Mindful Eating Mobile Health Apps: Review and Appraisal

Mind Your Heart: A Mindful Eating and Diet Education eHealth Program

OBJECTIVE

Examine user perceptions of the Mind Your Heart (MYH) program, a mindful eating and nutrition education program delivered via an eHealth system.

METHODS

Sixteen participants (41.5 ± 13.1 years) completed sample MYH lessons over 3 weeks. We examined changes in mindfulness from the State Mindfulness Scale via text messages sent 3 times per week. We assessed MYH user perceptions in a semistructured interview after 3 weeks. Analyses included Spearman's correlation, repeated measures ANOVA, and thematic analysis.

RESULTS

State Mindfulness Scale scores were significantly improved (F[1,15] = 5.35, P = 0.01) from week 1 (M = 2.28 ± 0.80) to week 3 (M = 2.75 ± 1.04). Four themes emerged: (1) MYH is supportive of health goals, (2) text messages act as an intervention, (3) facilitators or inhibitors of use, and (4) enhancing engagement.

CONCLUSIONS AND IMPLICATIONS

Based on participant feedback, the final version of MYH should include example-based learning to translate abstract concepts like mindful eating into action.

Attrition rate and predictors of a monitoring mHealth application in adolescents with obesity

BACKGROUND

Integrating mobile health (mHealth) into paediatric obesity treatment can provide opportunities for more personalized and lifetime treatment. However, high attrition rates pose a significant challenge. The current study attempts to better understand attrition by exploring (1) attrition rates of a monitoring mHealth application for usage over 14 days and (2) testing predictors of attrition in adolescents with obesity.

METHODS

Participants were 69 adolescents between 12 and 16 years old who engaged in a multidisciplinary obesity treatment centre (either outpatient or inpatient) in two countries (Belgium and France). To assess the attrition rates, frequency distributions were used. To test the predictors of attrition, zero-inflated negative binomial regression was performed.

RESULTS

Attrition rates were high, in the outpatient group, more than half of the participants (53.3%) used the app for only 0-7 days. In the inpatient group, this percentage was 24.1%. Only deficits in initiating (a component of executive functions) were a negative predictor of attrition, indicating that deficits in initiating lead to lower attrition rates.

CONCLUSIONS

This study provides evidence for high attrition rates in mHealth interventions for adolescents with obesity and was the first to investigate psychological predictors of attrition to an mHealth monitoring tool in adolescents with obesity in treatment. Findings regarding predictors of attrition should be approached with caution due to the small sample size.

An Evaluation of Interactive mHealth Applications for Adults Living with Cancer

This study evaluated the quality and usefulness of interactive mobile health (mHealth) applications (apps) for adults with cancer. The PRISMA guidelines were followed to add rigor to the search, as well as to the data collection and analysis. The apps available in the most used app stores (Google Play and Apple) with interactive tailored features were identified. To supplement this, a Google web search was also conducted. The apps were evaluated for their quality using the validated Mobile App Rating Scale (MARS) and for their usefulness using a checklist of end users' desired features derived from the literature. The searches returned 3046 apps and 17 were retained for evaluation. The average quality score of the apps across the sample was 3.62/5 (SD 0.26, range: 3.14-4.06), with Outcomes4me scoring the highest. On average, the apps scored 50% (SD 2.5, range: 31-88%) on the usefulness checklist, with Cancer.net scoring the highest. The lowest-scoring categories were communications features on the usefulness checklist and "information" on the MARS, indicating areas for future work. The findings identified the apps of an acceptable quality and usefulness that could be recommended to those with cancer.

A smartphone application as a personalized treatment tool for adolescents with overweight: an explorative qualitative study

BACKGROUND

The present study is the first step of a 3-year European project in which a tailored smartphone application will be developed and tested as a potential tool in the personalized treatment of children and adolescents with overweight.

