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      Health-E-Call, a Smartphone-Assisted Behavioral Obesity Treatment: Pilot Study

      research-article
      , PhD (Clin. Psycho.) 1 , , , PhD 1
      (Reviewer), (Reviewer)
      JMIR mHealth and uHealth
      JMIR Publications Inc.
      obesity, behavior, weight loss, mobile phone, technology

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          Abstract

          Background

          Individual and group-based behavioral weight loss treatment (BWL) produces average weight loss of 5-10% of initial body weight, which improves health and wellbeing. However, BWL is an intensive treatment that is costly and not widely available. Smartphones may be a useful tool for promoting adherence to key aspects of BWL, such as self-monitoring, thereby facilitating weight loss while reducing the need for intensive in-person contact.

          Objective

          The objective of this study was to evaluate smartphones as a method of delivering key components of established and empirically validated behavioral weight loss treatment, with an emphasis on adherence to self-monitoring.

          Methods

          Twenty overweight/obese participants (95% women; 85% non-Hispanic White; mean age 53.0, SE 1.9) received 12-24 weeks of behavioral weight loss treatment consisting of smartphone-based self-monitoring, feedback, and behavioral skills training. Participants also received brief weekly weigh-ins and paper weight loss lessons.

          Results

          Average weight loss was 8.4kg (SE 0.8kg; 9%, SE 1% of initial body weight) at 12 weeks and 10.9kg (SE 1.1kg; 11%, SE 1% of initial body weight) at 24 weeks. Adherence to the self-monitoring protocol was 91% (SE 3%) during the first 12 weeks and 85% (SE 4%) during the second 12 weeks.

          Conclusions

          Smartphones show promise as a tool for delivering key components of BWL and may be particularly advantageous for optimizing adherence to self-monitoring, a cornerstone of BWL.

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          Most cited references24

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          Association between obesity and psychiatric disorders in the US adult population.

          Epidemiologic data suggest an association between obesity and depression, but findings vary across studies and suggest a stronger relationship in women than men. To evaluate the relationship between obesity and a range of mood, anxiety, and substance use disorders in the US general population. Cross-sectional epidemiologic survey. Nationally representative sample of US adults. A total of 9125 respondents who provided complete data on psychiatric disorder, height, and weight. Response rate was 70.9%. Participants completed an in-person interview, including assessment of a range of mental disorders (assessed using the World Health Organization Composite International Diagnostic Interview) and height and weight (by self-report). Obesity (defined as body mass index [calculated as weight in kilograms divided by the square of height in meters] of > or =30) was associated with significant increases in lifetime diagnosis of major depression (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.09-1.35), bipolar disorder (OR, 1.47; 95% CI, 1.12-1.93), and panic disorder or agoraphobia (OR, 1.27; 95% CI, 1.01-1.60). Obesity was associated with significantly lower lifetime risk of substance use disorder (OR, 0.78; 95% CI, 0.65-0.93). Subgroup analyses found no difference in these associations between men and women, but the association between obesity and mood disorder was strongest in non-Hispanic whites (OR, 1.38; 95% CI, 1.20-1.59) and college graduates (OR, 1.44; 95% CI, 1.14-1.81). Obesity is associated with an approximately 25% increase in odds of mood and anxiety disorders and an approximately 25% decrease in odds of substance use disorders. Variation across demographic groups suggests that social or cultural factors may moderate or mediate the association between obesity and mood disorder.
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            The Look AHEAD study: a description of the lifestyle intervention and the evidence supporting it.

