Christine A. Pellegrini

Integrating Technology Into Standard Weight Loss Treatment: A Randomized Controlled Trial

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.

The Comparison of a Technology-Based System and an In-Person Behavioral Weight Loss Intervention

The purpose of this study was to compare a technology‐based system, an in‐person behavioral weight loss intervention, and a combination of both over a 6‐month period in overweight adults. Fifty‐one subjects (age: 44.2 ± 8.7 years, BMI: 33.7 ± 3.6 kg/m2) participated in a 6‐month behavioral weight loss program and were randomized to one of three groups: standard behavioral weight loss (SBWL), SBWL plus technology‐based system (SBWL+TECH), or technology‐based system only (TECH). All groups reduced caloric intake and progressively increased moderate intensity physical activity. SBWL and SBWL+TECH attended weekly meetings. SBWL+TECH also received a TECH that included an energy monitoring armband and website to monitor energy intake and expenditure. TECH used the technology system and received monthly telephone calls. Body weight and physical activity were assessed at 0 and 6 months. Retention at 6 months was significantly different (P = 0.005) between groups (SBWL: 53%, SBWL+TECH: 100%, and TECH: 77%). Intent‐to‐treat (ITT) analysis revealed significant weight losses at 6 months in SBWL+TECH (−8.8 ± 5.0 kg, −8.7 ± 4.7%), SBWL (−3.7 ± 5.7 kg, −4.1 ± 6.3%), and TECH (−5.8 ± 6.6 kg, −6.3 ± 7.1%) (P < 0.001). Self‐report physical activity increased significantly in SBWL (473.9 ± 800.7 kcal/week), SBWL+TECH (713.9 ± 1,278.8 kcal/week), and TECH (1,066.2 ± 1,371 kcal/week) (P < 0.001), with no differences between groups (P = 0.25). The TECH used in conjunction with monthly telephone calls, produced similar, if not greater weight losses and changes in physical activity than the standard in‐person behavioral program at 6 months. The use of this technology may provide an effective short‐term clinical alternative to standard in‐person behavioral weight loss interventions, with the longer term effects warranting investigation.

Acute effect of walking on energy intake in overweight/obese women.

This study examined the acute effect of a bout of walking on hunger, energy intake, and appetite-regulating hormones [acylated ghrelin and glucagon-like peptide-1 (GLP-1)] in 19 overweight/obese women (BMI: 32.5 ± 4.3 kg/m²). Subjects underwent two experimental testing sessions in a counterbalanced order: exercise and rest. Subjects walked at a moderate-intensity for approximately 40 min or rested for a similar duration. Subjective feelings of hunger were assessed and blood was drawn at 5-time points (pre-, post-, 30-, 60-, 120-min post-testing). Ad libitum energy intake consumed 1-2h post-exercise/rest was assessed and similar between conditions (mean ± standard deviation; exercise: 551.5 ± 245.1 kcal [2.31 ± 1.0 MJ] vs. rest: 548.7 ± 286.9 kcal [2.29 ± 1.2 MJ]). However, when considering the energy cost of exercise, relative energy intake was significantly lower following exercise (197.8 ± 256.5 kcal [0.83 ± 1.1 MJ]) compared to rest (504.3 ± 290.1 kcal [2.11 ± 1.2 MJ]). GLP-1 was lower in the exercise vs. resting condition while acylated ghrelin and hunger were unaltered by exercise. None of these variables were associated with energy intake. In conclusion, hunger and energy intake were unaltered by a bout of walking suggesting that overweight/obese individuals do not acutely compensate for the energy cost of the exercise bout through increased caloric consumption. This allows for an energy deficit to persist post-exercise, having potentially favorable implications for weight control.

Technology Interventions to Curb Obesity: A Systematic Review of the Current Literature.

Obesity is a public health crisis that has reached epidemic proportions. Although intensive behavioral interventions can produce clinically significant weight loss, their cost to implement, coupled with resource limitations, pose significant barriers to scalability. To overcome these challenges, researchers have made attempts to shift intervention content to the Internet and other mobile devices. This article systematically reviews the recent literature examining technology-supported interventions for weight loss and maintenance among overweight and obese adults. Thirteen studies were identified that satisfied our inclusion criteria (12 weight loss trials, 1 weight maintenance trial). Our findings suggest that technology interventions may be efficacious at producing weight loss. However, several studies are limited by methodologic shortcomings. There are insufficient data to evaluate their efficacy for weight maintenance. Further research is needed that employs state-of-the-art methodology, with careful attention being paid to adherence and fidelity to intervention protocols.

A smartphone-supported weight loss program: design of the ENGAGED randomized controlled trial

BackgroundObesity remains a major public health challenge, demanding cost-effective and scalable weight management programs. Delivering key treatment components via mobile technology offers a potential way to reduce expensive in-person contact, thereby lowering the cost and burden of intensive weight loss programs. The ENGAGED study is a theory-guided, randomized controlled trial designed to examine the feasibility and efficacy of an abbreviated smartphone-supported weight loss program.Methods/designNinety-six obese adults (BMI 30–39.9 kg/m2) will be randomized to one of three treatment conditions: (1) standard behavioral weight loss (STND), (2) technology-supported behavioral weight loss (TECH); or (3) self-guided behavioral weight loss (SELF). All groups will aim to achieve a 7% weight loss goal by reducing calorie and fat intake and progressively increasing moderate intensity physical activity to 175 minutes/week. STND and TECH will attend 8 group sessions and receive regular coaching calls during the first 6 months of the intervention; SELF will receive the Group Lifestyle Balance Program DVD’s and will not receive coaching calls. During months 1–6, TECH will use a specially designed smartphone application to monitor dietary intake, body weight, and objectively measured physical activity (obtained from a Blue-tooth enabled accelerometer). STND and SELF will self-monitor on paper diaries. Linear mixed modeling will be used to examine group differences on weight loss at months 3, 6, and 12. Self-monitoring adherence and diet and activity goal attainment will be tested as mediators.DiscussionENGAGED is an innovative weight loss intervention that integrates theory with emerging mobile technologies. We hypothesize that TECH, as compared to STND and SELF, will result in greater weight loss by virtue of improved behavioral adherence and goal achievement.Trial registrationNCT01051713

