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Sun H, Zhang K, Lan W, Gu Q, Jiang G, Yang X, Qin W, Han D. An AI Dietitian for Type 2 Diabetes Mellitus Management Based on Large Language and Image Recognition Models: Preclinical Concept Validation Study. J Med Internet Res 2023; 25:e51300. [PMID: 37943581 PMCID: PMC10667983 DOI: 10.2196/51300] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/18/2023] [Accepted: 10/06/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Nutritional management for patients with diabetes in China is a significant challenge due to the low supply of registered clinical dietitians. To address this, an artificial intelligence (AI)-based nutritionist program that uses advanced language and image recognition models was created. This program can identify ingredients from images of a patient's meal and offer nutritional guidance and dietary recommendations. OBJECTIVE The primary objective of this study is to evaluate the competence of the models that support this program. METHODS The potential of an AI nutritionist program for patients with type 2 diabetes mellitus (T2DM) was evaluated through a multistep process. First, a survey was conducted among patients with T2DM and endocrinologists to identify knowledge gaps in dietary practices. ChatGPT and GPT 4.0 were then tested through the Chinese Registered Dietitian Examination to assess their proficiency in providing evidence-based dietary advice. ChatGPT's responses to common questions about medical nutrition therapy were compared with expert responses by professional dietitians to evaluate its proficiency. The model's food recommendations were scrutinized for consistency with expert advice. A deep learning-based image recognition model was developed for food identification at the ingredient level, and its performance was compared with existing models. Finally, a user-friendly app was developed, integrating the capabilities of language and image recognition models to potentially improve care for patients with T2DM. RESULTS Most patients (182/206, 88.4%) demanded more immediate and comprehensive nutritional management and education. Both ChatGPT and GPT 4.0 passed the Chinese Registered Dietitian examination. ChatGPT's food recommendations were mainly in line with best practices, except for certain foods like root vegetables and dry beans. Professional dietitians' reviews of ChatGPT's responses to common questions were largely positive, with 162 out of 168 providing favorable reviews. The multilabel image recognition model evaluation showed that the Dino V2 model achieved an average F1 score of 0.825, indicating high accuracy in recognizing ingredients. CONCLUSIONS The model evaluations were promising. The AI-based nutritionist program is now ready for a supervised pilot study.
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Affiliation(s)
- Haonan Sun
- School of Life Science, Beijing University of Chinese Medicine, Beijing, China
| | - Kai Zhang
- School of Life Science, Beijing University of Chinese Medicine, Beijing, China
| | - Wei Lan
- Department of Pediatrics, Peking University Shenzhen Hospital, Shenzhen, China
| | - Qiufeng Gu
- Department of Pediatrics, Peking University Shenzhen Hospital, Shenzhen, China
| | - Guangxiang Jiang
- School of Life Science, Beijing University of Chinese Medicine, Beijing, China
| | - Xue Yang
- School of Life Science, Beijing University of Chinese Medicine, Beijing, China
| | - Wanli Qin
- School of Life Science, Beijing University of Chinese Medicine, Beijing, China
| | - Dongran Han
- School of Life Science, Beijing University of Chinese Medicine, Beijing, China
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Hughes ME, Chico TJA. How Could Sensor-Based Measurement of Physical Activity Be Used in Cardiovascular Healthcare? SENSORS (BASEL, SWITZERLAND) 2023; 23:8154. [PMID: 37836984 PMCID: PMC10575134 DOI: 10.3390/s23198154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/27/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023]
Abstract
Physical activity and cardiovascular disease (CVD) are intimately linked. Low levels of physical activity increase the risk of CVDs, including myocardial infarction and stroke. Conversely, when CVD develops, it often reduces the ability to be physically active. Despite these largely understood relationships, the objective measurement of physical activity is rarely performed in routine healthcare. The ability to use sensor-based approaches to accurately measure aspects of physical activity has the potential to improve many aspects of cardiovascular healthcare across the spectrum of healthcare, from prediction, prevention, diagnosis, and treatment to disease monitoring. This review discusses the potential of sensor-based measurement of physical activity to augment current cardiovascular healthcare. We highlight many factors that should be considered to maximise the benefit and reduce the risks of such an approach. Because the widespread use of such devices in society is already a reality, it is important that scientists, clinicians, and healthcare providers are aware of these considerations.
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Affiliation(s)
- Megan E. Hughes
- Clinical Medicine, School of Medicine and Population Health, The Medical School, University of Sheffield, Beech Hill Road, Sheffield S10 2RX, UK
| | - Timothy J. A. Chico
- Clinical Medicine, School of Medicine and Population Health, The Medical School, University of Sheffield, Beech Hill Road, Sheffield S10 2RX, UK
- British Heart Foundation Data Science Centre, Health Data Research, London WC1E 6BP, UK
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Branch OH, Rikhy M, Auster-Gussman LA, Lockwood KG, Graham SA. Relationships Between Blood Pressure Reduction, Weight Loss, and Engagement in a Digital App–Based Hypertension Care Program: Observational Study. JMIR Form Res 2022; 6:e38215. [DOI: 10.2196/38215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 09/09/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022] Open
Abstract
Background
Home blood pressure (BP) monitoring is recommended for people with hypertension; however, meta-analyses have demonstrated that BP improvements are related to additional coaching support in combination with self-monitoring, with little or no effect of self-monitoring alone. High-contact coaching requires substantial resources and may be difficult to deliver via human coaching models.
Objective
This observational study assessed changes in BP and body weight following participation in a fully digital program called Lark Hypertension Care with coaching powered by artificial intelligence (AI).
Methods
Participants (N=864) had a baseline systolic BP (SBP) ≥120 mm Hg, provided their baseline body weight, and had reached at least their third month in the program. The primary outcome was the change in SBP at 3 and 6 months, with secondary outcomes of change in body weight and associations of changes in SBP and body weight with participant demographics, characteristics, and program engagement.
Results
By month 3, there was a significant drop of –5.4 mm Hg (95% CI –6.5 to –4.3; P<.001) in mean SBP from baseline. BP did not change significantly (ie, the SBP drop maintained) from 3 to 6 months for participants who provided readings at both time points (P=.49). Half of the participants achieved a clinically meaningful drop of ≥5 mm Hg by month 3 (178/349, 51.0%) and month 6 (98/199, 49.2%). The magnitude of the drop depended on starting SBP. Participants classified as hypertension stage 2 had the largest mean drop in SBP of –12.4 mm Hg (SE 1.2 mm Hg) by month 3 and –13.0 mm Hg (SE 1.6 mm Hg) by month 6; participants classified as hypertension stage 1 lowered by –5.2 mm Hg (SE 0.8) mm Hg by month 3 and –7.3 mm Hg (SE 1.3 mm Hg) by month 6; participants classified as elevated lowered by –1.1 mm Hg (SE 0.7 mm Hg) by month 3 but did not drop by month 6. Starting SBP (β=.11; P<.001), percent weight change (β=–.36; P=.02), and initial BMI (β=–.56; P<.001) were significantly associated with the likelihood of lowering SBP ≥5 mm Hg by month 3. Percent weight change acted as a mediator of the relationship between program engagement and drop in SBP. The bootstrapped unstandardized indirect effect was –0.0024 (95% CI –0.0052 to 0; P=.002).
