JMIR Publications

ABSTRACT

Background:

Detailed self-monitoring (or “tracking”) of dietary intake is a popular and effective weight loss approach that can be delivered via digital tools, though engagement declines over time. To counteract this decline in engagement, simplified dietary self-monitoring strategies that reduce burden are needed. It is unclear how feasible and acceptable both simplified and detailed dietary self-monitoring strategies are among racial/ethnic minority groups, who are disproportionately affected by obesity yet underrepresented in behavioral obesity treatment.

Objective:

The aim of this two-arm pilot study was to evaluate the feasibility and acceptability of a digital weight loss intervention with either detailed or simplified dietary self-monitoring delivered to adults from racial and/or ethnic minority groups with overweight or obesity.

Methods:

Racial/ethnic minority adults ages ≥ 21 years with a BMI of 25-45 kg/m2 and living in the U.S. Pacific Time Zone were recruited to a fully remote study. Participants received a 3-month standalone digital weight loss intervention and were randomized 1:1 to either the Detailed arm that was instructed to self-monitor all foods and drinks consumed each day using the Fitbit mobile app or to the Simplified arm that was instructed to self-monitor only “Red Zone Foods” (highly caloric and of limited nutritional value) each day via an online checklist. All participants were instructed to self-monitor both steps and body weight daily. Each week, participants were emailed behavioral lessons, action plans, and personalized feedback. Twelve a priori benchmarks were set to establish feasibility, including outcomes related to reach, study retention, and self-monitoring engagement over 3 months (assessed objectively via digital tools). Acceptability was assessed via questionnaire. Weight change was assessed via scales shipped to participants’ homes and is reported descriptively.

Results:

The online eligibility screen was completed by 248 individuals, of whom 38 (15%) were randomized, 18 to Detailed and 20 to Simplified. At baseline, participants had a mean age of 47.4 years (SD=14.0) and BMI of 31.2 kg/m2 (SD=4.8). Over half (58%) identified as Hispanic of any race. Study retention was 92% at 3 months. The Detailed arm met 9 of 12 feasibility benchmarks, while the Simplified arm met all 12. Self-monitoring engagement was moderate-to-high (self-monitoring diet: median of 49% of days for Detailed, 97% for Simplified; self-monitoring steps: 99% for Detailed, 100% for Simplified; self-monitoring weight: 67% for Detailed, 80% for Simplified). Participants in both arms reported high satisfaction, with 89% indicating they would recommend the intervention to a friend seeking to lose weight. Weight change was -3.4 kg (95% CI: -4.6, -2.2) for Detailed and 3.3 kg ( 4.4, 2.2) for Simplified.

Conclusions:

A digital weight loss intervention that incorporated either detailed or simplified dietary self-monitoring was feasible to deliver, with high retention and engagement, and acceptable to racial/ethnic minority adults. Clinical Trial: ASPREDICTED #66674