METHODS

In this study, 10 focus groups (n = 48 participants) were conducted in Belgium, The Netherlands and France with adolescents with overweight (12-16 years; n = 30) and parents of adolescents with overweight (n = 18) to investigate their perceptions on (un)healthy behavior, the drivers of these behaviors, and the needs of an eHealth application for weight loss. A thorough thematic analysis was performed using Nvivo12.

RESULTS

Results show that adolescents with overweight have a well-articulated perspective on (un)healthy behavior and their needs. Parents underestimate their own influence on the (un)healthy behavior of their children and report difficulties in healthy lifestyle parenting, which makes their role as a coach rather ambiguous. Concerning the needs of an eHealth application, both parents and adolescents formulated some challenging expectations regarding the content and the format including information, a monitoring feature and features that increase participants' motivation to behave healthy. The results of this analysis will form the basis for designing a personalized eHealth application, which will be tested in a next phase.

CONCLUSION

We can conclude that adolescents have a well-articulated perspective on healthy and unhealthy behavior and their needs, whereby a new app could be of great help. It could function as a day-by-day diary and as a supportive coach.

Feasibility of a multiple-component mindfulness intervention for Chinese adolescents living with overweight: A pilot randomized trial

The prevalence of obesity among Chinese adolescents is rising rapidly, and theoretically informed, scalable weight management interventions are needed. We developed and evaluated the feasibility and preliminary effects of an mHealth nutrition education and mindful snacking intervention for weight loss and improved dietary practices among Chinese adolescents with overweight. We examined whether including implementation intention formation (using if-then plans) improved outcomes. With user consultation, we created a 3-week mindful eating intervention delivered as 10 videos to user smartphones. Participants (n = 55) were randomly assigned to mindful eating or mindful eating + planning. Forty-six (83.6%) participants (age = 16.35 ± 0.48 years; body mass index [BMI] = 25.79 ± 2.05 kg/m² ) completed the intervention. Both groups exhibited significant pre- to post-intervention weight loss (M = 1.42 and 1.79 kg, respectively); decreases in snacking frequencies, emotional eating, external eating, and trait craving; and significant increases in mindful eating and eating self-efficacy. No significant intervention group differences were observed. User experience data (n = 16) indicated acceptability and meaningful behavior change. Findings suggest that a smartphone-delivered mindfulness-based intervention for Chinese adolescents living with overweight is feasible and efficacious.

The role of body mass index, healthy eating-related apps and educational activities on eating motives and behaviours among women during the COVID-19 pandemic: A cross sectional study

The COVID-19 related lockdown made it much more difficult for people to control their eating behaviours and body weight with the methods and means they had used before. This is reflected in reports that show that eating behaviours deteriorated significantly during the COVID-19 pandemic (including in Poland). Therefore, it is important to determine what factors may be conducive to healthy eating behaviours among people with different BMI. As previous studies show, the use of healthy eating related-apps and training programs may be a protective factor against the development of unhealthy eating behaviours. Therefore, it is worth checking whether their action will be a protective factor during COVID-19. The aim of this cross sectional study was to analyse whether the current use of healthy eating-related apps and previous participation in training in this field (educational activities) as well as body mass index may play a role in eating motives and behaviours among women during COVID-19. Our final sample included 1,447 women (age: M = 31.34 ± 11.05). Participants completed: the Eating Motivation Survey, the Emotional Overeating Questionnaire, the Mindful Eating Questionnaire, socio-demographic survey and questions about healthy eating-related apps and training (educational activities). Referring to the selected significant results, our study shows that during COVID-19, the use of healthy eating-related apps alone, as well as the use of apps and prior training participation promote healthy eating motives and behaviours. It suggests that promoting the use of healthy eating applications and the acquisition of knowledge and skills in this field could be one way of shaping resources that can be effectively used to deal with crisis situations.

