Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Jun 17, 2024
Date Accepted: May 30, 2025
Behavior Change Resources Used in Mobile Application-Based Interventions: A Systematic Review and Meta-Analysis of Weight-Related, Behavioral, and Metabolic Outcomes in Randomized Controlled Trials for Overweight and Obese Adults
ABSTRACT
Background:
Overweight and obesity have become a public health issue. Lifestyle modifications delivered via mobile devices, especially mobile phones, present an opportunity to help people lose weight.
Objective:
The meta-analysis aimed to explore the effects of mobile phone applications on weight-related outcomes (weight, BMI, fat mass, body fat percentage), behavior outcomes (physical activity, energy intake), and metabolic outcomes [systolic blood pressure (SBP), diastolic blood pressure (DBP), triglycerides, hemoglobin A1c (HbA1c)] among adults with overweight and obesity. Behavior change techniques (BCTs) and resources used in these interventions were also identified to clarify components used in current studies.
Methods:
Six databases (PubMed, Embase, CENTRAL, Web of Science, PsycINFO, and CINAHL) were searched for relevant randomized controlled trials (RCTs) published between January 1, 2010 and May 20, 2024 in English. Two independent authors conducted study selection, data extraction, quality assessment. The effect size of interventions was calculated using mean difference. A random-effects model was applied for data analysis.
Results:
A total of 29 studies were included. The results indicated that mobile phone application intervention reduced weight (MD=-1.45 kg, P<0.001, 95% CI -2.01 to -0.89), BMI (MD=-0.35 kg/m2, P=0.002, 95% CI -0.57 to -0.13), WC (MD=-1.98 cm, P=0.007, 95% CI -3.42 to -0.55), fat mass (MD=-1.32 kg, P<0.001, 95% CI -1.94 to -0.69), DBP (MD=-1.76 mmHg, P=0.04, 95% CI -3.47 to -0.04), and HbA1c (MD=-0.13%, P=0.005, 95% CI -0.22 to -0.04) with statistical significance. However, non-significant effects were observed on other outcomes, including fat mass percentage, behavior outcomes (i.e., MVPA, energy intake), and metabolic outcomes (i.e., SBP, and triglycerides). 59% of included studies utilized three resource types (i.e., facilitating, boosting, and nudging).
Conclusions:
This meta-analysis presents findings indicating that mobile phone application interventions significantly reduce weight, BMI, WC, fat mass, DBP, and HbA1c among adults with overweight and obesity. However, future studies could consider how to optimize app interventions through behavior change strategies and resources to enhance overall effectiveness.
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