Introducing overweight patients to one of the most popular weight-loss apps didn’t help them shed pounds in a prospective, randomized, controlled trial with 212 patients in primary care clinics.
The two-clinic study screened 633 patients with a body mass index of at least 25 kg/m2, most of whom did not own a smartphone (421) or were not interested in losing weight (135), with 86 patients declining the study for other reasons. The remaining 212 patients were randomized to 6 months of usual care or usual care plus the free MyFitnessPal app. Research assistants helped patients download the app during a regular clinic visit, showed them an instructional video developed by MyFitnessPal, and followed up a week later with a phone call to assist patients with any technical problems with the app.
Not much weight was lost in the following 6 months. The app group lost a mean of 0.03 kg and the control group gained a mean of 0.3 kg, a 0.3-kg difference between groups that was not statistically significant, Dr. Brian Y. Laing and his associates reported ( Ann. Intern. Med. 2014 Nov. 18 [doi:10.7326/M13-3005] ). Among the 158 patients with 6-month measurements, 13 of 71 in the app group lost 2.7 kg or more (18%), as did 14 of 87 in the control group (16%).
The groups also did not differ significantly in changes in systolic blood pressure, with the app group losing a mean of 0.3 mm Hg and the control group gaining a mean of 1.5 mm Hg, reported Dr. Laing, now of the Los Angeles County Department of Health Services.
Patients in the app group seldom bothered to open it after the first month, with open rates dropping from 94 patients in the first month (97%) to 34 patients in the sixth month (35%). The ones who stopped using it complained in a survey that the app was “tedious,” or said they were too busy or stressed to use it, or dropped it for other reasons.
There were a few hopeful signs, however, Dr. Laing said in an interview. A few patients continued using the app at least 30 times in month 6. The app group was more likely to report using a “personal calorie goal” significantly more often than the control group – a mean of 2 days per week, compared with a quarter-day per week, respectively. And perhaps outcomes might have been better if physicians instead of research assistants had introduced patients to the app and followed up, he speculated.
Success may depend more on the patient’s readiness for change than on the app itself. “There was a subset of patients who used the app a lot and appeared to lose more weight, but on average, there wasn’t a significant difference between the groups. I think what it tells us is the app still can be a very powerful tool for patients who are truly motivated to track calories, but not for everyone,” said Dr. Laing, who works on operational issues for the county and practices part-time as a family physician in a county clinic.
Dr. Laing still recommends MyFitnessPal to overweight patients if they answer his questions by saying they’re interested in losing weight and enjoy using a smartphone. But he adds a warning: If you want the app to work, “you’ll have to put some time into this” and spend 5 minutes or so entering calories at each meal.
“I’m a primary care physician. One thing we struggle with is the 10- to 15-minute visit. I think about how we can help patients lead healthy lives when they’re not in front of us except for 10 minutes twice a year,” he said. For the right patients, apps could help, he believes.
Dr. Laing was one of the investigators in a previous study that evaluated the quality of 23 of the top-rated free health and fitness apps. The apps seldom employed evidence-based theories of behavior change, they found. The mean behavioral theory score was 8 out of 100, and the mean persuasive technology score on the Fogg Behavioral Model was 2 out of a possible 6. The top-scoring app on both scales was Lose It! ( Am. J. Prev. Med. 2013;45:583-9 ).
A separate study by other investigators rated 62 apps for the prevention of pediatric obesity and found that the apps were likely to incorporate expert-recommended behaviors such as eating five servings of fruit or vegetables per day (94%) but few adhered to expert-recommended strategies such as self-monitoring diet and physical activity (21%). Approximately half the apps addressed physical activity and consumption of fruit or vegetables and only 2% of apps addressed the child’s amount of screen time or the importance of family meals together, among other important behaviors ( Child. Obes. 2014;10:132-44 ).
The company Weight Watchers funded a randomized study of 292 participants in the company’s programs that found they lost more weight by attending its in-person meetings than by using its app or online tools ( Am. J. Med. 2013;126:1143e19-1143.324 ).
Dr. Laing reported having no financial disclosures. MyFitnessPal shared users’ log-on data with investigators for the study.
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