Patient generated health data: Benefits and challenges

Patient Generated Health Data (PGHD) is defined as data generated by and from patients.¹ The use of PGHD has rapidly increased with the widespread availability of smart phone mobile health applications (mHealth apps) and wearable devices. Currently, the vast majority of PGHD is generated via the use of mHealth apps and wearables like "Fitbit" or medical devices such as a continuous glucose monitoring device. There are many benefits of PGHD including increased monitoring of children's chronic health conditions outside clinical care to supplement ambulatory clinic visits, improved health outcomes, increased patient awareness and engagement and improved patient-provider communication. When leveraged properly, PGHD can be a powerful tool in delivering safe, effective, patient centered, efficient and equitable care as outlined by the Institute of Medicine (IOM).² The challenges that limit collection, use and acceptance of PGHD include limited access to the internet, inability to incorporate PGHD into clinical workflows, data privacy and security concerns and apprehension about accuracy and safety of mHealth apps. These issues can lead to a lack of use or compliance with devices or apps associated with PGHD. To ensure optimal health benefits, agreement to leverage PGHD should be a joint decision between the clinician and the patient/caregiver. Future steps to ensure safety and clinical relevance of PGHD include involving regulatory authorities, device manufacturers and professional bodies to develop standards for mHealth apps and wearables to promote uncomplicated PGHD integration into workflows, easy and secure sharing of PGHD. Wearable technology, medical devices and smart phone apps become more advanced and widespread among the population, there will be an increasing potential for PGHD to facilitate personalized, efficient, and collaborative care resulting in improved health outcomes for children and adolescent and young adult. More research and innovation is needed to facilitate this transition.

The Use of Self-Help Strategies in Obesity Treatment. A Narrative Review Focused on Hypnosis and Mindfulness

PURPOSE OF REVIEW

The aim of this narrative review was to summarize the evidence evaluating the possibilities and limitations of self-hypnosis and mindfulness strategies in the treatment of obesity.

RECENT FINDINGS

Psychological factors, such as mood disorders and stress, can affect eating behaviors and deeply influence weight gain. Psychological approaches to weight management could increase the motivation and self-control of the patients with obesity, limiting their impulsiveness and inappropriate use of food. The cognitive-behavioral therapy (CBT) represents the cornerstone of obesity treatment, but complementary and self-directed psychological interventions, such as hypnosis and mindfulness, could represent additional strategies to increase the effectiveness of weight loss programs, by improving dysfunctional eating behaviors, self-motivation, and stimulus control. Both hypnosis and mindfulness provide a promising therapeutic option by improving weight loss, food awareness, self-acceptance of body image, and limiting food cravings and emotional eating. Greater effectiveness occurs when hypnosis and mindfulness are associated with other psychological therapies in addition to diet and physical activity. Additional research is needed to determine whether these strategies are effective in the long term and whether they can be routinely introduced into the clinical practice.

A Real-Time Eating Detection System for Capturing Eating Moments and Triggering Ecological Momentary Assessments to Obtain Further Context: System Development and Validation Study

BACKGROUND

Eating behavior has a high impact on the well-being of an individual. Such behavior involves not only when an individual is eating, but also various contextual factors such as with whom and where an individual is eating and what kind of food the individual is eating. Despite the relevance of such factors, most automated eating detection systems are not designed to capture contextual factors.

OBJECTIVE

The aims of this study were to (1) design and build a smartwatch-based eating detection system that can detect meal episodes based on dominant hand movements, (2) design ecological momentary assessment (EMA) questions to capture meal contexts upon detection of a meal by the eating detection system, and (3) validate the meal detection system that triggers EMA questions upon passive detection of meal episodes.

METHODS

The meal detection system was deployed among 28 college students at a US institution over a period of 3 weeks. The participants reported various contextual data through EMAs triggered when the eating detection system correctly detected a meal episode. The EMA questions were designed after conducting a survey study with 162 students from the same campus. Responses from EMAs were used to define exclusion criteria.

