The Use of mHealth to Deliver Tailored Messages Reduces Reported Energy and Fat Intake

Abstract

Background Evidence supports the role of feedback in reinforcing motivation for behavior change. Feedback that provides reinforcement has the potential to increase dietary self-monitoring and enhance attainment of recommended dietary intake. Objective To examine the impact of daily feedback (DFB) messages, delivered remotely, on changes in dietary intake. Methods A secondary analysis of the SMART trial, a single-center, 24-month randomized clinical trial of behavioral treatment for weight loss. Participants included 210 obese adults (mean body mass index=34.0 kg/m2) who were randomized to either a paper diary (PD), personal digital assistant (PDA), or PDA plus daily, tailored feedback messages (PDA+FB). To determine the role of daily tailored feedback in dietary intake, we compared the self-monitoring with daily feedback group (DFB, n=70) to the self-monitoring without daily feedback group (No-DFB, n=140). All participants received a standard behavioral intervention for weight loss. Self-reported changes in dietary intake were compared between the DFB and No-DFB groups and were measured at baseline, 6, 12, 18, and 24 months. Linear mixed modeling was used to examine percent changes in dietary intake from baseline. Results Compared to the No-DFB group, the DFB group achieved a larger reduction in energy (−22.8% vs. −14.0%, p=0.02) and saturated fat (−11.3% vs. −0.5%, p=0.03) intake, and a trend toward a greater decrease in total fat intake (−10.4% vs. −4.7%, p=0.09). There were significant improvements over time in carbohydrate intake and total fat intake for both groups (p’s<0.05). Conclusion Daily, tailored feedback messages, designed to target energy and fat intake and delivered remotely in real-time using mobile devices, may play an important role in the reduction of energy and fat intake.

Can metabotyping help deliver the promise of personalised nutrition?

“…Randomised to one of three groups: waiting-list control; basic version of commercial web-based weight loss programme; enhanced version of commercial web-based weight loss programme Both basic and enhanced groups increased their percentage energy contribution from fruit and reduced energy-dense, nutrient foods compared with control (P < 0·001) Ambeba et al (16) 24 month RCT Obese adults (n 210) Randomised to one of three groups: paper diary (PD); personal digital assessment (PDA); PDA and daily feedback (DFB)…”

Personalised nutrition: the role of new dietary assessment methods

“…Participants who received daily tailored energy and fat feedback messages delivered remotely on a PDA in realtime significantly reduced their energy (P = 0·03) and saturated fat intake (P = 0·04) after 24 months compared with participants receiving no daily feedback messages (63) . Mean differences in energy and fat intake at 24 months were −9·3 and −12·7 % greater, respectively, for those who received the daily tailored feedback messages compared with those receiving no daily feedback messages (63) . In addition to the frequency of feedback, the mode of delivery of personalised advice is another element that could influence the efficacy of personalised dietary advice.…”

“…The study where feedback was provided more frequently was associated with greater changes in a variety of dietary outcomes. Concurrent with this, recent evidence has shown the application of PDA to provide daily tailored advice to have a considerable impact on dietary behaviours (63) . Participants who received daily tailored energy and fat feedback messages delivered remotely on a PDA in realtime significantly reduced their energy (P = 0·03) and saturated fat intake (P = 0·04) after 24 months compared with participants receiving no daily feedback messages (63) .…”

“…Concurrent with this, recent evidence has shown the application of PDA to provide daily tailored advice to have a considerable impact on dietary behaviours (63) . Participants who received daily tailored energy and fat feedback messages delivered remotely on a PDA in realtime significantly reduced their energy (P = 0·03) and saturated fat intake (P = 0·04) after 24 months compared with participants receiving no daily feedback messages (63) . Mean differences in energy and fat intake at 24 months were −9·3 and −12·7 % greater, respectively, for those who received the daily tailored feedback messages compared with those receiving no daily feedback messages (63) .…”

“…These instruments are being increasingly utilised in intervention studies to provide personalised or tailored feedback, with numerous randomised controlled trials demonstrating this personalised advice to be more effective than generic advice in improving selected dietary outcomes (17,62,63) . As illustrated in Table 2, PDA, online FFQ and webbased dietary questionnaires have all been utilised for providing personalised dietary advice, with studies in recent years also examining the potential for smartphone app to provide tailored or personalised feedback advice (15,16) .…”