Mao Alice Yuqing, Chen Connie, Magana Candy, Caballero Barajas Karla, Olayiwola J Nwando
School of Medicine, University of California San Francisco, San Francisco, CA, United States.
Department of Medicine, Stanford University, Palo Alto, CA, United States.
JMIR Mhealth Uhealth. 2017 Jun 8;5(6):e80. doi: 10.2196/mhealth.7591.
The prevalence of obesity and associated metabolic conditions continue to be challenging and costly to address for health care systems; 71% of American adults were overweight, with 35% of men and 40% of women diagnosed with obesity in 2014. Digital health coaching is an innovative approach to decreasing the barriers of cost and accessibility of receiving health coaching for the prevention and management of chronic disease in overweight or obese individuals.
To evaluate the early impact of a mobile phone-based health coaching service on weight loss and blood pressure management in a commercially insured population.
This was a retrospective study using existing registry data from a pilot commercial collaboration between Vida Health and a large national insurance provider, which enrolled adult members who were overweight (body mass index >25 kg/m2) and able to engage in a mobile phone-based coaching intervention. Participants received 4 months of intensive health coaching via live video, phone, and text message through the Vida Health app. Participants were also provided with a wireless scale, pedometer, and blood pressure cuff. Of the 1012 enrolled, 763 (75.40%) participants had an initial weight upon enrollment and final weight between 3 and 5 months from enrollment; they served as our intervention group. There were 73 participants out of the 1012 (7.21%) who had weight data 4 months prior to and after Vida coaching, who served as the matched-pair control group.
Participants in the intervention group lost an average of 3.23% total body weight (TBW) at 4 months of coaching and 28.6% (218/763) intervention participants achieved a clinically significant weight loss of 5% or more of TBW, with an average of 9.46% weight loss in this cohort. In the matched-pair control group, participants gained on average 1.81% TBW in 4 months without Vida coaching and lost, on average, 2.47% TBW after 4 months of Vida coaching, demonstrating a statistically significant difference of 4.28% in mean percentage weight change (P<.001). Among 151 intervention participants with blood pressure data, 112 (74.2%) had a baseline blood pressure that was above the goal (systolic blood pressure >120 mmHg); 55 out of 112 (49.1%) participants improved their blood pressure at 4 months by an entire hypertensive stage-as defined by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.
Mobile phone app-based health coaching interventions can be an acceptable and effective means to promote weight loss and improve blood pressure management in overweight or obese individuals. Given the ubiquity of mobile phones, digital health coaching may be an innovative solution to decreasing barriers of access to much-needed weight management interventions for obesity.
肥胖及相关代谢疾病的流行，对医疗保健系统而言，仍是具有挑战性且成本高昂的问题；2014年，71%的美国成年人超重，其中35%的男性和40%的女性被诊断为肥胖。数字健康指导是一种创新方法，可减少超重或肥胖个体在接受慢性病预防和管理健康指导时面临的成本和可及性障碍。
评估基于手机的健康指导服务对商业保险人群体重减轻和血压管理的早期影响。
这是一项回顾性研究，使用了来自Vida Health与一家大型全国性保险提供商试点商业合作的现有登记数据，该合作纳入了超重（体重指数>25kg/m²）且能够参与基于手机的指导干预的成年会员。参与者通过Vida Health应用程序，通过实时视频、电话和短信接受了4个月的强化健康指导。参与者还获得了一个无线体重秤、计步器和血压袖带。在登记的1012名参与者中，763名（75.40%）参与者在登记时的初始体重以及登记后3至5个月的最终体重数据可用；他们作为我们的干预组。在1012名参与者中，有73名（7.21%）在Vida指导前后4个月有体重数据，他们作为配对对照组。
干预组参与者在接受4个月指导后，平均总体重减轻了3.23%，28.6%（218/763）的干预参与者实现了临床上显著的体重减轻，即总体重减轻5%或更多，该队列平均体重减轻了9.46%。在配对对照组中，如果没有Vida指导，参与者在4个月内平均总体重增加了1.81%，而在接受4个月的Vida指导后，平均总体重减轻了2.47%，平均体重变化百分比的差异有统计学意义，为4.28%（P<0.001）。在151名有血压数据的干预参与者中，112名（74.2%）的基线血压高于目标值（收缩压>120mmHg）；在这112名参与者中，55名（49.1%）在4个月时血压改善了整个高血压阶段，这是根据美国预防、检测、评估和治疗高血压联合委员会第七次报告所定义的。
基于手机应用程序的健康指导干预可以是促进超重或肥胖个体体重减轻和改善血压管理的一种可接受且有效的手段。鉴于手机的普及，数字健康指导可能是一种创新解决方案，可减少肥胖人群获得急需的体重管理干预措施的障碍。