RESULTS

Among the total consumed meals, 89.8% (264/294) of breakfast, 99.0% (406/410) of lunch, and 98.0% (589/601) of dinner episodes were detected by our novel meal detection system. The eating detection system showed a high accuracy by capturing 96.48% (1259/1305) of the meals consumed by the participants. The meal detection classifier showed a precision of 80%, recall of 96%, and F1 of 87.3%. We found that over 99% (1248/1259) of the detected meals were consumed with distractions. Such eating behavior is considered "unhealthy" and can lead to overeating and uncontrolled weight gain. A high proportion of meals was consumed alone (680/1259, 54.01%). Our participants self-reported 62.98% (793/1259) of their meals as healthy. Together, these results have implications for designing technologies to encourage healthy eating behavior.

CONCLUSIONS

The presented eating detection system is the first of its kind to leverage EMAs to capture the eating context, which has strong implications for well-being research. We reflected on the contextual data gathered by our system and discussed how these insights can be used to design individual-specific interventions.

Weight Management Apps in Saudi Arabia: Evaluation of Features and Quality

Background

Weight management apps may provide support and management options for individuals with overweight and obesity. Research on the quality of weight management mHealth apps among the Saudi population is insufficient despite frequent use.

Objective

The aims of this study were to explore user perceptions of weight management apps, explore reasons for starting and stopping app use, appraise the quality of weight management apps available in the App Store, and compare the features currently available within the app market and those that are most desirable to weight management app users.

Methods

A web-based survey consisted of 31 open and closed questions about sociodemographic information, general health questions, app use, app user perceptions, and discontinuation of app use. The quality of the weight management apps available on the App Store was assessed using the Mobile App Rating Scale and evidence-based strategies. We also used six sigma evaluations to ensure that the quality measured by the tools consistently meets customer expectations.

Results

Data from the survey were analyzed. Of the respondents, 30.17% (324/1074) had used a weight management app, 18.16% (195/1074) used the apps and stopped, and 51.68% (555/1074) had never used a weight management app. Of apps mentioned, 23 met the inclusion criteria. The overall average Mobile App Rating Scale quality of apps was acceptable; 30% (7/23) received a quality mean score of 4 or higher (out of 5), and 30% (7/23) did not meet the acceptability score of 3 or higher. Evidence-based strategy results showed that feedback was not observed in any of the apps, and motivation strategy was observed in only 1 app. The sigma results of evidence-based strategies reflect that most of the apps fail to pass the mean.

Conclusions

App users desired a feature that allows them to communicate with a specialist, which is a missing in the available free apps. Despite the large number and accessibility of weight management apps, the quality and features of most are variable. It can be concluded from six sigma results that passing the mean does not ensure that the quality is consistently distributed through all app quality properties and Mobile App Rating Scale and evidence-based strategies do not give developers an indication of the acceptance of their apps by mobile users. This finding stresses the importance of reevaluating the passing criterion, which is ≥50% for designing an effective app.

Mobile Phone Apps for Food Allergies or Intolerances in App Stores: Systematic Search and Quality Assessment Using the Mobile App Rating Scale (MARS)

Background

Food allergies and intolerances are increasing worldwide, and mobile phone apps could be a promising tool for self-management of these issues.

Objective

This study aimed to systemically search and assess food allergy or intolerance apps in app stores using the multidimensional Mobile App Rating Scale (MARS) to rate the objective and subjective quality and to identify critical points for future improvements.

Methods

This systematic search identified apps through the keywords “food allergy,” “food intolerance,” and “allergens” in English, Spanish, and Italian in the Apple App Store (iOS) and Google Play Store (Android). The inclusion criteria were a user star rating of ≥3 (of 5 stars) to limit the selection to the most highly rated apps; ≥1000 reviews as an indicator of reliability; and the most recent update performed up to 2017. Then, the apps were divided according to their purpose (searching for allergen-free “food products,” “restaurants,” or recipes in “meal planners”) and evaluated on a scale of 1 to 5 points using the MARS in terms of (1) app classification category with a descriptive aim; (2) app subjective and objective quality categories comprised of engagement, functionality, esthetics, and information sections (Medline was searched for eligible apps to check whether they had been tested in trials); and (3) an optional app-specific section. Furthermore, the output and input features were evaluated. Differences between MARS sections and between app purposes and correlations among MARS sections, star ratings, and numbers of reviews were evaluated.