Conclusions
A hypertension care program with coaching powered by AI was associated with a clinically meaningful reduction in SBP following 3 and 6 months of program participation. Percent weight change was significantly associated with the likelihood of achieving a ≥5 mm Hg drop in SBP. An AI-powered solution may offer a scalable approach to helping individuals with hypertension achieve clinically meaningful reductions in their BP and associated risk of cardiovascular disease and other serious adverse outcomes via healthy lifestyle changes such as weight loss.
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Nagata T, Aoyagi SS, Takahashi M, Nagata M, Mori K. Effects of Feedback From Self-Monitoring Devices on Lifestyle Changes in Workers with Diabetes: 3-Month Randomized Controlled Pilot Trial. JMIR Form Res 2022; 6:e23261. [PMID: 35943766 PMCID: PMC9399840 DOI: 10.2196/23261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 03/02/2021] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Although lifestyle interventions are useful in the prevention and management of diabetes, they can be expensive and time-consuming. There is some evidence on the effectiveness of automated mobile technology for health self-monitoring; however, few studies have used such devices in the occupational health field.
Objective
We aimed to examine the effectiveness of a digital self-monitoring device on glucose levels and activity of workers with diabetes in Japan. The primary outcomes were changes in blood glucose levels, and the secondary outcomes were changes in weight and BMI.
Methods
A 2-arm randomized controlled pilot trial was conducted with workers from 23 organizations. The intervention group (n=50) wore an armband activity monitor, a body composition monitor, and a blood pressure monitor for 3 months and received semiautomated weekly email messages tailored to their device data. The control group (n=53) engaged in no self-monitoring. Messages were developed by a physician and a dietician. Postintervention changes in blood glucose levels, weight, and BMI were compared between the intervention and control groups, using blood tests and questionnaires.
Results
At the end of 3 months, the intervention group showed significantly lower blood glucose levels (HbA1c: intervention group mean 6.4% (SD 0.3%) vs control group mean 6.6% (SD 0.3%); Cohen d=0.7, 95% CI 0.2-1.1; P=.009). There were no significant between-group differences in weight and BMI.
Conclusions
Mobile digital self-monitoring was effective in improving blood glucose levels in workers with diabetes. The use of digital health devices is a cost-effective way of implementing health self-monitoring for large numbers of individuals in the workplace. However, due to the large volume of missing values in this study, we need to be careful in interpreting the results, and well-designed intervention studies need to be conducted.
Trial Registration
University Hospital Medical Information Network UMIN000023651;
https://upload.umin.ac.jp/cgi-open-bin/icdr/ctr_view_cb.cgi?recptno=R000027244&flwp_key=1008PYbOcXKmk7CAg4Th1FWS
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Affiliation(s)
- Tomohisa Nagata
- Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Sona-Sanae Aoyagi
- Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Minekazu Takahashi
- Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Masako Nagata
- Department of Occupational Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Koji Mori
- Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
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Forkmann K, Roth L, Mehl N. Introducing zanadio—A Digitalized, Multimodal Program to Treat Obesity. Nutrients 2022; 14:nu14153172. [PMID: 35956348 PMCID: PMC9370658 DOI: 10.3390/nu14153172] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 12/17/2022] Open
Abstract
While the prevalence of overweight and obesity has been increasing annually, the accessibility of on-site treatment programs is not rising correspondingly. Digital, evidence-based obesity treatment programs could potentially alleviate this situation. The application zanadio has been developed to enable patients with obesity (BMI 30–45 kg/m2) to participate in a digital, multimodal weight reduction program based on current treatment guidelines. This article is divided into two parts: (I) it introduces zanadio, its aims and therapeutic concept, and (II) provides a first impression and demographic data on more than 11,000 patients from across the country who have used zanadio within the last 16 months, which demonstrates the demand for a digital obesity treatment. zanadio has the potential to partially close the current gap in obesity care. Future work should focus on identifying predictors of successful weight loss to further individualize digital obesity treatment, and an important next step would be to prevent obesity, i.e., to start the treatment at lower BMI levels, and to invent digital treatment programs for children and adolescents.
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Affiliation(s)
| | - Lena Roth
- Max Planck Institute for Human Cognitive and Brain Sciences, 04103 Leipzig, Germany;
| | - Nora Mehl
- aidhere GmbH, 20354 Hamburg, Germany;
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Hori JH, Sia EX, Lockwood KG, Auster-Gussman LA, Rapoport S, Branch OH, Graham SA. Discovering Engagement Personas in a Digital Diabetes Prevention Program. Behav Sci (Basel) 2022; 12:bs12060159. [PMID: 35735369 PMCID: PMC9220103 DOI: 10.3390/bs12060159] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 01/27/2023] Open
Abstract
Digital health technologies are shaping the future of preventive health care. We present a quantitative approach for discovering and characterizing engagement personas: longitudinal engagement patterns in a fully digital diabetes prevention program. We used a two-step approach to discovering engagement personas among n = 1613 users: (1) A univariate clustering method using two unsupervised k-means clustering algorithms on app- and program-feature use separately and (2) A bivariate clustering method that involved comparing cluster labels for each member across app- and program-feature univariate clusters. The univariate analyses revealed five app-feature clusters and four program-feature clusters. The bivariate analysis revealed five unique combinations of these clusters, called engagement personas, which represented 76% of users. These engagement personas differed in both member demographics and weight loss. Exploring engagement personas is beneficial to inform strategies for personalizing the program experience and optimizing engagement in a variety of digital health interventions.
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7
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Tricás-Vidal HJ, Lucha-López MO, Hidalgo-García C, Vidal-Peracho MC, Monti-Ballano S, Tricás-Moreno JM. Health Habits and Wearable Activity Tracker Devices: Analytical Cross-Sectional Study. SENSORS 2022; 22:s22082960. [PMID: 35458945 PMCID: PMC9031391 DOI: 10.3390/s22082960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 11/23/2022]
Abstract
Wearable activity trackers are electronic devices that facilitate self-monitoring of information related to health. The purpose of this study was to examine the use of tracker devices to record daily activity (calories) and its associations with gender, generation, BMI, and physical activity behavior of United States of America resident adults; a cross-sectional study in 892 subjects recruited to participate in an anonymous online survey was performed. Being female increased the odds of using a tracker device by 2.3 times. Having low cardiovascular disease mortality risk related to time spent sitting increased the odds for using a tracker device by 2.7 times, and having medium risk 1.9 times, with respect to having high risk. For every 1-point increase in BMI, the odds for using a tracker device increased by 5.2%. Conclusions: Subjects who had ever used any tracker device had a higher BMI. The use of tracker devices was related to lower cardiovascular disease mortality risk related to sitting time. The amount of physical activity and the time spent walking were not associated with the usage of tracker devices. It is possible that the user of tracker devices should be supported by professionals to implement deep change in health habits.
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Affiliation(s)
- Héctor José Tricás-Vidal
- Unidad de Investigación en Fisioterapia, Universidad de Zaragoza, Domingo Miral, s/n, 50009 Zaragoza, Spain; (H.J.T.-V.); (M.C.V.-P.); (S.M.-B.); (J.M.T.-M.)
