JMIR Publications

ABSTRACT

Background:

Long-term adherence to weight loss behaviors remains a challenge, and most people who achieve significant weight loss regain 1-2 kg per year. Reinforcing healthy behaviors through financial incentives is a promising strategy to promote adherence to weight loss initiation and maintenance skills. Yet, there are many questions regarding how to optimize incentives to maximize weight loss and maintenance outcomes. In September 2020, we launched a 5-year, multisite, randomized clinical trial, Log2Lose, to address key research gaps related to effective behavioral incentivization modalities for weight loss and maintenance. Log2Lose was originally designed to include a series of in-person group meetings along with reinforcement and informational text messaging, in-person data collection, and remote monitoring; however, the COVID-19 pandemic forced a pivot from a partial to a fully remote weight loss program. Since the launch of Log2Lose in 2020, the technology landscape has continually evolved as consumer technology companies change ownership, business agreements, and consumer protection practices.

Objective:

The objective of this manuscript is to describe how we have approached the development and evolution of Log2Lose in the face of a rapidly changing technology landscape. We report on technical and logistical challenges encountered thus far, and highlight strengths of our technology approach that have been stress-tested in real-world settings.

Methods:

The Log2Lose platform automates the collection and processing of daily calorie intake and weight measurements, enabling weekly delivery of financial incentives and text messages to promote weight loss and maintenance. The system's design ensures flexibility to address technical challenges and maintain data integrity and intervention fidelity.

Results:

By July 5, 2024, 706 participants submitted 170,024 remote weight measurements and 110,594 daily calorie entries. The platform sent 115,146 text messages and calculated 33,414 incentive payments. We tested the approach across geographies and cellular carriers, adapting to many challenges. Automation handled 99% of data collection and feedback. Technical support was essential for troubleshooting and success.

Conclusions:

Weight management requires innovative approaches for effective initiation and maintenance. The Log2Lose platform’s automation allows scalability but necessitates ongoing technical support. Its agile design enables adaptation to changing consumer technology and regulatory landscapes. Log2Lose demonstrates feasibility of a scalable, digital health weight management program. Effectiveness stems from technical adaptability, continuous monitoring, and problem-solving capabilities. Log2Lose offers detailed insights on how to process remote collected weight and dietary data over time for investigators, health care providers, and employers creating similar digital health interventions. Clinical Trial: https://clinicaltrials.gov/ct2/show/NCT04770909