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Randomized Controlled Trial
. 2022 Jul 5;24(7):e38243.
doi: 10.2196/38243.

The Effect of Tailored, Daily, Smartphone Feedback to Lifestyle Self-Monitoring on Weight Loss at 12 Months: the SMARTER Randomized Clinical Trial

Lora E Burke  1 , Susan M Sereika  1 , Zhadyra Bizhanova  2 , Bambang Parmanto  3 , Jacob Kariuki  1 , Jessica Cheng  2 , Britney Beatrice  1 , Maribel Cedillo  4 , I Wayan Pulantara  3 , Yuhan Wang  3 , India Loar  1 , Molly B Conroy  4
Affiliations
Randomized Controlled Trial

The Effect of Tailored, Daily, Smartphone Feedback to Lifestyle Self-Monitoring on Weight Loss at 12 Months: the SMARTER Randomized Clinical Trial

Lora E Burke et al. J Med Internet Res. .

Abstract

Background: Self-monitoring (SM) is the centerpiece of behavioral weight loss treatment, but the efficacy of smartphone-delivered SM feedback (FB) has not been tested in large, long-term, randomized trials.

Objective: The aim of this study was to establish the efficacy of providing remote FB to diet, physical activity (PA), and weight SM on improving weight loss outcomes when comparing the SM plus FB (SM+FB) condition to the SM-only condition in a 12-month randomized controlled trial. The study was a single-site, population-based trial that took place in southwestern Pennsylvania, USA, conducted between 2018 and 2021. Participants were smartphone users age ≥18 years, able to engage in moderate PA, with a mean BMI between 27 and 43 kg/m2.

Methods: All participants received a 90-minute, one-to-one, in-person behavioral weight loss counseling session addressing behavioral strategies, establishing participants' dietary and PA goals, and instructing on use of the PA tracker (Fitbit Charge 2), smart scale, and diet SM app. Only SM+FB participants had access to an investigator-developed smartphone app that read SM data, in which an algorithm selected tailored messages sent to the smartphone up to 3 times daily. The SM-only participants did not receive any tailored FB based on SM data. The primary outcome was percent weight change from baseline to 12 months. Secondary outcomes included engagement with digital tools (eg, monthly percentage of FB messages opened and monthly percentage of days adherent to the calorie goal).

Results: Participants (N=502) were on average 45.0 (SD 14.4) years old with a mean BMI of 33.7 (SD 4.0) kg/m2. The sample was 79.5% female (n=399/502) and 82.5% White (n=414/502). At 12 months, retention was 78.5% (n=394/502) and similar by group (SM+FB: 202/251, 80.5%; SM: 192/251, 76.5%; P=.28). There was significant percent weight loss from baseline in both groups (SM+FB: -2.12%, 95% CI -3.04% to -1.21%, P<.001; SM: -2.39%, 95% CI -3.32% to -1.47%; P<.001), but no difference between the groups (-0.27%; 95% CI -1.57% to 1.03%; t =-0.41; P=.68). Similarly, 26.3% (66/251) of the SM+FB group and 29.1% (73/251) of the SM group achieved ≥5% weight loss (chi-square value=0.49; P=.49). A 1% increase in FB messages opened was associated with a 0.10 greater percent weight loss at 12 months (b=-0.10; 95% CI -0.13 to -0.07; t =-5.90; P<.001). A 1% increase in FB messages opened was associated with 0.12 greater percentage of days adherent to the calorie goal per month (b=0.12; 95% CI 0.07-0.17; F=22.19; P<.001).

Conclusions: There were no significant between-group differences in weight loss; however, the findings suggested that the use of commercially available digital SM tools with or without FB resulted in a clinically significant weight loss in over 25% of participants. Future studies need to test additional strategies that will promote greater engagement with digital tools.

Trial registration: Clinicaltrials.gov NCT03367936; https://clinicaltrials.gov/ct2/show/NCT03367936.

Keywords: adherence; behavioral intervention/weight loss; digital health; engagement; feedback messages; mHealth; obesity; physical activity trackers; randomized clinical trial; self-monitoring; smart scales.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
CONSORT (Consolidated Standards of Reporting Trials) diagram for the SMARTER trial.
Figure 2
Figure 2
Effect of treatment assignment on weight change.
Figure 3
Figure 3
Effect of treatment assignment on percent weight change.
Figure 4
Figure 4
The associations between percentages of feedback messages opened and percent weight change at 12 months.
Figure 5
Figure 5
Effect of treatment assignment on percentage of days adherent to the calorie goal over 12 months.
Figure 6
Figure 6
Change in monthly percentages of feedback messages opened and days adherent to the calorie goal in SM+FB over 12 months.
Figure 7
Figure 7
The associations between monthly percentages of feedback messages opened and days adherent to the calorie goal in SM+FB over 12 months.
See this image and copyright information in PMC

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