- School of Health Professions, University of Mary Hardin Baylor, 900 College St., Belton, TX 76513, USA
| | - María Orosia Lucha-López
- Unidad de Investigación en Fisioterapia, Universidad de Zaragoza, Domingo Miral, s/n, 50009 Zaragoza, Spain; (H.J.T.-V.); (M.C.V.-P.); (S.M.-B.); (J.M.T.-M.)
- Correspondence: (M.O.L.-L.); (C.H.-G.); Tel.: +34-626-480-131 (M.O.L.-L.)
| | - César Hidalgo-García
- Unidad de Investigación en Fisioterapia, Universidad de Zaragoza, Domingo Miral, s/n, 50009 Zaragoza, Spain; (H.J.T.-V.); (M.C.V.-P.); (S.M.-B.); (J.M.T.-M.)
- Correspondence: (M.O.L.-L.); (C.H.-G.); Tel.: +34-626-480-131 (M.O.L.-L.)
| | - María Concepción Vidal-Peracho
- Unidad de Investigación en Fisioterapia, Universidad de Zaragoza, Domingo Miral, s/n, 50009 Zaragoza, Spain; (H.J.T.-V.); (M.C.V.-P.); (S.M.-B.); (J.M.T.-M.)
- Department of Endocrinology and Nutrition, Hospital Royo Villanova, SALUD, Barrio San Gregorio s/n, 50015 Zaragoza, Spain
| | - Sofía Monti-Ballano
- Unidad de Investigación en Fisioterapia, Universidad de Zaragoza, Domingo Miral, s/n, 50009 Zaragoza, Spain; (H.J.T.-V.); (M.C.V.-P.); (S.M.-B.); (J.M.T.-M.)
| | - José Miguel Tricás-Moreno
- Unidad de Investigación en Fisioterapia, Universidad de Zaragoza, Domingo Miral, s/n, 50009 Zaragoza, Spain; (H.J.T.-V.); (M.C.V.-P.); (S.M.-B.); (J.M.T.-M.)
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8
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Chan A, Chan D, Lee H, Chin Ng C, Hui Ling Yeo A. Reporting adherence, validity and physical activity measures of wearable activity trackers in medical research: A systematic review. Int J Med Inform 2022; 160:104696. [DOI: 10.1016/j.ijmedinf.2022.104696] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/19/2021] [Accepted: 01/16/2022] [Indexed: 01/18/2023]
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Choudhury A, Asan O. Impact of using wearable devices on psychological Distress: Analysis of the health information national Trends survey. Int J Med Inform 2021; 156:104612. [PMID: 34649113 DOI: 10.1016/j.ijmedinf.2021.104612] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 09/28/2021] [Accepted: 10/01/2021] [Indexed: 01/11/2023]
Abstract
AIM This study explores the possible impact of wearables on psychological distress and their implications on designs. METHOD The study conceptualizes and tests two exploratory models by analyzing the US-based Health Information National Trends Survey of 2019 and 2020. Six variants from the databases were used in the study as predictors. We used models 4 and 6 of the Hayes PROCESS macros to test our conceptual parallel and sequential mediation models, respectively. RESULTS The finding indicates significant and negative indirect effects of 'Use of wearable device' on 'Psychological distress.' In parallel mediation models, 'self-care' and 'health perception' were noted to be significant mediators. Wearable devices were associated with improved 'Health perception,' 'Self-care,' and longer 'workout duration,', which in turn helped reduce 'psychological distress' (better mental health). The sequential mediation model captured the indirect effect of 'Use of wearable device' on 'Psychological distress' when sequentially mediated by 'workout duration,' 'BMI,' 'self-care,' and 'health perception' in the given order. CONCLUSION As the adoption of digital wearables is increasing due to their growing potential to augment physiological and psychosocial health, it is critical that these technologies are designed to address the needs of users from diverse backgrounds (race, education level, age).
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Affiliation(s)
- Avishek Choudhury
- Stevens Institute of Technology, School of Systems and Enterprises, United States.
| | - Onur Asan
- Stevens Institute of Technology, School of Systems and Enterprises, United States.
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Friel CP, Cornelius T, Diaz KM. Factors associated with long-term wearable physical activity monitor user engagement. Transl Behav Med 2021; 11:262-269. [PMID: 31671174 DOI: 10.1093/tbm/ibz153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Wearable physical activity monitors (PAMs) have potential to positively influence physical activity. However, high rates of disengagement have been reported, which dampens enthusiasm, as these devices are unlikely to impact habitual physical activity if they are not worn for a sustained period of time. The purpose of this study was to identify demographic and device-use characteristics (e.g., data sharing) associated with sustained device engagement. Current PAM users (n = 418; mean age: 35.0 ± 12.5; 78% female) from across the USA were recruited online and completed a baseline web-based survey in 2015-2016 comprising questions about demographics and device use. Participants were followed-up again in 2017, at which time they reported whether or not they still used a PAM. Sustained PAM engagement was defined as those who continued use at follow-up. The median follow-up time was 15.5 (±3.7) months. In fully adjusted models, the following were significantly associated with long-term engagement: age (odds ratio [OR]: 1.03; 95% confidence interval [CI]: 1.01-1.05, p = .014), Hispanic ethnicity (OR: 3.67; 95% CI: 1.20-11.26, p = .023), running as a preferred exercise (OR: 1.82; 95% CI: 1.02-3.24, p = .043), wanting to monitor health variables as a reason for choosing to use a PAM (OR: 1.73; 95% CI: 1.02-2.92, p = .042), and sharing data from the PAM publicly on social media (e.g., Facebook and Twitter; OR: 5.11; 95% CI: 1.64-15.93, p = .005). A number of sociodemographic and use characteristics were associated with sustained device use over a median follow-up of 1.3 years. One modifiable factor that may lead to longer device engagement is encouraging users to share data publicly.