            The Look AHEAD (Action for Health in Diabetes) study is a multicenter, randomized controlled trial designed to determine whether intentional weight loss reduces cardiovascular morbidity and mortality in overweight individuals with type 2 diabetes. The study began in 2001 and is scheduled to conclude in 2012. A total of 5145 participants have been randomly assigned to a lifestyle intervention or to an enhanced usual care condition (i.e., diabetes support and education). This article describes the lifestyle intervention and the empirical evidence to support it. The two principal intervention goals are to induce a mean loss >or = 7% of initial weight and to increase participants' moderately intense physical activity to > or =175 min/wk. For the first 6 months, participants attend one individual and three group sessions per month and are encouraged to replace two meals and one snack a day with liquid shakes and meal bars. From months 7 to 12, they attend one individual and two group meetings per month and continue to replace one meal per day (which is recommended for the study's duration). Starting at month 7, more intensive behavioral interventions and weight loss medication are available from a toolbox, designed to help participants with limited weight loss. In Years 2 to 4, treatment is provided mainly on an individual basis and includes at least one on-site visit per month and a second contact by telephone, mail, or e-mail. After Year 4, participants are offered monthly individual visits. The intervention is delivered by a multidisciplinary team that includes medical staff who monitor participants at risk of hypoglycemic episodes.
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              The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: the Diabetes Prevention Program randomized trial.

              The metabolic syndrome is a high-risk state for diabetes and cardiovascular disease. Little is known about its prevalence and prevention in those with impaired glucose tolerance. To determine the prevalence of the metabolic syndrome at baseline in the Diabetes Prevention Program and the effect of intensive lifestyle intervention and metformin therapy on the syndrome's incidence and resolution. Randomized, controlled clinical trial. Research and community-based centers. Participants had impaired glucose tolerance (World Health Organization criteria plus fasting plasma glucose level >or=5.3 mmol/L [>or=95 mg/dL]) and were followed for a mean of 3.2 years after random assignment to intensive lifestyle intervention, metformin therapy, or placebo. Metformin, 850 mg twice daily, or intensive lifestyle intervention designed to achieve and maintain a 7% weight loss and 150 minutes of exercise per week. The metabolic syndrome was defined as having 3 or more characteristics (waist circumference; blood pressure; and levels of high-density lipoprotein cholesterol, triglycerides, and fasting plasma glucose) that met criteria from the National Cholesterol Education Program Adult Treatment Panel III. Fifty-three percent of participants (n = 1711) had the metabolic syndrome at baseline; incidence did not vary substantially by age. However, low levels of high-density lipoprotein cholesterol predominated in younger participants (age 25 to 44 years), and high blood pressure predominated in older participants (age 60 to 82 years). In life-table analyses (log-rank test), incidence of the metabolic syndrome was reduced by 41% in the lifestyle group (P < 0.001) and by 17% in the metformin group (P = 0.03) compared with placebo. Three-year cumulative incidences were 51%, 45%, and 34% in the placebo, metformin, and lifestyle groups, respectively. There was no significant heterogeneity by ethnic group. The study involved a volunteer group with impaired glucose tolerance, which limits generalizability. The metabolic syndrome affected approximately half of the participants in the Diabetes Prevention Program at baseline. Both lifestyle intervention and metformin therapy reduced the development of the syndrome in the remaining participants.
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                Author and article information

                Contributors
                Journal
                JMIR Mhealth Uhealth
                JMIR Mhealth Uhealth
                JMU
                JMIR mHealth and uHealth
                JMIR Publications Inc. (Toronto, Canada )
                2291-5222
                Jan-Jun 2013
                17 April 2013
                : 1
                : 1
                : e3
                Affiliations
                [1] 1Weight Control and Diabetes Research Center Department of Psychiatry and Human Behavior Warren Alpert Medical School of Brown University & The Miriam Hospital Providence, RIUnited States
                Author notes
                Corresponding Author: J Graham Thomas jthomas4@ 123456lifespan.org
                Article
                v1i1e3
                10.2196/mhealth.2164
                4114436
                25100672
                1c7d4744-c8ab-4432-84eb-5bf304e0d9d6
                ©J Graham Thomas, Rena R Wing. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 17.04.2013.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mHealth and uHealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/, as well as this copyright and license information must be included.

                History
                : 08 May 2012
                : 25 August 2012
                : 24 October 2012
                : 13 March 2013
                Categories
                Original Paper
                Original Paper

                obesity,behavior,weight loss,mobile phone,technology
                obesity, behavior, weight loss, mobile phone, technology

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