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

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Abstract

Background

Evidence on the long-term effects of weight management smartphone apps on various weight-related outcomes remains scarce.

Objective

In this review, we aimed to examine the effects of smartphone apps on anthropometric, metabolic, and dietary outcomes at various time points.

Methods

Articles published from database inception to March 10, 2022 were searched, from 7 databases (Embase, CINAHL, PubMed, PsycINFO, Cochrane Library, Scopus, and Web of Science) using forward and backward citation tracking. All randomized controlled trials that reported weight change as an outcome in adults with overweight and obesity were included. We performed separate meta-analyses using random effects models for weight, waist circumference, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, blood glucose level, blood pressure, and total energy intake per day. Methodological quality was assessed using the Cochrane Risk of Bias tool.

Results

Based on our meta-analyses, weight loss was sustained between 3 and 12 months, with a peak of 2.18 kg at 3 months that tapered down to 1.63 kg at 12 months. We did not find significant benefits of weight loss on the secondary outcomes examined, except for a slight improvement in systolic blood pressure at 3 months. Most of the included studies covered app-based interventions that comprised of components beyond food logging, such as real-time diet and exercise self-monitoring, personalized and remote progress tracking, timely feedback provision, smart devices that synchronized activity and weight data to smartphones, and libraries of diet and physical activity ideas.

Conclusions

Smartphone weight loss apps are effective in initiating and sustaining weight loss between 3 and 12 months, but their effects are minimal in their current states. Future studies could consider the various aspects of the socioecological model. Conversational and dialectic components that simulate health coaches could be useful to enhance user engagement and outcome effectiveness.

Trial Registration

International Prospective Register of Systematic Reviews (PROSPERO) CRD42022329197; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=329197

Related collections

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Interrater reliability: the kappa statistic

Mary L McHugh (2012)

The kappa statistic is frequently used to test interrater reliability. The importance of rater reliability lies in the fact that it represents the extent to which the data collected in the study are correct representations of the variables measured. Measurement of the extent to which data collectors (raters) assign the same score to the same variable is called interrater reliability. While there have been a variety of methods to measure interrater reliability, traditionally it was measured as percent agreement, calculated as the number of agreement scores divided by the total number of scores. In 1960, Jacob Cohen critiqued use of percent agreement due to its inability to account for chance agreement. He introduced the Cohen’s kappa, developed to account for the possibility that raters actually guess on at least some variables due to uncertainty. Like most correlation statistics, the kappa can range from −1 to +1. While the kappa is one of the most commonly used statistics to test interrater reliability, it has limitations. Judgments about what level of kappa should be acceptable for health research are questioned. Cohen’s suggested interpretation may be too lenient for health related studies because it implies that a score as low as 0.41 might be acceptable. Kappa and percent agreement are compared, and levels for both kappa and percent agreement that should be demanded in healthcare studies are suggested.

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The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.

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Author and article information

Contributors

Han Shi Jocelyn Chew:

ORCID: https://orcid.org/0000-0002-4209-1647

Alice Lee Centre for Nursing StudiesYong Loo Lin School of MedicineNational University of SingaporeLevel 3, Clinical Research Centre, Block MD1110 Medical DriveSingapore, 117597Singapore65 65168687jocelyn.chew.hs@nus.edu.sg

Journal

Journal ID (nlm-ta): J Med Internet Res

Journal ID (iso-abbrev): J Med Internet Res

Journal ID (publisher-id): JMIR

Title: Journal of Medical Internet Research

Publisher: JMIR Publications (Toronto, Canada )

ISSN (Print): 1439-4456

ISSN (Electronic): 1438-8871

Publication date Collection: September 2022

Publication date (Electronic): 21 September 2022

Volume: 24

Issue: 9

Electronic Location Identifier: e40141

Affiliations

[1 ] Alice Lee Centre for Nursing Studies Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore

[2 ] Department of Surgery Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore

[3 ] Department of Surgery National University Hospital Singapore Singapore

Author notes

Corresponding Author: Han Shi Jocelyn Chew jocelyn.chew.hs@ 123456nus.edu.sg

Author information

Han Shi Jocelyn Chew https://orcid.org/0000-0002-4209-1647

Wee Ling Koh https://orcid.org/0000-0003-2261-8357

Janelle Shaina Hui Yi Ng https://orcid.org/0000-0001-8329-8495

Ker Kan Tan https://orcid.org/0000-0002-0410-0450

Article

Publisher ID: v24i9e40141

DOI: 10.2196/40141

PMC ID: 9536524

PubMed ID: 36129739

SO-VID: 81cc05c8-dcb6-45dd-8bfa-aba231ae3d52

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.

History

Date received : 8 June 2022

Date revision requested : 13 July 2022

Date revision received : 14 July 2022

Date accepted : 18 July 2022

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