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Affiliation(s)
- Ciarán P Friel
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA.,Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
| | - Talea Cornelius
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
| | - Keith M Diaz
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
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McDonald JB, Rancourt D. Treating Bulimia Nervosa and Achieving Medically Required Weight Loss: A Case Study. COGNITIVE AND BEHAVIORAL PRACTICE 2021. [DOI: 10.1016/j.cbpra.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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12
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El Fatouhi D, Delrieu L, Goetzinger C, Malisoux L, Affret A, Campo D, Fagherazzi G. Associations of Physical Activity Level and Variability With 6-Month Weight Change Among 26,935 Users of Connected Devices: Observational Real-Life Study. JMIR Mhealth Uhealth 2021; 9:e25385. [PMID: 33856352 PMCID: PMC8085744 DOI: 10.2196/25385] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/31/2020] [Accepted: 02/26/2021] [Indexed: 12/16/2022] Open
Abstract
Background Physical activity (PA) is a modifiable lifestyle factor that can be targeted to increase energy expenditure and promote weight loss. However, the amount of PA required for weight loss remains inconsistent. Wearable activity trackers constitute a valuable opportunity to obtain objective measurements of PA and study large populations in real-life settings. Objective We aim to study the associations of initial device-assessed PA characteristics (average step counts and step count variability) and their evolution with 6-month weight change. Methods We analyzed data from 26,935 Withings-connected device users (wearable activity trackers and digital scales). To assess the initial PA characteristics and their 6-month changes, we used data recorded during the first and sixth 30-day periods of activity tracker use. For each of these periods, we used the monthly mean of daily step values as a proxy for PA level and derived the monthly coefficient of variation (CV) of daily step values to estimate PA level variability. Associations between initial PA characteristics and 6-month weight change were assessed using multivariable linear regression analyses controlled for age, sex, blood pressure, heart rate, and the predominant season. Restricted cubic spline regression was performed to better characterize the continuous shape of the associations between PA characteristics and weight change. Secondary analyses were performed by analyzing the 6-month evolution of PA characteristics in relation to weight change. Results Our results revealed that both a greater PA level and lower PA level variability were associated with weight loss. Compared with individuals who were initially in the sedentary category (<5000 steps/day), individuals who were low active (5000-7499 steps/day), somewhat active (7500-9999 steps/day), and active (≥10,000 steps/day) had a 0.21-kg, a 0.52-kg, and a 1.17-kg greater decrease in weight, respectively (95% CI −0.36 to −0.06, −0.70 to −0.33, and −1.42 to −0.93, respectively). Compared with users whose PA level CV was >63%, users whose PA level CV ranged from 51% to 63%, 40% to 51%, and was ≤40%, had a 0.19-kg, a 0.23-kg, and a 0.33-kg greater decrease in weight, respectively (95% CI −0.38 to −0.01, −0.41 to −0.04, and −0.53 to −0.13, respectively). We also observed that each 1000 steps/day increase in PA level over the 6-month follow-up was associated with a 0.26-kg (95% CI −0.29 to −0.23) decrease in weight. No association was found between the 6-month changes in PA level variability and weight change. Conclusions Our results add to the current body of knowledge that health benefits can be observed below the 10,000 steps/day threshold and suggest that not only increased mean PA level but also greater regularity of the PA level may play important roles in short-term weight loss.
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Affiliation(s)
- Douae El Fatouhi
- Center of Research in Epidemiology and Population Health, UMR 1018 INSERM, Institut Gustave Roussy, Paris-Sud Paris-Saclay University, Villejuif, France
| | - Lidia Delrieu
- Residual Tumor & Response to Treatment Laboratory (RT2Lab), U932 Immunity and Cancer, INSERM, Institut Curie, Paris, France
| | - Catherine Goetzinger
- Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg.,Faculty of Science, Technology and Medicine, University of Luxembourg, Luxembourg, Luxembourg
| | - Laurent Malisoux
- Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Aurélie Affret
- Center of Research in Epidemiology and Population Health, UMR 1018 INSERM, Institut Gustave Roussy, Paris-Sud Paris-Saclay University, Villejuif, France
| | | | - Guy Fagherazzi
- Center of Research in Epidemiology and Population Health, UMR 1018 INSERM, Institut Gustave Roussy, Paris-Sud Paris-Saclay University, Villejuif, France.,Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
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13
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Robertson MC, Raber M, Liao Y, Wu I, Parker N, Gatus L, Le T, Durand CP, Basen-Engquist KM. Patterns of self-monitoring technology use and weight loss in people with overweight or obesity. Transl Behav Med 2021; 11:1537-1547. [PMID: 33837792 DOI: 10.1093/tbm/ibab015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Mobile applications and paired devices allow individuals to self-monitor physical activity, dietary intake, and weight fluctuation concurrently. However, little is known regarding patterns of use of these self-monitoring technologies over time and their implications for weight loss. The objectives of this study were to identify distinct patterns of self-monitoring technology use and to investigate the associations between these patterns and weight change. We analyzed data from a 6-month weight loss intervention for school district employees with overweight or obesity (N = 225). We performed repeated measures latent profile analysis (RMLPA) to identify common patterns of self-monitoring technology use and used multiple linear regression to evaluate the relationship between self-monitoring technology use and weight change. RMLPA revealed four distinct profiles: minimal users (n = 65, 29% of sample), activity trackers (n = 124, 55%), dedicated all-around users (n = 25, 11%), and dedicated all-around users with exceptional food logging (n = 11, 5%). The dedicated all-around users with exceptional food logging lost the most weight (X2[1,225] = 5.27, p = .0217). Multiple linear regression revealed that, adjusting for covariates, only percentage of days of wireless weight scale use (B = -0.05, t(212) = -3.79, p < .001) was independently associated with weight loss. We identified distinct patterns in mHealth self-monitoring technology use for tracking weight loss behaviors. Self-monitoring of weight was most consistently linked to weight loss, while exceptional food logging characterized the group with the greatest weight loss. Weight loss interventions should promote self-monitoring of weight and consider encouraging food logging to individuals who have demonstrated consistent use of self-monitoring technologies.
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Affiliation(s)
- Michael C Robertson
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.,Department of Health Promotion and Behavioral Science, University of Texas School of Public Health, Houston, TX 77030, USA
| | - Margaret Raber
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Yue Liao
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ivan Wu
- Department of Health Disparities, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Nathan Parker
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Leticia Gatus
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Thuan Le
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Casey P Durand
- Department of Health Promotion and Behavioral Science, University of Texas School of Public Health, Houston, TX 77030, USA
| | - Karen M Basen-Engquist
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Bowen-Jallow K, Nunez-Lopez O, Wright A, Fuchs E, Ahn M, Lyons E, Jupiter D, Berry L, Suman O, Radhakrishnan RS, Glaser AM, Thompson DI. Wearable Activity Tracking Device Use in an Adolescent Weight Management Clinic: A Randomized Controlled Pilot Trial. J Obes 2021; 2021:7625034. [PMID: 33505717 PMCID: PMC7811568 DOI: 10.1155/2021/7625034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 12/02/2020] [Accepted: 12/30/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The use of physical activity tracker devices has increased within the general population. However, there is limited medical literature studying the efficacy of such devices in adolescents with obesity. In this study, we explored the feasibility of using wearable activity tracking devices as an adjunct intervention on adolescents with obesity. METHODS Randomized controlled pilot trial evaluated the feasibility (attrition ≤50%) of an activity tracking intervention (ATI) and its effects on weight loss in adolescents with obesity enrolled in an adolescent weight management clinic (AWMC). Outcomes included feasibility (attrition rate) and absolute change in BMI. Differences between groups at 6, 12, and 18 weeks were examined. RESULTS Forty-eight participants were enrolled in the study. Eighteen subjects were randomly assigned to the ATI group and 30 to control. The average age was 14.5 years. Overall, the majority of participants were Hispanic (56%). Sexes were equally distributed. The average baseline BMI was 37.5 kg/m2. At the study conclusion, the overall attrition rate was 52.1%, 44.4% in the ATI group versus 56.6% in the control group, with a differential attrition of 12.2%. The ATI and control groups each showed an absolute decrease in BMI of -0.25 and -2.77, respectively, with no significant differences between the groups. CONCLUSION The attrition rate in our study was >50%. Participation in the AWMC by the ATI and control groups resulted in maintenance of BMI and body weight for the study duration. However, the use of an activity tracking device was not associated with greater weight loss. This trial is registered with NCT03004378.
