JMIR Publications

ABSTRACT

Background:

Obesity underlies much chronic disease. Digitalization of Obesity management provides an opportunity to innovate our traditional model of healthcare delivery within this setting, and to transform its scalability potentially to the population level. The COVID-19 pandemic has catalysed this process.

Objective:

The aim of our study was to assess the feasibility and effectiveness of the Low Carb Program app for weight loss, applied within our hospital-based (tier 3) Obesity service. Due to the disrupting effects of the COVID-19 pandemic on our Obesity service, we also compared the clinical outcomes from the Low Carb Program app applied in the context of remote patient appointments over the telephone with pre-pandemic traditional standard of care.

Methods:

We invited patients who attended our hospital-based Obesity service to engage with the Low Carb Program app for use on mobile smartphones. We combined this approach with remote delivery (over the telephone) of Obesity management from medical and psychology members of our Obesity team during the COVID-19 pandemic. Outcome variables included changes in body weight and changes in HbA1C as a marker of glycaemic control. We compared data from the Low Carb Program group with those from a retrospective control group (n=126), who had received traditional face-to-face Obesity management from our team (without concomitant use of the Low Carb Program app) in the pre-COVID-19 era.

Results:

The vast majority of participants (n=90, 86%) completed the Low Carb Program app registration process and engaged with the Low Carb Program app, most of whom (n=88, 84%) actively engaged with the Low Carb Program app within the prior 30-days. The majority of participants (n=58, 55%) self-reported outcomes from the Low Carb Program app. Mean duration of clinical follow-up for recruited participants who received the Low Carb Program app was 7.4-months. Paired data were available from 48 participants for body weight and 41 participants for HbA1C. Paired sample t-test analysis revealed a statistically significant mean loss of body weight of 2.7 Kg (P=0.001) and improvement in HbA1C of 3.3 mmol/mol, (P=0.01). Data comparisons between the app user group and the pre-COVID 19 retrospective control group revealed equivalence for loss of body weight and change in HbA1C between the two groups.

Conclusions:

We provide the first evidence to support the feasibility of implementing the Low Carb Program app combined with remote management, providing the first proof of concept for digitalized management within a hospital-based (tier 3) Obesity service. We demonstrate the clinical efficacy of such an approach, both regarding loss of body weight and improvement in glycaemic control. Clinical Trial: As a service evaluation, this trial was approved by local NHS ethics committee.