SMARTPHONE APPLICATIONS FOR THE TREATMENT OF OBESITY IN ADULTS AND ADOLESCENTS: A SYSTEMATIC REVIEW WITH META- ANALYSIS

Abstract

Introduction Obesity continues to overwhelm health care in the US with 33.1% of adults overweight, and 35.7% of adults obese.1 Obesity causes the atherometabolic syndrome, which includes the deadly triad of dysglycemia, atherogenic dyslipoproteinemia, and hypertension, and is associated with other health problems such as the development of type 2 diabetes mellitus (T2DM), non-alcoholic fatty liver disease (NAFLD), atherosclerotic cardiovascular disease, increased risk of certain cancers, degenerative joint disease, sleep apnea, and asthma. Favorable changes in lifestyle remain difficult to achieve, and so clinicians now rely heavily on weight-loss medications and bariatric surgery for the treatment of obesity and its associated health problems. Because of the zeal with which many people use smartphone applications (“apps”), several research groups have attempted to use applications as tools for lifestyle interventions. The applications are used primarily as instruments to decrease caloric consumption and increase physical activity. We conducted a meta-analysis of published studies to determine the strength of current evidence for an effect of smartphone applications on body weight in overweight and obese subjects. Methods We performed searches in databases including PubMed, Embase, Web of Science, SCOPUS, and psycINFO. Randomized controlled clinical trials in adolescents or adults that included weight as a primary or secondary outcome and used smartphone applications in lifestyle interventions were selected for analysis. Only randomized clinical trials (RCTs) that specifically compared subjects randomized to use, or to not use, a smartphone app. Results Of 302 published studies on smartphone applications and weight loss, only 12 met our inclusion and exclusion criteria for our meta-analysis. The longest duration to measure weight outcome was 24 months. Taken individually, only 10 of the 12 studies reported statistically significantly more weight loss with versus without a smartphone app, and 2 studies reported significantly less weight loss with versus without a smartphone application. Moreover, there was considerable heterogeneity amongst the 12 studies in the smartphone applications they used and how they tested them. Nevertheless, in our meta-analysis combining the 12 studies, we found a statistically significant Hedges’ g effect size of -2.260 (95% CI: -3.251 to -1.269, p<0.001, I2 = 98.591%) from the use of smartphone applications as part of a weight loss intervention. Conclusion Despite the low number of qualifying studies and their heterogeneity, our meta-analysis suggests that smartphone applications may be useful tools for lifestyle interventions for weight loss. Areas of need include longer-term studies and studies that examine hard clinical endpoints, such as effects on progression to T2DM or atherosclerotic cardiovascular events.