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Affiliation(s)
- Kanika Bowen-Jallow
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
- Department of Pediatrics, University of Texas Medical Branch, Galveston, TX, USA
| | - Omar Nunez-Lopez
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Alex Wright
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Erika Fuchs
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, USA
| | - Mollie Ahn
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Elizabeth Lyons
- Department of Nutrition and Metabolism, University of Texas Medical Branch, Galveston, TX, USA
| | - Daniel Jupiter
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Lindsey Berry
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Oscar Suman
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Ravi S. Radhakrishnan
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
- Department of Pediatrics, University of Texas Medical Branch, Galveston, TX, USA
| | - Andrea M. Glaser
- Department of Pediatrics, University of Texas Medical Branch, Galveston, TX, USA
| | - Deborah I. Thompson
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
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15
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Laranjo L, Quiroz JC, Tong HL, Arevalo Bazalar M, Coiera E. A Mobile Social Networking App for Weight Management and Physical Activity Promotion: Results From an Experimental Mixed Methods Study. J Med Internet Res 2020; 22:e19991. [PMID: 33289670 PMCID: PMC7755540 DOI: 10.2196/19991] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/06/2020] [Accepted: 11/11/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Smartphone apps, fitness trackers, and online social networks have shown promise in weight management and physical activity interventions. However, there are knowledge gaps in identifying the most effective and engaging interventions and intervention features preferred by their users. OBJECTIVE This 6-month pilot study on a social networking mobile app connected to wireless weight and activity tracking devices has 2 main aims: to evaluate changes in BMI, weight, and physical activity levels in users from different BMI categories and to assess user perspectives on the intervention, particularly on social comparison and automated self-monitoring and feedback features. METHODS This was a mixed methods study involving a one-arm, pre-post quasi-experimental pilot with postintervention interviews and focus groups. Healthy young adults used a social networking mobile app intervention integrated with wireless tracking devices (a weight scale and a physical activity tracker) for 6 months. Quantitative results were analyzed separately for 2 groups-underweight-normal and overweight-obese BMI-using t tests and Wilcoxon sum rank, Wilcoxon signed rank, and chi-square tests. Weekly BMI change in participants was explored using linear mixed effects analysis. Interviews and focus groups were analyzed inductively using thematic analysis. RESULTS In total, 55 participants were recruited (mean age of 23.6, SD 4.6 years; 28 women) and 45 returned for the final session (n=45, 82% retention rate). There were no differences in BMI from baseline to postintervention (6 months) and between the 2 BMI groups. However, at 4 weeks, participants' BMI decreased by 0.34 kg/m2 (P<.001), with a loss of 0.86 kg/m2 in the overweight-obese group (P=.01). Participants in the overweight-obese group used the app significantly less compared with individuals in the underweight-normal BMI group, as they mentioned negative feelings and demotivation from social comparison, particularly from upward comparison with fitter people. Participants in the underweight-normal BMI group were avid users of the app's self-monitoring and feedback (P=.02) and social (P=.04) features compared with those in the overweight-obese group, and they significantly increased their daily step count over the 6-month study duration by an average of 2292 steps (95% CI 898-3370; P<.001). Most participants mentioned a desire for a more personalized intervention. CONCLUSIONS This study shows the effects of different interventions on participants from higher and lower BMI groups and different perspectives regarding the intervention, particularly with respect to its social features. Participants in the overweight-obese group did not sustain a short-term decrease in their BMI and mentioned negative emotions from app use, while participants in the underweight-normal BMI group used the app more frequently and significantly increased their daily step count. These differences highlight the importance of intervention personalization. Future research should explore the role of personalized features to help overcome personal barriers and better match individual preferences and needs.
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Affiliation(s)
- Liliana Laranjo
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.,Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Juan C Quiroz
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.,Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Huong Ly Tong
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | | | - Enrico Coiera
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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16
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Flitcroft L, Chen WS, Meyer D. The Demographic Representativeness and Health Outcomes of Digital Health Station Users: Longitudinal Study. J Med Internet Res 2020; 22:e14977. [PMID: 32589150 PMCID: PMC7381012 DOI: 10.2196/14977] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 11/20/2019] [Accepted: 12/15/2019] [Indexed: 11/30/2022] Open
Abstract
Background Digital health stations offer an affordable and accessible platform for people to monitor their health; however, there is limited information regarding the demographic profile of users and the health benefits of this technology. Objective This study aimed to assess the demographic representativeness of health station users, identify the factors associated with repeat utilization of stations, and determine if the health status of repeat users changed between baseline and final health check. Methods Data from 180,442 health station users in Australia, including 8441 repeat users, were compared with 2014-2015 Australian National Health Survey (NHS) participants on key demographic and health characteristics. Binary logistic regression analyses were used to compare demographic and health characteristics of repeat and one-time users. Baseline and final health checks of repeat users were compared using McNemar tests and Wilcoxon signed rank tests. The relationship between the number of checks and final health scores was investigated using generalized linear models. Results The demographic profile of SiSU health station users differs from that of the general population. A larger proportion of SiSU users were female (100,814/180,442, 55.87% vs 7807/15,393, 50.72%), younger (86,387/180,442, 47.88% vs 5309/15,393, 34.49% aged less than 35 years), and socioeconomically advantaged (64,388/180,442, 35.68% vs 3117/15,393, 20.25%). Compared with NHS participants, a smaller proportion of SiSU health station users were overweight or obese, were smokers, had high blood pressure (BP), or had diabetes. When data were weighted for demographic differences, only rates of high BP were found to be lower for SiSU users compared with the NHS participants (odds ratio [OR] 1.26; P<.001). Repeat users were more likely to be female (OR 1.37; P<.001), younger (OR 0.99; P<.001), and from high socioeconomic status areas—those residing in socioeconomic index for areas quintiles 4 and 5 were significantly more likely to be repeat users compared with those residing in quintile 1 (OR 1.243; P<.001 and OR 1.151; P<.001, respectively). Repeat users were more likely to have a higher BMI (OR 1.02; P<.001), high BP (OR 1.15; P<.001), and less likely to be smokers (OR 0.77; P<.001). Significant improvements in health status were observed for repeat users. Mean BMI decreased by 0.97 kg/m2 from baseline to final check (z=−14.24; P<.001), whereas the proportion of people with high BP decreased from 15.77% (1080/6848) to 12.90% (885/6860; χ21=38.2; P<.001). The proportion of smokers decreased from 11.91% (1005/8438) to 10.13% (853/8421; χ21=48.4; P<.001). Number of repeat health checks was significantly associated with smoking status (OR 0.96; P<.048) but not with higher BP (P=.14) or BMI (P=.23). Conclusions These findings provide valuable insight into the benefits of health stations for self-monitoring and partially support previous research regarding the effect of demographics and health status on self-management of health.
