Two randomized trials have shown that smartphone-based behavioral interventions for weight loss are more effective when accompanied by financial incentives and one-on-one coaching calls.
In one study, obese middle-aged men who received a financial incentive along with a behaviorally focused text message weighed 3.2 percentage points more after 12 months than men who did not receive a text message or financial incentive. Diminished.P<0.001), reported Pat Hoddinott, PhD MBBS, University of Stirling, Scotland, and colleagues. Japan Automobile Manufacturers Association.
Men who received only text messages lost a nonsignificant 1.4 percentage points more than men who received no intervention (P=0.05).
In another study, middle-aged participants using a smartphone app-based feedback system to manage their weight lost an average of 2 kg after six months if they also received weekly telephone coaching.P<0.001), reported Bonnie Spring, Ph.D., of Northwestern University Feinberg School of Medicine in Chicago, and colleagues. Japan Automobile Manufacturers Association.
Jamie D. Ard, M.D., of Wake Forest University School of Medicine in Winston, says that the ideal weight loss goal for obese people is at least 5% of their body weight, and that “loss of at least 10% has greater benefits for cardiometabolic health.'' It brings benefits.” Salem, N.C., and his colleagues said in an accompanying editorial.
The therapeutic effects in these studies were modest compared to those possible with GLP-1 receptor agonists, and the editorial authors said that “these lifestyle interventions are unlikely to lead to long-term maintenance of weight loss.” is writing. Still, the study still “represents an interesting innovation that will impact the practice of obesity medicine,” including the fact that the first trial successfully treated obesity in men.
“Given that many obese patients are unwilling or unable to undergo medical or surgical treatment, innovative, effective, low-intensity, relatively easy-to-distribute treatments such as those described in these studies They added that behavioral interventions may remain important in the evolving landscape of “effectiveness in obesity treatment.''
financial motive
The first study will involve 585 men with a body mass index (BMI) of 30 or higher (average BMI 37.7), all residing in Belfast, Ireland, Bristol, England, or Glasgow, Scotland, in July 2021. Registered from until May 2022. Men were predominantly white (90%), mean age was 50.7 years, and 39% lived in low socio-economic areas.
All participants received weight management information and a pedometer. Over a 12-month period, 194 men received text messages that focused on behaviors that would help them lose weight, and 196 men received the same text messages along with a financial incentive if they met their weight loss goals. The remaining 195 men were placed on a waiting list as a control group.
The text “incorporates evidence for weight management, links to websites to informational resources, and theory-based behavior change techniques based on the health behavior process approach, self-determination theory, and behavioral change maintenance models,” Hoddinott said. explained the team. The maximum number of text messages men could receive during the trial was 370, which included three weight appointment reminders and three weight goal achievement notifications, but the frequency of messages was paused and resumed. , it was possible to adjust.
Financial incentives are $64 for a 5% weight loss in 3 months, $191 for a 10% weight loss in 6 months, and $254 for maintaining a 10% weight loss in 12 months, with a maximum total if all goals are met. It will cost $490.
The primary endpoint was the difference in weight loss between the control group and each intervention group, with 3% set as the minimum clinically important difference.
Men who received text messages and financial incentives lost an average of 5.7 kg (-4.8% of their body weight) at 12 months, compared to 1.5 kg (-1.3%) in the control group. The text-only group lost an average of 3 kg, or -2.7% of their body weight. An average of 332 text messages were sent during the trial, and the financial incentive group was paid an average of $159 per participant. His 62% of this group received payment, of which 15% received the full amount.
The number of treatments required to lose at least 5% of body weight was 4 in the financial incentive and text group, compared to 15 in the text-only group.
The most common adverse event was infection (23%), but none of the 23 serious adverse events across the group were found to be related to the study.
“The technology and financial incentive approach used in this trial has the potential to be scaled to reach a broader audience, but there are questions about its sustainability, especially in the competitive and crowded phone app market. remain,” the editorial writers wrote. Furthermore, there are concerns about maladaptive behaviors such as excessive dietary restrictions and excessive exercise that are motivated by financial incentives.
Successful coaching call
The second study was a US-based non-inferiority trial in which 199 of 400 participants with an average BMI of 34.4 enrolled from June 2017 to March 2021 received the wireless feedback system for three months. (WFS) and the remaining 201 people used WFS. I received weekly phone coaching for 3 months. The mean age was 40.5 years, 76.3% were female, approximately 20% were black, and 66.5% were white.
WFS is a Wifi activity tracker (Fitbit Zip) and scale that sends data to a smartphone app with daily feedback on your progress. The goals include limiting calorie and saturated fat intake, and based on each participant's activity in the previous week, starting with her 60 minutes of physical activity per week and gradually increasing it to 300 minutes. It was included.
Weekly calls included 10 to 15 minutes of motivational interviewing, goal setting, problem solving, and technical support from a health coach who had access to participant progress data. Coaches were supervised by a licensed clinical health psychologist.
If the participant is not progressing toward the 5% weight loss goal at 6 months, step-up interventions may include a phone notification from the app, phone coaching if the call has not yet been received, or a phone call if the participant has already received a call. Powdered meal replacements were included if available. .
At 6 months, outcome data were available for 85.5% of participants, with mean weight loss of 2.8 kg in the WFS group (95% CI -3.5 to -2.0) and mean weight loss of 4.8 kg in the WFS plus coaching group. (95% CI). % CI -5.5 to -4.1). Half of the participants received the step-up intervention, with similar proportions divided between groups.
At 12 months, the coaching group lost an average of 1.7 kg more from baseline than the WFS-only group (95% CI -2.9 to -0.5). However, in the nonresponders, no significant differences in weight loss occurred between the groups at 3, 6, or 12 months.
disclosure
The UK study was funded by the National Institute for Health Research (NIHR), the National Health Service, the National Research Scottish Primary Care Network, Public Health England, and the Scottish Government Department of Health and Social Care.
Mr Hoddinott reported receiving grants from the NIHR and Scotland's Office of the Chief Scientist during the conduct of the study and chairing or serving on an independent trial steering committee unrelated to the weight control trial. He is also a member of the NIHR Primary Care Research Funding Committee.
Co-authors also reported relationships with government agencies and social organizations.
The US study was funded by the National Institutes of Health.
Study authors reported no conflicts of interest.
Mr. Ard reports receiving personal fees and research support from Nestle Healthcare Nutrition, Eli Lilly, Novo Nordisk, Weight Watchers, Regeneron, Boehringer Ingelheim, Intuitive, Epitome, UnitedHealth Group, and non-financial support from KVK Tech. did. Co-authors reported relationships with KVK Tech and Heali AI.
Primary information
Japan Automobile Manufacturers Association
Reference source: Hoddinott P, et al. “Text messages with financial incentives for obese men: A randomized clinical trial” JAMA 2024; DOI: 10.1001/jama.2024.7064.
secondary sources
Japan Automobile Manufacturers Association
Source reference: Spring B et al. “Adaptive Behavioral Interventions for Weight Loss Management: A Randomized Clinical Trial” JAMA 2024; DOI: 10.1001/jama.2024.0821.
additional sources
Japan Automobile Manufacturers Association
Source reference: Ard JD, et al. “Lifestyle interventions for obesity in the era of GLP-1 receptor agonists” JAMA 2024; DOI: 10.1001/jama.2024.7062.