College of Nursing-Northern Division, University of Nebraska Medical Center, 801 East Benjamin Avenue, Norfolk, NE, 68701, USA.
College of Public Health, University of Nebraska Medical Center, 984355 Medical Center, Omaha, NE, 68198-4355, USA.
BMC Public Health. 2021 Aug 18;21(1):1568. doi: 10.1186/s12889-021-11618-7.
Addressing overweight and obesity among men at-risk for obesity-related diseases and disability in rural communities is a public health issue. Commercial smartphone applications (apps) that promote self-monitoring for weight loss are widely available. Evidence is lacking regarding what support is required to enhance user engagement with and effectiveness of those technologies. Pragmatically comparing these apps effectiveness, including rural men's desired forms of support when using them, can lead to greater weight loss intervention impact and reach. This study assessed the feasibility and acceptability of a mobile technology application applied differently across two groups for weight loss.
In a two-armed, pragmatic pilot feasibility study, 80 overweight and obese men aged 40-69 were randomized using a 1:1 ratio to either an enhanced Mobile Technology Plus (MT+) intervention or a basic Mobile Technology (MT) intervention. The MT+ group had an enhanced smartphone app for self-monitoring (text messaging, discussion group, Wi-Fi scale) whereas the MT group received a basic app that allowed self-monitoring logging only. Assessments were collected at baseline, 3 and 6 months. App logs were analyzed to track engagement and adherence to self-monitoring. Acceptability was assessed via focus groups. Analysis included descriptive statistics and qualitative content analysis.
Of 80 men recruited, forty were allocated to each arm. All were included in the primary analysis. Recruitment ended after 10 months with a 97.5 and 92.5% (3 month, 6 month) retention rate. Over 90% of men reported via survey and focus groups that Lose-It app and smart scale (MT+) was an acceptable way to self-monitor weight, dietary intake and physical activity. Adherence to daily app self-monitoring of at least 800 dietary calories or more (reported respectively as MT+, MT) was positive with 73.4, 51.6% tracking at least 5 days a week. Adherence to tracking activity via recorded steps four or more days weekly was positive, 87.8, 64.6%. Men also adhered to self-weighing at least once weekly, 64, 46.3%. At 6 months, an observed mean weight loss was 7.03 kg (95% CI: 3.67, 10.39) for MT+ group and 4.14 kg (95% CI: 2.22, 6.06) for MT group, with 42.9 and 34.2% meeting ≥5% weight loss, respectively. No adverse events were reported.
This National Institutes of Health-funded pilot study using mobile technologies to support behavior change for weight loss was found to be feasible and acceptable among midlife and older rural men. The interventions demonstrated successful reductions in weight, noting differing adherence to lifestyle behaviors of eating, monitoring and activity between groups, with men in the MT+ having more favorable results. These findings will be used to inform the design of a larger scale, clinical trial.
The trial was prospectively registered with ClinicalTrials NCT03329079 . 11/1/2017.
解决农村社区中肥胖相关疾病和残疾高危男性的超重和肥胖问题是一个公共卫生问题。目前有许多商业智能手机应用程序（apps）可以促进减肥的自我监测，但缺乏关于增强用户参与和提高这些技术效果所需支持的证据。实际比较这些应用程序的效果，包括农村男性在使用这些应用程序时所需的支持形式，可以提高减肥干预的效果和覆盖面。本研究评估了一种移动技术应用程序在两组人群中的减肥效果。
在一项两臂、实用的初步可行性研究中，将 80 名 40-69 岁超重和肥胖男性按 1:1 的比例随机分为增强型移动技术加（MT+）干预组或基本移动技术（MT）干预组。MT+组使用增强型智能手机应用程序进行自我监测（短信、讨论组、Wi-Fi 秤），而 MT 组仅使用允许自我监测记录的基本应用程序。在基线、3 个月和 6 个月时进行评估。分析应用程序日志以跟踪自我监测的参与度和依从性。通过焦点小组评估可接受性。分析包括描述性统计和定性内容分析。
在招募的 80 名男性中，40 名男性被分配到每组。所有男性均被纳入主要分析。在 97.5%和 92.5%（3 个月、6 个月）的保留率下，招募于 10 个月后结束。超过 90%的男性通过调查和焦点小组报告说，Lose-It 应用程序和智能秤（MT+）是一种可以接受的自我监测体重、饮食摄入和身体活动的方式。每天至少记录 800 卡路里饮食或更多的应用程序自我监测（分别为 MT+、MT）的依从性为 73.4%，51.6%的人每周至少记录 5 天。每周至少记录 4 天的活动记录（通过记录的步骤）的依从性为 87.8%，64.6%。男性还每周至少记录一次自我称重，分别为 64%和 46.3%。在 6 个月时，MT+组的平均体重减轻了 7.03 公斤（95%CI：3.67，10.39），MT 组的平均体重减轻了 4.14 公斤（95%CI：2.22，6.06），分别有 42.9%和 34.2%的人达到了≥5%的体重减轻。没有不良事件报告。
这项由美国国立卫生研究院资助的使用移动技术支持中年和老年农村男性减肥的行为改变的初步可行性研究被证明是可行和可接受的。这两种干预措施都成功地减轻了体重，注意到两组之间在饮食、监测和活动等生活方式行为上的依从性不同，MT+组的男性结果更有利。这些发现将用于为更大规模的临床试验提供信息。
该试验前瞻性地在 ClinicalTrials.gov 上注册（NCT03329079），注册时间为 2017 年 11 月 1 日。
