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Digital Self-Monitoring Linked to Improvements in Weight Loss Trials

A review of 39 randomized clinical trials examining weight loss interventions is providing clinicians with an overview of engagement rates, mediums used, and effects of digital self-monitoring for weight loss among obese or overweight patients.

An analysis of more than 3 dozen studies examining behavioral weight loss interventions has returned positive evidence in support of using digital tools for self-monitoring.

Results of the systematic review outline the potential usefulness of these new technologies by providing evidence suggesting more than 70% of patients using digital self-monitoring technologies experienced weight loss and also finding rates of engagement were greater with digital rather than manual self-monitoring in 21 of 34 comparisons.

"Digital health tools have flourished in the past decade," said Michele L. Patel, PhD, post-doctoral research fellow, Stanford Prevention Research Center, Stanford University School of Medicine, in a statement."What this paper sought out to explore was whether tracking via these digital tools is effective at producing greater weight loss."

With the obesity epidemic expected to expand its foothold in the US and other countries, Patel, Lindsay Wakayama, PhD, and Gary Bennet, MD, sought to evaluate how digital monitoring is being used and whether use was associated with weight loss. To do so, investigators designed the current study as a systematic review of studies examining digital self-monitoring in behavioral weight loss interventions from randomized clinical trials within the PubMed, Embase, Scopus, PsycInfo, CINAHL, and ProQuest Dissertations & Theses databases.

For inclusion in the review, studies needed to be designed as randomized controlled trials, examine interventions lasting at least 12 weeks, report weight outcomes 6 months after baseline, and include outcomes on self-monitoring engagement and their relationship to weight loss. Eligible trials were required to enroll adult patients aged 18 years or older and be published between 2009-2019. The initial search yielded 4248 records. After application of the inclusion criteria, a total of 53 papers describing 39 unique randomized trials were identified for inclusion.

These 39 trials included 8232 patients with a mean age ranging from 29-56 years. The mean baseline BMI among these studies ranged from 28.3-37.0 kg/m2. Most of the trials were conducted in the US and the duration of interventions ranged from 3-24 months, with a median of 6 months.

In total, 67 interventions using digital self-monitoring were identified within the 39 trials—weight was tracked 72% percent of interventions with digital self-monitoring, diet was tracked in 81%, and physical activity was tracked in 82%. The most common medium of self-monitoring was websites and other common mediums included apps, wearables, electronic scales, and text messaging.

"This may be because many digital tools are highly portable, and therefore allow the user to track any time of the day; digital tools also may make tracking quicker, and may be less burdensome to use," added Patel.

Results of the investigators’ analysis indicated few interventions had engagement rates of 75% or more of the study days. Additionally, results suggested rates of engagement were greater with digital- rather than paper-based arms in 21 out of 34 comparisons and lower in only 2 comparisons. When assessing impact of self-monitoring adherence, investigators found greater digital self-monitoring was associated with weight loss in 74% of occurrences.

This study, “Self-Monitoring via Digital Health in Weight Loss Interventions: A Systematic Review Among Adults with Overweight or Obesity,” was published in Obesity.