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Affiliation(s)
- Leah Flitcroft
- Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, Australia
| | - Won Sun Chen
- Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, Australia
| | - Denny Meyer
- Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, Australia
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17
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Blackstone SR, Herrmann LK. Fitness Wearables and Exercise Dependence in College Women: Considerations for University Health Education Specialists. AMERICAN JOURNAL OF HEALTH EDUCATION 2020. [DOI: 10.1080/19325037.2020.1767004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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18
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Frie K, Hartmann-Boyce J, Jebb S, Oke J, Aveyard P. Patterns in Weight and Physical Activity Tracking Data Preceding a Stop in Weight Monitoring: Observational Analysis. J Med Internet Res 2020; 22:e15790. [PMID: 32181749 PMCID: PMC7109615 DOI: 10.2196/15790] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/13/2019] [Accepted: 12/31/2019] [Indexed: 01/16/2023] Open
Abstract
Background Self-regulation for weight loss requires regular self-monitoring of weight, but the frequency of weight tracking commonly declines over time. Objective This study aimed to investigate whether it is a decline in weight loss or a drop in motivation to lose weight (using physical activity tracking as a proxy) that may be prompting a stop in weight monitoring. Methods We analyzed weight and physical activity data from 1605 Withings Health Mate app users, who had set a weight loss goal and stopped tracking their weight for at least six weeks after a minimum of 16 weeks of continuous tracking. Mixed effects models compared weight change, average daily steps, and physical activity tracking frequency between a 4-week period of continuous tracking and a 4-week period preceding the stop in weight tracking. Additional mixed effects models investigated subsequent changes in physical activity data during 4 weeks of the 6-week long stop in weight tracking. Results People lost weight during continuous tracking (mean −0.47 kg, SD 1.73) but gained weight preceding the stop in weight tracking (mean 0.25 kg, SD 1.62; difference 0.71 kg; 95% CI 0.60 to 0.81). Average daily steps (beta=−220 daily steps per time period; 95% CI −320 to −120) and physical activity tracking frequency (beta=−3.4 days per time period; 95% CI −3.8 to −3.1) significantly declined from the continuous tracking to the pre-stop period. From pre-stop to post-stop, physical activity tracking frequency further decreased (beta=−6.6 days per time period; 95% CI −7.12 to −6.16), whereas daily step count on the day’s activity was measured increased (beta=110 daily steps per time period; 95% CI 50 to 170). Conclusions In the weeks before people stop tracking their weight, their physical activity and physical activity monitoring frequency decline. At the same time, weight increases, suggesting that declining motivation for weight control and difficulties with making use of negative weight feedback might explain why people stop tracking their weight. The increase in daily steps but decrease in physical activity tracking frequency post-stop might result from selective measurement of more active days.
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Affiliation(s)
- Kerstin Frie
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Jamie Hartmann-Boyce
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Susan Jebb
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Jason Oke
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Paul Aveyard
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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19
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Attig C, Franke T. Abandonment of personal quantification: A review and empirical study investigating reasons for wearable activity tracking attrition. COMPUTERS IN HUMAN BEHAVIOR 2020. [DOI: 10.1016/j.chb.2019.08.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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20
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Dounavi K, Tsoumani O. Mobile Health Applications in Weight Management: A Systematic Literature Review. Am J Prev Med 2019; 56:894-903. [PMID: 31003801 DOI: 10.1016/j.amepre.2018.12.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 12/13/2018] [Accepted: 12/14/2018] [Indexed: 12/23/2022]
Abstract
CONTEXT Weight management is an effective strategy for controlling chronic disease and maintaining physical health, and research on this topic has risen dramatically over the past four decades. The present systematic literature review aimed to identify existing evidence on the efficacy of mobile health technology in facilitating weight management behaviors, such as healthy food consumption and physical activity. EVIDENCE ACQUISITION A systematic search was conducted in Ovid MEDLINE and Ovid PsycINFO databases with the aim to identify studies published in peer-reviewed journal articles between 2012 and 2017. EVIDENCE SYNTHESIS A total of 39 studies were analyzed in spring 2018 and are presented here in terms of participant characteristics, effective technology components, additional treatments, impact on health-related behaviors, and treatment efficacy. Indicators of study quality and social validity are also provided. CONCLUSIONS Mobile health apps are widely considered as satisfactory, easy to use, and helpful in the pursuit of weight loss goals by patients. The potential of mobile health apps in facilitating weight loss lies in their ability to increase treatment adherence through strategies such as self-monitoring. These findings indicate that satisfactory treatment adherence and consequent weight loss and maintenance are achieved in the presence of high levels of engagement with a mobile health app. The research quality assessment of RCTs reveals a great need for following international standards both when conducting and reporting research.
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Affiliation(s)
- Katerina Dounavi
- School of Social Sciences, Education and Social Work, Queen's University of Belfast, Belfast, Northern Ireland.
| | - Olga Tsoumani
- Imec-SMIT, Vrije Universiteit Brussel, Brussels, Belgium
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21
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Affiliation(s)
- Melissa A Haendel
- From the Oregon Clinical and Translational Research Institute, Oregon Health and Science University, Portland, and the Linus Pauling Institute and the Center for Genome Research and Biocomputing, Oregon State University, Corvallis (M.A.H.); Johns Hopkins University Schools of Medicine, Public Health, and Nursing, Baltimore (C.G.C.); and the Jackson Laboratory for Genomic Medicine and the Institute for Systems Genomics, University of Connecticut - both in Farmington (P.N.R.)
| | - Christopher G Chute
- From the Oregon Clinical and Translational Research Institute, Oregon Health and Science University, Portland, and the Linus Pauling Institute and the Center for Genome Research and Biocomputing, Oregon State University, Corvallis (M.A.H.); Johns Hopkins University Schools of Medicine, Public Health, and Nursing, Baltimore (C.G.C.); and the Jackson Laboratory for Genomic Medicine and the Institute for Systems Genomics, University of Connecticut - both in Farmington (P.N.R.)
| | - Peter N Robinson
- From the Oregon Clinical and Translational Research Institute, Oregon Health and Science University, Portland, and the Linus Pauling Institute and the Center for Genome Research and Biocomputing, Oregon State University, Corvallis (M.A.H.); Johns Hopkins University Schools of Medicine, Public Health, and Nursing, Baltimore (C.G.C.); and the Jackson Laboratory for Genomic Medicine and the Institute for Systems Genomics, University of Connecticut - both in Farmington (P.N.R.)
