Even for older adults who aren’t tech-savvy, simple digital tools and occasional phone support can dramatically improve weight-management success – and at a fraction of the cost of intensive one-on-one counseling.
That’s what the latest research on the subject published in the journal Archives of Internal Medicine shows. Scientists worked with 70 overweight and obese adults enrolled in the Veterans Affairs weight-loss program, MOVE!, and randomly selected half of them to receive tech-based support tools in addition to MOVE!’s usual health-education class. Over three months to one year, people in the tech group lost 7 lbs more, on average, than people just attending classes – even though almost everyone in the study was computer-illiterate when the program began. People in the tech group were also almost four times as likely to have lost at least 5% of their body mass after six months, and twice as likely to have maintained a weight loss of that amount after one year.
But the secret to the new technology’s success, researchers say, are relatively low-tech and well-established principles of making weight-management convenient and ensuring that people feel accountable for their choices.
“As behavior-change specialists, we know a very sad truth: knowledge is rarely enough to change behavior,” says Bonnie Spring, lead author on the new study, and a professor of preventive medicine and the director for the Center of Behavior and Health at Northwestern Medicine.
“What it [usually] takes to treat obesity is a lot of in-person intensive counseling,” Spring says. But that’s not easy to provide within the current health-care system. “Physicians are asked to be responsible for their patients’ weight management,” she says, “but they don’t really have the time or the expertise.” That’s why she and her colleagues searched for a technology-based “work-around”: something that would be inexpensive and would not require a big time commitment from users, but would still provide the personalized attention and frequent feedback that makes expert counseling so effective.
In the study, every volunteer was encouraged to attend the biweekly MOVE! classes, which taught nutrition, realistic goal-setting, and strategies to overcome unhealthy habits. In addition, however, members of the technology group also received mobile personal digital assistants (PDAs) to help them track how many calories they were eating and how much exercise they were getting. When updated, those devices would inform the users about calorie consumption so far that day, and, importantly, transmit the data to a health coach. Then the coach, someone trained in counseling but without any specialized medical training, would check in with each user by phone for 10 or 15 minutes once every couple of weeks, to discuss the participant’s progress. At each point the participants interacted with their coach, their weight was measured and at each weigh-in—three months, six months, and one year into the study – the people using the devices had shed more pounds than the people attending just the classes.
“The two most effective components of weight management are encouraging [people] to self-monitor, and providing social support,” Spring says.
She believes the mobile-app intervention works because it simplifies calorie tracking and because participants know that someone, namely their health coach, is going to notice their efforts and will support them when they struggle. “I think it’s a mix of support and being held accountable,” Spring says. “We all need that. We need a parental figure, helping us stay on track.”
That personal connection sets Spring’s intervention apart from many previous tech-based weight-loss tools, which were less effective. In an editorial published with the new study in Archives, Dr. Goutham Rao of the University of Chicago Pritzker School of Medicine and Dr. Katherine Kirley of the NorthShore University Health System note that most weight-loss programs currently fall into one of two categories: “simple and easy to implement but minimally effective or intense and effective but impractical or expensive to implement.” Mobile technology, they say, presents an opportunity for programs that are both effective and cheap. Replacing in-person counseling with feedback by phone or by wireless devices, for example could potentially save hundreds of dollars in specialist fees, while saving patients significant travel time (along with babysitter costs or lost wages) at the same time.
Spring says she’s now working on weight-loss interventions that would cost no more than $500, since that’s roughly what insurance companies are willing to spend on preventive-health weight-loss programs. By comparison, bariatric surgery for weight loss can cost tens of thousands of dollars, and treating cardiovascular disease, a health consequence of obesity, can cost tens or hundreds of thousands as well.
Spring says the new interventions she is studying will be similar to those tested in the Archives study that combine online health education, digital tools to help users track and record their own behavior, and telephone support from a live person to provide that personal touch – and social pressure – to help people stay on track.