Results

Of the 1376 apps identified, 14 were included: 12 related to food allergies and intolerances that detect 2-16 food allergens and 2 related only to gluten intolerance. The mean (SD) MARS scores (maximum 5 points) were 3.8 (SD 0.4) for objective quality, highlighting whether any app had been tested in trials; 3.5 (SD 0.6) for subjective quality; and 3.6 (SD 0.7) for the app-specific section. Therefore, a rating ≥3 points indicated overall acceptable quality. From the between-section comparison, engagement (mean 3.5, SD 0.6) obtained significantly lower scores than functionality (mean 4.1, SD 0.6), esthetics (mean 4, SD 0.5), and information (mean 3.8, SD 0.4). However, when the apps were compared by purpose, critical points were identified: meal planner apps showed significantly higher engagement (mean 4.1, SD 0.4) than food product (mean 3.0, SD 0.6; P=.05) and restaurant (mean 3.2, SD 0.3; P=.02) apps.

Conclusions

In this systematic search of food allergy or intolerance apps, acceptable MARS quality was identified, although the engagement section for food product and restaurant purpose apps should be improved and the included apps should be tested in trials. The critical points identified in this systematic search can help improve the innovativeness and applicability of future food allergy and intolerance apps.

Mobile Health Apps in Pediatric Obesity Treatment: Process Outcomes From a Feasibility Study of a Multicomponent Intervention

BACKGROUND

Multicomponent family interventions underline current best practice in childhood obesity treatment. Mobile health (mHealth) adjuncts that address eating and physical activity behaviors have shown promise in clinical studies.

OBJECTIVE

This study aimed to describe process methods for applying an mHealth intervention to reduce the rate of eating and monitor physical activity among children with obesity.

METHODS

The study protocol was designed to incorporate 2 mHealth apps as an adjunct to usual care treatment for obesity. Children and adolescents (aged 9-16 years) with obesity (BMI ≥98th centile) were recruited in person from a weight management service at a tertiary health care center in the Republic of Ireland. Eligible participants and their parents received information leaflets, and informed consent and assent were signed. Participants completed 2 weeks of baseline testing, including behavioral and quality of life questionnaires, anthropometry, rate of eating by Mandolean, and physical activity level using a smart watch and the myBigO smartphone app. Thereafter, participants were randomized to the (1) intervention (usual clinical care+Mandolean training to reduce the rate of eating) or (2) control (usual clinical care) groups. Gender and age group (9.0-12.9 years and 13.0-16.9 years) stratifications were applied. At the end of a 4-week treatment period, participants repeated the 2-week testing period. Process evaluation measures included recruitment, study retention, fidelity parameters, acceptability, and user satisfaction.

RESULTS

A total of 20 participants were enrolled in the study. A web-based randomization system assigned 8 participants to the intervention group and 12 participants to the control group. Attrition rates were higher among the participants in the intervention group (5/8, 63%) than those in the control group (3/12, 25%). Intervention participants undertook a median of 1.0 training meal using Mandolean (25th centile 0, 75th centile 9.3), which represented 19.2% of planned intervention exposure. Only 50% (9/18) of participants with smart watches logged physical activity data. Significant differences in psychosocial profile were observed at baseline between the groups. The Child Behavior Checklist (CBCL) mean total score was 71.7 (SD 3.1) in the intervention group vs 57.6 (SD 6.6) in the control group, t-test P<.001, and also different among those who completed the planned protocol compared with those who withdrew early (CBCL mean total score 59.0, SD 9.3, vs 67.9, SD 5.6, respectively; t-test P=.04).

CONCLUSIONS

A high early attrition rate was a key barrier to full study implementation. Perceived task burden in combination with behavioral issues may have contributed to attrition. Low exposure to the experimental intervention was explained by poor acceptability of Mandolean as a home-based tool for treatment. Self-monitoring using myBigO and the smartwatch was acceptable among this cohort. Further technical and usability studies are needed to improve adherence in our patient group in the tertiary setting.