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22
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Thomas J, Moring J, Nagel M, Lee M, Linford C, Woods T, Clinkenbeard S. Demands of Multiple Behavior Change in Type 2 Diabetes Risk Reduction. J Nurse Pract 2018. [DOI: 10.1016/j.nurpra.2018.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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23
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Martin CL, Tate DF, Valle CG. Nonadherence to daily self-weighing and activity tracking is associated with weight fluctuations among African American breast cancer survivors. PLoS One 2018; 13:e0199751. [PMID: 29944706 PMCID: PMC6019092 DOI: 10.1371/journal.pone.0199751] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 06/13/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Daily self-weighing (DSW) and daily activity tracking (DAT) are useful strategies for preventing weight gain among African American breast cancer survivors. However, self-monitoring behaviors vary over time, increasing risk of weight gain. This study explored the association of nonadherence to DSW and DAT with corresponding weight fluctuations among African American breast cancer survivors. METHODS Using data from a 6-month randomized controlled trial, we conducted a secondary data analysis among women randomized into a DSW group (n = 13) and a DSW+DAT group (n = 11). DSW and DAT were captured from wireless scale and activity tracker data. Nonadherence to DSW was defined as one or more days without a weight measurement, and nonadherence to DAT was defined as one or more days without activity tracking. Generalized estimating equations were used to examine weight fluctuations in relation to nonadherence to DSW and DAT. Data analysis occurred from September 2016-April 2017. RESULTS Over the 6-month study period, women provided 119.2 ± 46.0 weight measurements and 121.9 ± 53.2 days of physical activity tracking. Nonadherence to DSW was associated with weight fluctuations. For every 1-day increase in nonadherence to DSW, weight increased by 0.031 kg (95% CI: 0.012, 0.050; p<0.01). Additionally, during periods of DSW and DAT weight decreased by 0.028 kg (95% CI: -0.042, -0.014; p<0.001) and 0.017 kg (95% CI: -0.030; -0.004) respectively. CONCLUSIONS Our findings suggest that nonadherence to DSW was associated with weight gain among breast cancer survivors. Weight loss was enhanced during periods of DSW and DAT.
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Affiliation(s)
- Chantel L. Martin
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America
| | - Deborah F. Tate
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States of America
| | - Carmina G. Valle
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States of America
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24
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Schembre SM, Liao Y, Robertson MC, Dunton GF, Kerr J, Haffey ME, Burnett T, Basen-Engquist K, Hicklen RS. Just-in-Time Feedback in Diet and Physical Activity Interventions: Systematic Review and Practical Design Framework. J Med Internet Res 2018; 20:e106. [PMID: 29567638 PMCID: PMC5887039 DOI: 10.2196/jmir.8701] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 12/19/2017] [Accepted: 12/22/2017] [Indexed: 01/14/2023] Open
Abstract
Background The integration of body-worn sensors with mobile devices presents a tremendous opportunity to improve just-in-time behavioral interventions by enhancing bidirectional communication between investigators and their participants. This approach can be used to deliver supportive feedback at critical moments to optimize the attainment of health behavior goals. Objective The goals of this systematic review were to summarize data on the content characteristics of feedback messaging used in diet and physical activity (PA) interventions and to develop a practical framework for designing just-in-time feedback for behavioral interventions. Methods Interventions that included just-in-time feedback on PA, sedentary behavior, or dietary intake were eligible for inclusion. Feedback content and efficacy data were synthesized descriptively. Results The review included 31 studies (15/31, 48%, targeting PA or sedentary behavior only; 13/31, 42%, targeting diet and PA; and 3/31, 10%, targeting diet only). All studies used just-in-time feedback, 30 (97%, 30/31) used personalized feedback, and 24 (78%, 24/31) used goal-oriented feedback, but only 5 (16%, 5/31) used actionable feedback. Of the 9 studies that tested the efficacy of providing feedback to promote behavior change, 4 reported significant improvements in health behavior. In 3 of these 4 studies, feedback was continuously available, goal-oriented, or actionable. Conclusions Feedback that was continuously available, personalized, and actionable relative to a known behavioral objective was prominent in intervention studies with significant behavior change outcomes. Future research should determine whether all or some of these characteristics are needed to optimize the effect of feedback in just-in-time interventions.
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Affiliation(s)
- Susan M Schembre
- Department of Behavioral Science, Division of Cancer Control and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Yue Liao
- Department of Behavioral Science, Division of Cancer Control and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Michael C Robertson
- Department of Behavioral Science, Division of Cancer Control and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Genevieve Fridlund Dunton
- Institute for Health Promotion & Disease Prevention, Department of Preventive Medicine, University of Southern California, Los Angeles, CA, United States
| | - Jacqueline Kerr
- Division of Behavioral Medicine, Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA, United States
| | - Meghan E Haffey
- Department of Epidemiology, University of Texas School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Taylor Burnett
- Department of Family and Consumer Sciences, College of Health Science, Sam Houston State University, Huntsville, TX, United States
| | - Karen Basen-Engquist
- Department of Behavioral Science, Division of Cancer Control and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Rachel S Hicklen
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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25
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Bender MS, Cooper BA, Park LG, Padash S, Arai S. A Feasible and Efficacious Mobile-Phone Based Lifestyle Intervention for Filipino Americans with Type 2 Diabetes: Randomized Controlled Trial. JMIR Diabetes 2017; 2:e30. [PMID: 30291068 PMCID: PMC6238885 DOI: 10.2196/diabetes.8156] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 10/02/2017] [Accepted: 10/29/2017] [Indexed: 01/05/2023] Open
Abstract
Background Filipino Americans have a high prevalence of obesity, type 2 diabetes (T2D), and cardiovascular disease compared with other Asian American subgroups and non-Hispanic whites. Mobile health (mHealth) weight loss interventions can reduce chronic disease risks, but these are untested in Filipino Americans with T2D. Objective The objective of this study was to assess feasibility and potential efficacy of a pilot, randomized controlled trial (RCT) of a culturally adapted mHealth weight loss lifestyle intervention (Pilipino Americans Go4Health [PilAm Go4Health]) for overweight Filipino Americans with T2D. Methods This was a 2-arm pilot RCT of the 3-month PilAm Go4Health intervention (phase 1) with an active waitlist control and 3-month follow-up (phase 2). The waitlist control received the PilAm Go4Health in phase 2, whereas the intervention group transitioned to the 3-month follow-up. PilAm Go4Health incorporated a Fitbit accelerometer, mobile app with diary for health behavior tracking (steps, food/calories, and weight), and social media (Facebook) for virtual social support, including 7 in-person monthly meetings. Filipino American adults ≥18 years with T2D were recruited from Northern California. Feasibility was measured by rates of recruitment, engagement, and retention. Multilevel regression analyses assessed within and between group differences for the secondary outcome of percent weight change and other outcomes of weight (kg), body mass index (BMI), waist circumference, fasting plasma glucose, HbA1c, and steps. Results A total of 45 Filipino American adults were enrolled and randomized. Mean age was 58 (SD 10) years, 62% (28/45) were women, and mean BMI was 30.1 (SD 4.6). Participant retention and study completion were 100%, with both the intervention and waitlist group achieving near-perfect attendance at all 7 intervention office visits. Groups receiving the PilAm Go4Health in phase 1 (intervention group) and phase 2 (waitlist group) had significantly greater weight loss, −2.6% (−3.9 to −1.4) and −3.3% (−1.8 to −4.8), respectively, compared with the nonintervention group, resulting in a moderate to small effect sizes (d=0.53 and 0.37, respectively). In phase 1, 18% (4/22) of the intervention group achieved a 5% weight loss, whereas 82% (18/22) maintained or lost 2% to 5% of their weight and continued to maintain this weight loss in the 3-month follow-up. Other health outcomes, including waist circumference, BMI, and step counts, improved when each arm received the PilAm Go4Health, but the fasting glucose and HbA1c outcomes were mixed. Conclusions The PilAm Go4Health was feasible and demonstrated potential efficacy in reducing diabetes risks in overweight Filipino Americans with T2D. This study supports the use of mHealth and other promising intervention strategies to reduce obesity and diabetes risks in Filipino Americans. Further testing in a full-scale RCT is warranted. These findings may support intervention translation to reduce diabetes risks in other at-risk diverse populations. Trial Registration Clinicaltrials.gov NCT02290184; https://clinicaltrials.gov/ct2/show/NCT02290184 (Archived by WebCite at http://www.webcitation.org/6vDfrvIPp)
