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Original Investigation |

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

Bonnie Spring, PhD; Jennifer M. Duncan, PsyD; E. Amy Janke, PhD; Andrea T. Kozak, PhD; H. Gene McFadden, BA; Andrew DeMott, BA; Alex Pictor, BA; Leonard H. Epstein, PhD; Juned Siddique, PhD; Christine A. Pellegrini, PhD; Joanna Buscemi, PhD; Donald Hedeker, PhD
JAMA Intern Med. 2013;173(2):105-111. doi:10.1001/jamainternmed.2013.1221.
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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

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Figures

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Figure 1. Trial phases. PDA indicates personal digital assistant.

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Figure 2. Participant flow. BMI indicates body mass index and VA, Veterans Affairs. Chronic pain was eliminated as a study entry criterion 1 year after the study began.

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Figure 3. Weight loss plotted over time for the connective mobile technology (+mobile) and standard groups. Weight loss was significantly greater for the +mobile group at 3, 6, and 9 months.

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Figure 4. Weight loss over time as a function of treatment assignment and MOVE! adherence. Participants in the connective mobile technology (+mobile) group who were adherent to MOVE! treatment (ie, attended ≥80% of treatment sessions) lost significantly more weight than less adherent +mobile participants and either adherent or nonadherent standard-of-care participants. Data were available from the following: standard adherers, 15 participants at baseline and 13 at month 12; standard nonadherers, 20 at baseline and 14 at month 12; +mobile adherers, 21 at baseline and 18 at month 12; and +mobile nonadherers, 13 at baseline and 9 at month 12.

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