Objectively measured physical activity and sedentary behavior and quality of life indicators in survivors of breast cancer

The primary purpose of the current study was to determine prospective associations of accelerometer‐assessed physical activity intensity and sedentary time with health‐related quality of life (HRQOL) indicators among survivors of breast cancer.

Optimization of remotely delivered intensive lifestyle treatment for obesity using the Multiphase Optimization Strategy: Opt-IN study protocol

BACKGROUND Obesity-attributable medical expenditures remain high, and interventions that are both effective and cost-effective have not been adequately developed. The Opt-IN study is a theory-guided trial using the Multiphase Optimization Strategy (MOST) to develop an optimized, scalable version of a technology-supported weight loss intervention. OBJECTIVE Opt-IN aims to identify which of 5 treatment components or component levels contribute most meaningfully and cost-efficiently to the improvement of weight loss over a 6 month period. STUDY DESIGN Five hundred and sixty obese adults (BMI 30-40 kg/m(2)) between 18 and 60 years old will be randomized to one of 16 conditions in a fractional factorial design involving five intervention components: treatment intensity (12 vs. 24 coaching calls), reports sent to primary care physician (No vs. Yes), text messaging (No vs. Yes), meal replacement recommendations (No vs. Yes), and training of a participants self-selected support buddy (No vs. Yes). During the 6-month intervention, participants will monitor weight, diet, and physical activity on the Opt-IN smartphone application downloaded to their personal phone. Weight will be assessed at baseline, 3, and 6 months. SIGNIFICANCE The Opt-IN trial is the first study to use the MOST framework to develop a weight loss treatment that will be optimized to yield the best weight loss outcome attainable for

Telehealth Weight Management Intervention for Adults with Physical Disabilities A Randomized Controlled Trial

500 or less.

Smartphone applications to support weight loss: current perspectives

ObjectiveWeight reduction programs are not generally designed or adapted for people with physical disabilities. This study examined the effect of a 9-months remote, telephone-based weight management program for people with physical disabilities using a Web-based system (Personalized Online Weight and Exercise Response System [POWERS]). DesignA total of 102 participants (mean ± SD age, 46.5 ± 12.7 yrs; body mass index, 32.0 ± 5.8 kg/m2) with a physical disability (spinal cord injury, multiple sclerosis, spina bifida, cerebral palsy, stroke, or lupus) were randomized to one of three conditions: physical activity only (POWERS), physical activity plus nutrition (POWERSplus), and control. The POWERS group received a physical activity tool kit and regular coaching telephone calls. The POWERSplus group received an intervention identical to that of the POWERS group plus nutritional information. The control group received the physical activity tool kit and self-guided health promotion resources at the completion of the trial but no coaching. ResultsPostintervention differences in body weight were found between the groups. There was a significant group × time interaction (P < 0.01) in postintervention body weight, with both the POWERS and POWERSplus groups demonstrating greater reduction in body weight compared with the control group (POWERS: −2.1 ± 5.5 kg, −2.4 ± −5.9%; POWERSplus: −0.5 ± 5.0 kg, −0.6 ± 4.3%; control: +2.6 ± 5.3 kg, 3.1 ± 7.4%). ConclusionsA low-cost telephone intervention supported with a Web-based remote coaching tool (POWERS) can be an effective strategy for assisting overweight adults with physical disabilities in maintaining or reducing their body weight.

Accuracy of Wristband Activity Monitors during Ambulation and Activities.

Lower cost alternatives are needed for the traditional in-person behavioral weight loss programs to overcome challenges of lowering the worldwide prevalence of overweight and obesity. Smartphones have become ubiquitous and provide a unique platform to aid in the delivery of a behavioral weight loss program. The technological capabilities of a smartphone may address certain limitations of a traditional weight loss program, while also reducing the cost and burden on participants, interventionists, and health care providers. Awareness of the advantages smartphones offer for weight loss has led to the rapid development and proliferation of weight loss applications (apps). The built-in features and the mechanisms by which they work vary across apps. Although there are an extraordinary number of a weight loss apps available, most lack the same magnitude of evidence-based behavior change strategies typically used in traditional programs. As features develop and new capabilities are identified, we propose a conceptual model as a framework to guide the inclusion of features that can facilitate behavior change and lead to reductions in weight. Whereas the conventional wisdom about behavior change asserts that more is better (with respect to the number of behavior change techniques involved), this model suggests that less may be more because extra techniques may add burden and adversely impact engagement. Current evidence is promising and continues to emerge on the potential of smartphone use within weight loss programs; yet research is unable to keep up with the rapidly improving smartphone technology. Future studies are needed to refine the conceptual model’s utility in the use of technology for weight loss, determine the effectiveness of intervention components utilizing smartphone technology, and identify novel and faster ways to evaluate the ever-changing technology.