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Affiliation(s)
- Melinda S Bender
- Family Health Care Nursing Department, School of Nursing, University of California San Francisco, San Francisco, CA, United States
| | - Bruce A Cooper
- Office of the Dean and Administration, School of Nursing, University of California San Francisco, San Francisco, CA, United States
| | - Linda G Park
- Community Health Services, School of Nursing, University of California San Francisco, San Francisco, CA, United States
| | - Sara Padash
- School of Nursing, University of San Francisco, San Francisco, CA, United States
| | - Shoshana Arai
- Family Health Care Nursing Department, School of Nursing, University of California San Francisco, San Francisco, CA, United States
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26
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Simpson CC, Mazzeo SE. Calorie counting and fitness tracking technology: Associations with eating disorder symptomatology. Eat Behav 2017; 26:89-92. [PMID: 28214452 DOI: 10.1016/j.eatbeh.2017.02.002] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 02/01/2017] [Accepted: 02/08/2017] [Indexed: 02/07/2023]
Abstract
The use of online calorie tracking applications and activity monitors is increasing exponentially. Anecdotal reports document the potential for these trackers to trigger, maintain, or exacerbate eating disorder symptomatology. Yet, research has not examined the relation between use of these devices and eating disorder-related attitudes and behaviors. This study explored associations between the use of calorie counting and fitness tracking devices and eating disorder symptomatology. Participants (N=493) were college students who reported their use of tracking technology and completed measures of eating disorder symptomatology. Individuals who reported using calorie trackers manifested higher levels of eating concern and dietary restraint, controlling for BMI. Additionally, fitness tracking was uniquely associated with ED symptomatology after adjusting for gender and bingeing and purging behavior within the past month. Findings highlight associations between use of calorie and fitness trackers and eating disorder symptomatology. Although preliminary, overall results suggest that for some individuals, these devices might do more harm than good.
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Affiliation(s)
- Courtney C Simpson
- Department of Psychology, Virginia Commonwealth University, P.O. Box 842018, Richmond, VA 23284-2018, USA.
| | - Suzanne E Mazzeo
- Departments of Psychology & Pediatrics, Virginia Commonwealth University, P.O. Box 842018, Richmond, VA 23284-2018, USA.
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27
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Goldstein CM, Thomas JG, Wing RR, Bond DS. Successful weight loss maintainers use health-tracking smartphone applications more than a nationally representative sample: comparison of the National Weight Control Registry to Pew Tracking for Health. Obes Sci Pract 2017; 3:117-126. [PMID: 28702210 PMCID: PMC5478812 DOI: 10.1002/osp4.102] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 01/06/2017] [Accepted: 01/15/2017] [Indexed: 11/21/2022] Open
Abstract
Objective The objective of this paper is to evaluate successful weight loss maintainers' use of self‐monitoring technology. Methods National Weight Control Registry (NWCR) participants, who maintained a ≥13.6 kg weight loss for ≥1 year, completed an online survey about self‐monitoring technology use. The NWCR sample (n = 794) was compared with a demographically similar subsample of 833 individuals answering the same questions in the Pew Tracking for Health Survey. Results The NWCR had higher rates of tracking weight, diet or exercise using any modality (92.8% vs. 71.3%), on a regular basis (67.4% vs. 41.3%), and frequency of updating records, compared with Pew (ps < .01). Smartphone ownership was higher in NWCR participants (80.2% vs. 52.8%, p < .001), and NWCR smartphone owners had 23.1 times greater odds for using diet, food or calorie counter apps (58.9% vs. 5.9%) and 15.5 times greater odds for using weight monitoring apps (31.7% vs. 3.0%; all ps < .01). Pew respondents more often changed their behaviour based on their tracking data (ps < .01). Conclusion Use of self‐monitoring technology is common in weight loss maintainers: more so than in a nationally representative sample. However, the national sample more often changed their behaviour based on tracking data, perhaps suggesting that weight loss maintainers could derive additional benefit from technology they are already using.
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Affiliation(s)
- C M Goldstein
- Department of Psychiatry and Human Behavior, Alpert Medical School Brown University Providence USA.,The Weight Control and Diabetes Research Center The Miriam Hospital Providence USA
| | - J G Thomas
- Department of Psychiatry and Human Behavior, Alpert Medical School Brown University Providence USA.,The Weight Control and Diabetes Research Center The Miriam Hospital Providence USA
| | - R R Wing
- Department of Psychiatry and Human Behavior, Alpert Medical School Brown University Providence USA.,The Weight Control and Diabetes Research Center The Miriam Hospital Providence USA
| | - D S Bond
- Department of Psychiatry and Human Behavior, Alpert Medical School Brown University Providence USA.,The Weight Control and Diabetes Research Center The Miriam Hospital Providence USA
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28
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Tanenbaum ML, Ross KM, Wing RR. Overeat today, skip the scale tomorrow: An examination of caloric intake predicting nonadherence to daily self-weighing. Obesity (Silver Spring) 2016; 24:2341-2343. [PMID: 27619935 PMCID: PMC5093049 DOI: 10.1002/oby.21650] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 07/15/2016] [Accepted: 07/16/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Daily self-weighing is an effective weight loss strategy. Little is known about "micro" factors influencing nonadherence to self-weighing (e.g., daily overeating). It was hypothesized that increased caloric intake on a given day would increase odds of not self-weighing the following day. METHODS Daily self-reports of weight and caloric intake were collected from 74 adults with overweight and obesity (mean BMI = 31.2 ± 4.5 kg/m2 , age = 50.6 ± 10 years, 69% female, 87% Caucasian) throughout a 12-week Internet-based weight management intervention. Multilevel logistic regression investigated odds of nonadherence to self-weighing on a given day based on the previous day's caloric intake. RESULTS Self-monitoring adherence was high (weights: 87%; calories: 85%); adherence was associated with greater 12-week weight loss (weighing: r = -0.24, P = 0.04; calories: r = -0.26, P = 0.04). Increased caloric intake on a given day, relative to the individual's average intake, was associated with increased odds of nonadherence to self-weighing the next day (F(1,5106) = 12.66, P = 0.0004, β = 0.001). For example, following a day of eating 300 calories more than usual, odds of not self-weighing increased by 1.33. CONCLUSIONS Odds of nonadherence to self-weighing increased following a day with higher-than-usual caloric intake. Weight management interventions collecting daily self-monitoring data could provide support to participants who report increased caloric intake to prevent self-weighing nonadherence.
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Affiliation(s)
- Molly L Tanenbaum
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Kathryn M Ross
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, The Miriam Hospital/Weight Control and Diabetes Research Center, Providence, Rhode Island, USA
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Rena R Wing
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, The Miriam Hospital/Weight Control and Diabetes Research Center, Providence, Rhode Island, USA.
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