JMIR Publications

ABSTRACT

Background:

Obesity represents a major public health crisis in the United States, imposing substantial health risks and economic costs. Medical nutrition therapy (MNT) has been demonstrated to be an effective intervention for weight loss among patients with obesity. With the rise of telehealth, virtual MNT has gained popularity as an accessible alternative to traditional in-person care. A nationwide program was developed that integrates virtual MNT with a companion mobile app, offering a comprehensive approach to weight management. However, the effectiveness of this combined intervention has not yet been evaluated.

Objective:

To evaluate the effect of a virtual MNT program with a companion mobile app on weight loss in adults with overweight and obesity.

Methods:

This retrospective cohort study included users of Nourish, a virtual MNT program with a companion mobile app, who attended at least one appointment between August 2023 and October 2024 and had a baseline body mass index (BMI) 30 kg/m2 or a BMI between 27-30 kg/m2 with diabetes or prediabetes. Engagement was assessed based on completed appointments and app usage. Mean weight change, mean percent weight change, and proportion of participants who achieved at least 3% and 5% weight loss were calculated. T-tests were used to evaluate the statistical significance of weight change. Subgroup analyses were performed by follow-up time between weights, number of appointments completed, and level of engagement by appointments and app usage.

Results:

In total, 3,951 participants were included in the analysis. The mean (standard deviation (SD)) age was 38 (10) years, and 78% of participants were female. Weight loss was reported as a program goal by 70% of participants, with 31% self-reporting diabetes or prediabetes and 24% self-reporting a cardiovascular condition. Over a median follow-up of 2.2 months, 74% of participants experienced weight loss, and 34% and 17% achieved at least 3% and 5% weight loss, respectively. The mean (SD) weight change was -4.5 (8.9) pounds, corresponding to -2.0% (3.9) weight change (P<.001). Males and participants aged 60 years or older experienced greater weight loss than females and younger participants. Longer follow-up time between weights and a higher number of completed appointments (≥5 appointments) were significantly associated with a higher likelihood of achieving at least 5% weight loss (P<.001 for both). Additionally, participants who had the highest number of appointments and highest app engagement were more likely to achieve at least 5% weight loss compared to those with fewer appointments or lower app engagement (P<.001).

Conclusions:

Enrollment in a virtual MNT program with a companion mobile app was associated with clinically meaningful weight loss among adults with overweight and obesity across the United States, highlighting the potential of tech-enabled solutions to provide scalable weight management strategies.