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The Effectiveness of Cellular Phone-based Interventions for Weight Loss in Overweight and Obese Adults:… Chen, Jennifer; Ghanavati, Vesta; Lam, Rachel; Mundy, Nate; Woo, Jayde 2012-08

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The Effectiveness of Cellular Phone‐based Interventions for Weight Loss in Overweight and Obese Adults: A Systematic Review 1,2 1,2 1,2 1,2 1,2 2,3 J. Chen , V. Ghanavati , R. Lam , N. Mundy , J. Woo , and L. Li 1  Masters Program in Physical Therapy, 2 Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada, 3 Arthritis Research Center of Canada  INTRODUCTON: • Statistics Canada in 2010 states that over 4.5 million people were overweight or obese. • The dramatic increase in obesity and its correlation with serious diseases has caused the World Health Organization (WHO) to declare an immediate need for effective and widely‐accessible interventions. • Cellular phone devices are portable, convenient, and popular among people of varying economic status and ethnicities,, renderingg this an ideal medium for a lifestyle intervention.  PURPOSE: • To determine the effectiveness of cellular phones for delivering weight loss interventions in the obese or overweight population.  METHODS: • Literature Search: An electronic database search of MEDLINE, EMBASE, CINAHL, the Cochrane Library, Web of Science and PsycINFO was conducted. • Major search terms included: “overweight” or “obesity” and “weight loss” and “cellular phone”. The search strategy identified both published and unpublished studies and was limited to English. Inclusion Criteria  Exclusion Criteria  1. Delivered a weight‐loss intervention using a 1. Systematic review, cellular or mobile phone opinion pieces and 2. Reported absolute or percentage change in editorial studies weight, BMI, waist circumference, body fat or any other proxy for weight loss 3. Participants age > 18 4. Participants’ BMI ≥ 25 kg/m2 5 Published 5. P bli h d iin EEnglish li h Table 1: Studies Inclusion and Exclusion Criteria  • Data Extraction: All eligible studies were screened and underwent data extraction by two independent reviewers. • Any disagreements between the reviewers were resolved byy a third independent p reviewer. • Categorization of Studies: 1) One‐way interaction: the researcher could contact the participants, but the participants could not respond 2) Two‐way interaction – low: open communication between researchers and participants, with less than 14 interactions per week 3) Two‐way interaction – high: open communication between researchers and participants, with greater than or equal to 14 interactions per week  RESEARCH POSTER PRESENTATION DESIGN © 2012  RESULTS:  Table 2: Study Characteristics of Mobile‐Phone Delivered Interventions for Weight Loss (2007‐ 2011) Authors; Country  Study Design  Sample Characteristics  Intervention  Results1  One way Interaction; [Overall Oxford Level of Evidence: Grade C] One‐way Weight: EG weight loss = 1.5kg ± 3.0 Joo and Kim; One group n= 927 (female=89%) EG: A 12 week weight reduction program including behaviour modification, BMI: EG: decrease of 0.6 ± 1.2 Korea (2007) pre‐post • EG (n=297): individually prescribed exercise and diet. Participants received a weekly SMS design Age: > 30, n=99.9% message on behaviour modification by mobile phone and brochures about Waist Circumference: EG: decrease of exercise and diet by post weekly. Participants might borrow exercise equipment 4.3cm ± 1.2 • CG: Not applicable without charge. Lombard, C. Cluster RCT n= 250 (female=100%) EG: Interactive group sessions that focused on goal setting, and behavioural Weight [ES=0.23]: • EG (n= 127): et al.; change. Pedometers + text messages were given to reinforce nutrition, physical EG: decrease of 0.2kg; 95% CI [‐0.9, 0.49] Australia activity and behavioural change. The program ran for 52 weeks. CG: increase of 0.83kg; 95%CI [0.12, 1.54] Age: 40.56 ± 4.75 (2010) CG: One non‐interactive lecture with general dietary and physical activity Waist Circumference [ES=0.33]: • CG (n = 123): guidelines. Participants were given brochures + a pedometer to use at their EG: decrease of 1.3cm; 95% CI [‐2.4, ‐0.15] Age: 40.26 ± 4.8 discretion. CG: increase of 0.12cm; 95% CI [‐0.96, 1.2] EG: A 12 week home‐based obesity‐control program including exercise, diet, Weight: Lee et al.; Controlled n= 108 (female=100%) monthly group workshops & phone counseling, 2 health education sessions, and EG: decrease of 1.85kg Korea (2011) clinical trial • EG (n=60): bi‐weekly SMS messages. CG: decrease of 3.1kg Age: 47 CG: structured exercise intervention (three 1‐h walking classes per week) with BMI: • CG (n=48): an exercise coordinator as well as the same orientation and 2 health education EG: decrease of 1.05; CG: decrease of 1.22 Age: 45 % BF: sessions as the EG EG: decrease of 2.64% CG: decrease of 2.98% Low Two‐way Interaction; [Overall Oxford Level of Evidence: Grade C] H li ett al.; Hurling l RCT n= 77 (female=66%) (f l 66%) EG A 9 weekk PA intervention EG: i t ti d delivered li d th through h an Internet‐based I t tb db behavior h i BMI [ES=0.265]: [ES 0 265] England change system addressing barriers to PA, self‐report of exercise level, tailored EG: decrease of 0.24; SE=0.11 • EG (n=47): (2007) feedback, weekly schedule for PA planning with automated assessor, and CG: decrease of 0.10; SE: 0.14 Age: 40.5 ± 7.1 email/phone reminders. Participants wore an accelerometer for activity %BF [ES=0.283]: • CG (n=30): monitoring. EG: decrease of 2.18%; SE: 0.59 Age: 40.1 ± 7.7 CG: Participants received one‐time verbal advice on recommended physical CG: decrease of 0.17%; SE: 0.81 activity levels. Participants also wore an accelerometer for activity monitoring Haapala et al.’ RCT n= 125 (female=76.8%) EG: A 52 week weight reduction program delivered via text messages weekly Weight change [ES=0.62]: Finland (2009) • EG (n=62): advising the participants to reduce their food intake and increase their PA, and EG: decrease of 4.5kg ± 5.0 report their weight daily via text messages or through the programme’s website; CG: decrease of 1.1kg ± 5.4 Age: 38.1 ± 4.7 ) and p provided immediate automatically‐generated yg tailored feedback. Waist Circumference [[ES=0.72]: ] • CG ((n=63): Age: 38 ± 4.7 CG: Participants were offered no advice on diet or PA. EG: decrease of 6.3cm ± 5.3 CG: decrease of 2.4cm ± 5.4 Joo et al.; Controlled n= 925 (female=72%) EG: A 12 week internet‐based obesity control intervention involving educational Weight [ES=1.42]: Korea (2010) clinical trial • EG (n= 410): information, two weekly SMS prompts for behaviour modification and access to EG: decrease of 1.09kg ± 3.70 CG: decrease of 4.71kg ± 2.55 a website which provided a weekly diet regimen, a daily food diary, and Age: 36.9 ± 10.4 BMI [ES = 1.47]: information/answers about nutrition and exercise. • CG (n= 515): CG: Regular visits to the local public health centre at 1‐ or 2‐week intervals and EG: decrease of 0.40 ± 1.38 Age: 41.9 ± 9.8 were instructed on behaviour modification, nutrition and exercise by registered CG: decrease of 1.88 ± 1.01 Waist Circumference [ES = 1.35]: nurses, nutritionists and exercise trainers. EG: decrease of 2.61cm ± 4.27 CG: decrease of 6.73cm ± 3.05 EG: A 20 week customized diet intervention, SMS messages (pictures sent to Weight: decrease of 2.5kg; Rossi et al.; One Group n=140 (female=58.3%) participants) to aid in food choices ‐ The software also encourage physical 95% CI [‐3.2, ‐1.8] Italy (2010) Pre‐post • EG (n=140): activity. The proactive call center ‐ called participants to reinforce concepts BMI: decrease of 1; 95% CI [‐1.2, ‐0.7] design Age: 42.9 ± 12.2 • CG: Not applicable Waist circumference: decrease of 3.7cm; about nutrition and physical activity 95% CI [‐4.6, ‐2.9] Morak et al.; One Group n=25 (female=60%) EG: Therapy Management System application on the participant’s mobile phone Weight: