An addiction-based digital weight loss intervention: A multi-centre randomized controlled trial

Alaina P Vidmar; Sarah J Salvy; Choo Phei Wee; Robert Pretlow; D Steven Fox; Jennifer K Yee; Cambria Garell; Suzette Glasner; Steven D Mittelman

doi:10.1111/ijpo.12990

An addiction-based digital weight loss intervention: A multi-centre randomized controlled trial

Pediatr Obes. 2023 Mar;18(3):e12990. doi: 10.1111/ijpo.12990. Epub 2022 Dec 9.

Authors

Alaina P Vidmar¹, Sarah J Salvy², Choo Phei Wee³, Robert Pretlow⁴, D Steven Fox⁵, Jennifer K Yee⁶, Cambria Garell⁷, Suzette Glasner⁸, Steven D Mittelman^{7

9}

Affiliations

¹ Department of Pediatrics, Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles and Keck School of Medicine of USC, Los Angeles, California, USA.
² Department of Medicine, Cedars-Sinai Medical Center, Research Center for Health Equity Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California, USA.
³ Department of Population and Public Health Sciences, Keck School of Medicine of USC, Southern California Clinical Science Institute, Los Angeles, California, USA.
⁴ eHealth International, Seattle, Washington, USA.
⁵ Department of Pharmaceutical and Health Economics, School of Pharmacy of the University of Southern California, Los Angeles, California, USA.
⁶ Division of Pediatric Endocrinology, Harbor-UCLA Medical Center, Harbor-UCLA Medical Center, Torrance, California, United States.
⁷ Department of Pediatrics, Division of General Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
⁸ Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, California, USA.
⁹ Department of Pediatrics, Division of Endocrinology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.

Abstract

Objective: This randomized clinical trial tested the effectiveness of an addiction-based digital weight-loss intervention, focusing on withdrawal/abstinence from self-identified problem foods, snacking and excessive amounts at meals, and discomfort displacement, with and without coaching, compared to an in-person, multi-disciplinary, care model among adolescents with obesity. We hypothesized that the digital intervention with coaching would yield greater weight loss and lower delivery burden than the standard clinical arm, and greater participant engagement than the digital arm without coaching.

Methods: Adolescents were randomized to app intervention, with or without coaching, or in-person multidisciplinary obesity intervention for 6 months. The primary outcome was change in %BMI_p95 at weeks 12 and 24. A mixed-effects linear regression model was used to assess the association between change in %BMI_p95 and intervention arm. We were also interested in assessing delivery burden, participant engagement and evaluating the relationships between weight change and demographic characteristics, mood, executive function and eating behaviours.

Results: All adolescents (n = 161; BMI ≥95th%, age 16 ± 2.5 year; 47% Hispanic, 65% female, 59% publicly insured) lost weight over 24-weeks (-1.29%, [-1.82, -0.76], p < 0.0001), with no significant weight loss difference between groups (p = 0.3). Girls lost more weight than boys, whereas binge eating behaviour at baseline was associated with increase in %BMI_p95 when controlling for other covariates. There was no association between ethnicity, mood, timing of intervention in relation to the pandemic, or executive function and change in %BMI_p95 .

Conclusions: Contrary with our hypothesis, our results showed no difference in the change in BMI status between treatment arms. Since efficacy of this digital intervention was not inferior to in-person, multi-disciplinary care, this could offer a reasonable weight management option for clinicians, based on youth and family specific characteristics, such as accessibility, resources, and communication styles.

Clinical trial registration: ClinicalTrials.gov identifier: NCT035008353.

Keywords: binge eating disorder; coaching; digital health; executive functioning; food addiction; obesity; paediatrics; weight loss.

Publication types

Randomized Controlled Trial
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Behavior, Addictive*
Ethnicity
Female
Food
Humans
Male
Obesity / therapy
Weight Loss*

Abstract

Publication types

MeSH terms

Grants and funding