Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Sep 29, 2021
Date Accepted: Jan 28, 2022
Use of a Mobile Health Ketogenic Diet App Intervention and User Behaviors Associated with Weight Loss in Adults with Overweight or Obesity: A Secondary Analysis of a Randomized Clinical Trial
ABSTRACT
Background:
Low-carbohydrate ketogenic diets are a viable method to lose weight that have regained popularity in recent years. Technology in the form of mobile Health (mHealth) applications (apps) allows for scalable and remote delivery of such dietary interventions and are increasingly being employed by the general population without direct medical supervision. However, it is currently unknown which factors related to app usage and user behavior are associated with successful weight loss.
Objective:
Firstly, we examined characteristics and user behaviors over time of participants that were enrolled in a remotely delivered clinical weight loss trial that tested an mHealth ketogenic diet app paired with a breath acetone biofeedback device. Secondly, we explored which app- and adherence-related user behaviors characterized successful weight loss.
Methods:
We analyzed app usage and self-reported questionnaire data from 75 adults with overweight or obesity who participated in the intervention arm of a previous weight loss study. We examined time-series patterns via linear mixed models, and performed correlation, linear regression and causal mediation analyses to characterize diet-, weight- and app-related user behavior associated with weight loss.
Results:
In the context of a low-carbohydrate ketogenic diet intervention delivered remotely via an mHealth application paired with a breath acetone biofeedback device, self-reported dietary adherence appeared to be the most important factor to predict weight loss. Furthermore, self-reported adherence mediated the relationship between greater app engagement or higher breath acetone levels and greater weight loss. User behavior (compliance with weight measurements, app engagement) and adherence-related aspects (breath acetone values, self-reported dietary adherence) over time differed between individuals achieving clinically significant weight loss of >5% compared to those that did not.
Conclusions:
Our in-depth examination of app- and adherence-related user behaviors offers insight into factors associated with successful weight loss in the context of mHealth interventions. In particular, our finding that self-reported dietary adherence was the most important metric predicting weight loss may aid in development of future mHealth dietary interventions. Clinical Trial: This trial was registered (NCT04165707) and the protocol published (DERR1-10.2196/19053).
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