decrease of 2.39kg ± 2.67 Austria (2008) Pre‐Post • EG (n=25): to monitor abdominal girth, weight and activity + neutrally expressed feedback Abdominal girth: decrease of 2.37cm ± Design Age: 48 (range 24‐71) 2.08 messages for sending in values at least once a week. The programme was 12 BMI: decrease of 0.78 ± 0.85 weeks. • CG: Not applicable High Two‐way Interaction; [Overall Oxford Level of Evidence: Grade D] Controlled n = 65 (female=80%) McGraa, EG: Sending motivational text messages 3x a day, in addition to control Karen Lee; clinical trial • EG (n=33): measures for 5 week. USA (2010) CG: Weekly emails of their progress Age: > 30, n= 84.8% • CG (n=32): Age: > 30, n=100% Turner‐ RCT n=96 (female=75%) EG: Podcast + enhanced mobile media (instructed to download diet and PA McGrievy and monitoring app and to add Twitter to their mobile device) for 27 weeks • EG (n=47): Tate; USA CG: Podcast + book with calorie and fat gram amounts of food Age: 42.6 ± 10.7 (2011) (n=49): 49): • CG (n Age: 43.2 ± 11.7 Patrick et al.; USA (2009)  RCT  BMI % Change [ES=0.004]: EG: decrease of 0.023 ± 0.33 CG decrease of 0.024 ± 0.031 No significant difference between groups.  3 months (% Weight Change): EG: decrease of 2.6 ± 3.5 CG: decrease of 2.6 ± 3.8 6 months (% Weight Change): EG: decrease of 2.7 ± 5.6 CG: decrease of 2.7 ± 5.1 EG: Personalized SMS and MMS messages sent two to five times daily for 16 Weight [ES=3.33]: weeks, printed materials, and brief monthly phone calls from a health counselor EG: decrease of 2.1kg ± 0.51 CG: receipt of monthly printed materials about weight control. Printed material CG: decrease of 0.4kg ± 0.51 differed from that given to the EG  n=65 (80% female) • EG (n=33): Age: 47.4 ± 7.1 • CG (n=32): 1 Effect size calculated using Cohen’s d where possible Age: 42.4 ± 7.5 Legend: BMI=Body Mass Index; CG=Control Group; EG=Experimental Group; SMS=Short Message Service; PA=Physical Activity; CI=Confidence Interval  Level of Evidence  • The studies were identified based on figure 1. 298 articles identified through search strategy  4  193 articles after duplicates removed 2b  4  193 articles screened by title and abstract 39 articles (including articles missingg information in abstract) for full review 11 included articles  154 articles excluded  Did not meet inclusion criteria (n=145)  Articles (abstracts) unobtainable (n=9) 28 full‐text articles excluded  Did not meet inclusion criteria (n=26)  Articles (full‐text) unobtainable (n=2)  Figure 1: Identifying Studies For Inclusion  1b  1b  • Overall level of evidence showed a Grade C in the one‐ way interactivity group as well as in the low frequency two‐way interactivity group, and a Grade D in the high frequency two‐way interactivity category • Modest evidence was found for the effectiveness of mobile phones in the deliverance of weight loss interventions.  DISCUSSION: 4  4  4  • Publication dates range from 2007 to 2011, with the majority after 2007, indicating an increase in this type of intervention for lifestyle changes • Inconsistencies in quality of studies with ~1/3 good quality and ~2/3 poor quality • Variety of mobile interventions with the majority using mobile bil phones h to their h i full f ll potential i l • 4 high quality studies had interventions including an accountability component, as well as a comparator group of no or minimal care  LIMITATIONS OF STUDIES:  4  • Quality of studies varied greatly. • Weaknesses of studies include: high dropout rates, lack of randomization, small sample sizes, company‐funded study, heterogeneity of sample populations, interventions, and control methods.  1b  ACKNOWLEDGEMENT  1b  • We would like to thank Charlotte Beck for her contributions to the search strategy, Diana Dawes for her assistance with developing the research protocol, Dr. Theresa Liu‐ Ambrose for her expertise in statistical analysis and Dr. Linda Li for supervising the entire project.  


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