JMIR Publications

ABSTRACT

Background:

There is large variance in weight loss outcomes of digital behavior change interventions (DBCIs). It has been suggested that different patterns of engagement in the program could be responsible for this variance in outcomes. Previous studies have found that the amount of engagement on DBCIs, such as the number of meals logged or articles read, is positively associated with weight loss.

Objective:

This retrospective study extends previous research by observing how important weight loss outcomes (high weight loss: ≥10% body weight loss, moderate weight loss: 5% ≤ loss<10%, stable weight: 0±1%) are associated with engagement on a publicly available mobile DBCI (Noom) from 9 to 52 weeks.

Methods:

Engagement and weight data for eligible participants (N=11,252) were extracted from the Noom database. Engagement measures included the number of articles read, meals logged, steps recorded, messages to coach, exercise logged, weigh-ins, and days with one meal logged per week. Weight was self-reported on the program. Multiple linear regressions examined how weight loss outcome (moderate and high vs. stable) was associated with each engagement measure across 3 study time periods: 9-16 weeks, 17-32 weeks and 33-52 weeks.

Results:

At 9-16 weeks, 2594 (23%) had stable weight, 6440 (57%) had moderate weight loss, and 2218 (20%) had high weight loss. By 33-52 weeks, 525 (18%) had stable weight, 1214 (42%) had moderate weight loss, and 1144 (40%) had high weight loss. Regression results showed that moderate weight loss and high weight loss outcomes were associated with all engagement measures to a significantly greater degree than stable weight. These differences held across all time periods with the exception of exercise for the moderate weight loss category at 33-52 weeks.

Conclusions:

Our results suggest that these clinically important weight loss outcomes are related to the number of articles read, meals logged, steps recorded, messages to coach, exercise logged, weigh-ins, and days with one meal logged per week, both short-term and long-term (i.e., 1 year) on Noom. This provides valuable data on engagement patterns over time on a self-directed DBCI, can help inform how interventions tailor recommendations for engagement depending on how much weight individuals have lost, and raises important questions for future research on engagement in DBCIs.