Efficacy of Interventions That Incorporate Mobile Apps in Facilitating Weight Loss and Health Behavior Change in the Asian Population: Systematic Review and Meta-analysis

Abstract

Background Smartphone apps have shown potential in enhancing weight management in Western populations in the short to medium term. With a rapidly growing obesity burden in Asian populations, researchers are turning to apps as a service delivery platform to reach a larger target audience to efficiently address the problem. Objective This systematic review and meta-analysis aims to determine the efficacy of interventions that incorporate apps in facilitating weight loss and health behavior change in the Asian population. Methods A total of 6 databases were searched in June 2020. The eligible studies included controlled trials in which an app was used in the intervention. The participants were aged 18 years or older and were of Asian ethnicity. A meta-analysis to test intervention efficacy, subgroup analyses, and post hoc analyses was conducted to determine the effects of adding an app to usual care and study duration. The primary outcome was absolute or percentage weight change, whereas the secondary outcomes were changes to lifestyle behaviors. Results A total of 21 studies were included in this review, and 17 (81%) were selected for the meta-analysis. The pooled effect size across 82% (14/17) of the randomized controlled trials for weight change was small to moderate (Hedges g=–0.26; 95% CI –0.41 to –0.11), indicating slightly greater weight loss achieved in the intervention group; however, this may not be representative of long-term studies (lasting for more than a year). Supplementing multicomponent usual care with an app led to greater weight loss (Hedges g=–0.28; 95% CI –0.47 to –0.09). Asian apps were largely culturally adapted and multifunctional, with the most common app features being communication with health professionals and self-monitoring of behaviors and outcomes. Conclusions More evidence is required to determine the efficacy of apps in the long term and address the low uptake of apps to maximize the potential of the intervention. Future research should determine the efficacy of each component of the multicomponent intervention to facilitate the designing of studies that are most effective and cost-efficient for weight management. Trial Registration PROSPERO CRD42020165240; https://tinyurl.com/2db4tvn6

Sustainability of Weight Loss Through Smartphone Apps: Systematic Review and Meta-analysis on Anthropometric, Metabolic, and Dietary Outcomes

“…By contrast, our meta-analysis results suggest significant effects of smartphone weight loss apps on weight loss from 3 to 12 months. This is consistent with existing systematic reviews [7][8][9], although the time points at which the analyzed data were retrieved were unclear. However, both our narrative synthesis and meta-analysis did not show the benefits of weight loss on secondary outcomes, except for a slight improvement in systolic blood pressure at 3 months.…”

“…Articles on people with diseases other than obesity and mobile interventions with only SMS text messaging were excluded [ 7 ]. Another study focused on the effects of mobile apps on weight loss in the Asian population and reported a small to moderate interventional effect on weight loss (Hedges g =−0.26) [ 8 ]. Lastly, a study on both children and adults reported a pooled interventional effect- of −1.07 kg on weight loss.…”

“…However, these reviews included studies of various study designs, such as randomized controlled trials (RCTs), case-control studies, and quasi-experimental studies, which could have reduced the quality and certainty of evidence [ 7 ]. Moreover, these systematic reviews included studies on both people with normal and high BMI [ 7 , 9 ] and studies on people with and without diseases (eg, cardiovascular diseases) [ 8 ]. These limitations render the interventional effects on each unique population unclear.…”

Motivation and Limiting Factors for Adherence to Weight Loss Interventions among Patients with Obesity in Primary Care

“…The scientific literature clearly identifies a number of resources in both clinical practice guidelines for obesity management and research articles, such as psychological interventions based on cognitive or problem-solving therapy [ 2 , 6 , 22 , 23 , 25 , 26 ] and other resources such as mobile applications, group treatment sessions and telephone follow-up to extend the reach of interventions to people in rural areas and reduce costs [ 27 , 28 , 29 ]. However, the nature of many of these resources raises the need for a multidisciplinary team for obesity management.…”

Duration of Treatment in a Weight Loss Program Using a Mobile App is Associated with Successful Weight Loss During the COVID-19 Pandemic

“… 27 In the Asian population, the use of a mobile app applied to weight loss may also have benefits for improving diet quality and weight loss self-efficacy. 28 , 29 During the COVID-19 pandemic, the use of telehealth increased by almost 200% in the US. 30 Recently, a randomized clinical trial, using the mHealth app to promote ketogenic diet during the COVID-19 pandemic, found that self-reported dietary adherence is an important predictor of weight-loss success.…”