buddies were trained and half were not. Some participants also had progress reports sent to their doctor, received motivational text messages, or used meal replacement bars and shakes. The researchers compared the groups to find the most cost-effective combination of features that yielded the most weight loss over six months. The best combination included:

Meeting with a coach every other week It was more effective than meeting once weekly, leading to about one pound more weight loss. “The coach helps you learn the skills you need to navigate your environment, feel empowered to make healthy choices, and understand areas that are challenging,” Dr. Spring says. “It was crucial that [the coaches] saw participants’ logs. It added to accountability, which is very important for weight loss success, and showed coaches where successes and obstacles were.”Having a trained buddy “Social support is really crucial,” Spring says. According to the new data, people in the group with weight loss buddies who had undergone the training lost two more pounds on average than people with a partner who hadn’t undergone the training. “In the DPP people get it from others in their classes. We wanted to draw in someone who is in the participants’ environment.” Participants chose their own buddy — and Spring notes that while men often picked their wife or partner, women tended to choose a friend or other relative. The buddies attended online webinars to learn about healthy weight loss strategies and how to best provide emotional support.Records sent to PCP Study participants whose records were sent to their primary care provider after three and six months lost slightly more weight than those who didn’t — about a tenth of a pound more. But Spring says having the doctor see what you’re doing adds another level of accountability. “Eventually you’re going to go to your PCP and that doctor is going to know how well you’ve been doing,” she says.

Things that didn’t improve weight loss: meal replacements and motivational text messages. Participants had to buy the meal replacement shakes and bars after the first week, which was burdensome, Spring says. “We also think people are so inundated with text messages these days that getting more had no effect.” RELATED: 9 Hard Truths About Weight Loss At the end of the study, 57 percent of those in this trial group lost 5 percent of their body weight; and 51 percent lost 7 percent of their body weight. Those losses can help control high blood pressure, and lower risk for type 2 diabetes, heart disease, and even some cancers, Spring says. The cost of the winning combination was about $427 per person, according to the researchers’ cost estimates computed for the study. A stripped-down version of the program with fewer components, but that still included diet, exercise, digital classes, and coaching all delivered via the app would cost $324 and lead to 5 percent weight loss for about 50 percent of the study participants in that group, according to estimates the researchers published in the study. Spring notes that either option is significantly cheaper than evidence-based weight loss tools doctors currently prescribe to patients and should appeal to health insurers as a more cost-effective option for a weight loss tool.

What Makes Opt-IN Better Than the Other Options Out There?

The current first-choice evidence-based weight loss tool prescribed by doctors is the Diabetes Prevention Program (DPP), which costs about $1,000 per person (before insurance) and requires 16 or more in-person classes, according to data published in the journal Obesity in 2017 and the Centers for Disease Control and Prevention’s National Diabetes Prevention Program website. A study evaluating its effectiveness conducted back in 2002 showed that dropping weight using DPP’s intensive lifestyle program (diet, exercise, in-person classes, and counseling) slashed diabetes risk by 58 percent over the four-year study period — which was better than taking the blood-sugar drug metformin or following conventional healthy-living advice, according to data published in the New England Journal of Medicine. Of the people in that trial who used DPP, 50 percent lost at least 7 percent of their body weight during the first six months of the study. It’s hailed as America’s gold-standard diet-and-exercise approach for weight loss. But 18 years later, studies suggest that as few as 2.4 percent of Americans who could benefit from DPP have tried it, according to data published in the American Journal of Preventive Medicine in 2019 — even though the program is covered by private insurance, Medicaid, and Medicare and is available at YMCAs, churches, and health centers nationally, according to information published jointly by the Centers for Disease Control and Prevention (CDC) and the National Association of Chronic Disease Directors (NACDD). RELATED: 14 Apps to Help Manage Diabetes Given that in the United States as many as two in every three adults is overweight or obese, according to National Institutes of Health data, people need strategies that they can actually make time for and that aren’t going to bankrupt them or the healthcare system. “Our key challenge is not determining what works, but determining how to get what works into the hands of patients and consumers,” says Gary Bennett, PhD, a professor of psychology and neuroscience at Duke University who designs and studies digital weight loss programs and who was not involved in the Opt-IN study or in developing the tool. “Research like this helps us to package effective treatments in ways that are affordable to payers and patients. Obesity is one of our single most important public health goals. If we could reduce the overall prevalence of obesity, we would make meaningful changes in conditions like cardiovascular disease, diabetes, and even COVID-19,” he says. RELATED: How Obesity May Increase the Risk for COVID-19 Complications One limitation: Study participants were mostly women, white, and middle-class. Asked if the results would apply to Black, Hispanic, Asian Americans, and others, Bennett noted “Maybe. This is why researchers usually say more research is necessary!” Spring says her lab aims to study the program in a more diverse population. “Traditionally, the majority of participants in our diet and healthy activity studies have been minorities and there’s usually no difference in response between underserved groups and white participants.”

What’s Next for Opt-IN?

The study’s digital approach is especially timely as U.S. doctors and health systems across the country have turned to telemedicine during the coronavirus epidemic, says Donna Spruijt-Metz, PhD, the director of the University of Southern California’s mHealth Collaboratory and the USC Dornsife Center for Economic and Social Research. She was not involved with the study. “Digital tools are a fantastic opportunity to reach outward to the most underserved populations, the most isolated populations, and now, to everyone who has the good sense to stay home when possible.” And they’re versatile, she adds. “As we get better and better at modeling the data for optimizing personal interventions and feedback, digital tools will become more essential than ever.” RELATED: Weight Loss Apps for Every Need Spring’s team is launching related studies aimed at giving dieters weight loss support when they need it. One, the SMART study, adds extra support for those who aren’t losing weight or are backsliding. For another, Spring hopes to give users digital “pokes” just when they’re about to backslide. Spring’s lab plans to make the Opt-IN program available to consumers in the near future. To join a mailing list for more information, sign up on the researchers’ website.