SAN DIEGO -- Patients and clinicians looking to mobile applications to support weight loss and heart health goals face a deluge of dubious options. One physician and "mHealth" expert highlighted a handful of the more promising candidates at the American College of Physicians Internal Medicine Meeting here on Friday.
There are an estimated 260,000 mHealth apps as of 2016 -- a 57% increase from 2015, according to Research2Guidance, a consultant for mobile app companies, said Rajesh Patel, MD, MPH, associate chief medical information officer and a hospitalist at Brigham and Women's Hospital in Boston.
But the explosion of mHealth apps is outpacing the research community's ability to vet them, said Patel.
And the FDA's "tailored risk-based approach" means that most of these apps don't fall under the agency's purview, he added. Only apps considered to be an "accessory to a regulated medical device" or those that can transform into such a device (i.e., electronic stethoscopes and glucometers) are evaluated by the agency.
Signs Point to 'No'
Patel said that according to what little research is available on apps that promote weight loss and physical activity, the majority do not leverage evidence-based strategies.
For example, a 2013 study published in the American Journal of Preventive Medicine, which analyzed 30 weight loss apps, including some of the most popular -- LoseIt, LiveStrong, and MyFitnessPal -- found that most incorporated less than 15%-20% of behavioral strategies from evidence-based weight loss programs such as the Diabetes Prevention Program (DPP).
A separate study from the Journal of Medical Internet Research published in 2016, which looked at 393 weight loss apps and evaluated them based on 10 agreed-upon strategies for weight-loss from obesity experts (e.g., goal-setting, personalized feedback, and social support) found that only 4% included even half of the strategies.
"Commercial mobile apps for weight loss/management lack important evidence-based features, do not involve healthcare experts in their development process, and have not undergone rigorous scientific testing," the study authors concluded.
But, Patel asked, does using clinician-vetted strategies really matter?
A third study, a meta-analysis of 12 studies of mobile phone apps' impact on weight loss and physical activity, also published in the Journal of Medical Internet Research, found no difference in physical activity, but there was a "significant reduction" in the pooled results for weight loss and BMI over the study period. Yet, the absolute difference in weight loss -- 1.04 kg over a roughly 3-6 month stretch -- and the BMI reduction of 0.43 points did not impress Patel, he said.
Hope for Overweight Patients
But the news is not all bad. Patel also highlighted a study of the Prevent app, published by Diabetes Educator, which examines the impact of transforming the Diabetes Prevention Program (DPP) into an online social network. The core online program lasted 16 weeks and included four components:
a peer group matched by age, location, and body mass index
a coach trained in the DPP curriculum
a tracking mechanism
weekly lesson plans
Lessons were divided into monthly phases, and participants received different tools in the mail at the start of each phase, including a pedometer, a digital scale, and a photo frame for motivational purposes. Participants were given the option of continuing a "post-core lifestyle change maintenance intervention," after 16 weeks, bringing the total length of the extended program to 12 months.
Instead of a randomized controlled trial, the study measured the online program against the standards of the Centers for Disease Control and Prevention's Diabetes Prevention and Recognition Program (DPRP) which set a 5.0% weight loss benchmark.
After 16 weeks, 68% of the 187 participants finished the program and hit the 5.0% weight loss benchmark, with most maintaining a 4.8% weight loss after 12 months -- a reduction of about 12.2 and 11.6 pounds, respectively. At the end of both the core and post-care phase of the program, 50% of participants "met or exceeded" the 5.0% weight loss benchmark.
Following the study, the program was commercialized by Omada Health, reportedly the largest app-based CDC-recognized DPP provider.
Curbing Hypertension
Patel also spotlighted another study: a randomized controlled trial of an online intervention for hypertension, published in the Journal of Clinical Outcomes Management.
A small study from Massachusetts General Hospital involved 44 patients randomized either to an experimental group using an app known as CollaboRhythm, or to a traditional coaching model. All patients' systolic/diastolic blood pressure was measured over 12 weeks.
The CollaboRhythm app leveraged visualization tools to help patients track their treatments and assess blood pressure measurements at a set time each day. The tools included personalized decision support intended to enhance self-efficacy and encourage patients to make "collaborative decisions," with health coaches offering support.
The traditional coaching model used an integrated care management approach; a nurse educator sent regular follow-up messages by email, text, or phone and arranged visits to assess changes in blood pressure.
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