Comparison of Smartphone‐Based Behavioral Obesity Treatment With Gold Standard Group Treatment and Control: A Randomized Trial
Open accessAbstract
Objective: This study aimed to determine whether weight losses from a primarily smartphone‐based behavioral obesity treatment (SMART) differed from those of a more intensive group‐based behavioral obesity treatment (GROUP) and a control condition (CONTROL). Methods: A total of 276 adults with overweight/obesity were randomly assigned to 18 months of GROUP‐based treatment with meetings weekly for 6 months, meetings biweekly for 6 months, and meetings monthly for 6 months and self‐monitoring via paper diaries with written feedback; SMART‐based treatment with online lessons, self‐monitoring, and feedback plus monthly weigh‐ins; or a CONTROL condition with self‐monitoring via paper diaries with written feedback and monthly weigh‐ins. Results: Among the 276 participants (17% men; 7.2% minority; mean [SD] age: 55.1 [9.9] years; weight: 95.9 [17.0] kg; BMI: 35.2 [5.0] kg/m 2), 18‐month retention was significantly higher in both GROUP (83%) and SMART (81%) compared with CONTROL (66%). Estimated mean (95% CI) weight change over 18 months did not differ across the three conditions: 5.9 kg (95% CI: 4.5‐7.4) in GROUP, 5.5 kg (95% CI: 3.9‐7.1) in SMART, and 6.4 kg (95% CI: 3.7‐9.2) in CONTROL. Conclusions: Mobile online delivery of behavioral obesity treatment can achieve weight loss outcomes that are at least as good as those obtained via the more intensive gold standard group‐based approach.
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Equivalence testing showed no significant 18-month weight loss differences between smartphone-based BWL (5.5 kg; 95% CI [3.9, 7.0]), in-person BWL (5.9 kg; 95% CI [4.5, 7.4]), and control (6.4 kg; 95% CI [3.7, 9.2]).
“Equivalence testing revealed no significant differences in 18-month weight loss across smartphone-based BWL (5.5 kg; 95% CI [3.9, 7.0]), in-person BWL (5.9 kg; 95% CI [4.5, 7.4]), and the control (6.4 kg; 95% CI [3.7, 9.2])”
From Associations Between Self-Monitoring and Weight Change in Behavioral Weight Loss Interventions (2019) · cites this paper as Thomas et al., 2019
The Results, Primary Outcome (Weight Change) section reports the quoted 18-month weight losses and confidence intervals, with no significant difference between SMART and GROUP and CONTROL indistinguishable from SMART. The Methods, Statistical Approach section describes WGEE analyses and significance-tested pairwise comparisons, not equivalence testing; that characterization of the analysis is unsupported. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe Live SMART trial was among the first to directly test whether smartphone-based BWL could achieve weight losses at least as good as gold-standard group treatment and to compare both with a control.
“The recent randomized controlled Live SMART trial (Thomas, Bond, Raynor, Papandonatos, & Wing, 2019), was one of the first investigations to directly assess if smartphone-based BWL intervention could produce weight losses at least as good as gold-standard group treatment, and compare both treatments to a control condition.”
From Associations Between Self-Monitoring and Weight Change in Behavioral Weight Loss Interventions (2019) · cites this paper as Thomas, Bond, Raynor, Papandonatos, & Wing, 2019
Self-weighing rates were lower in group-based BWL (21.2%; 95% CI [17.9, 25.9]) than in smartphone-based BWL (30.7%; 95% CI [26.2, 37.2]) and control (29.7%; 95% CI [21.7, 37.7]).
“Self-weighing rates were also lower in the group-based BWL (21.2%; 95% CI [17.9, 25.9]) compared to smartphone-based BWL (30.7%; 95% CI [26.2, 37.2] and control [29.7%; 95% CI [21.7, 37.7].”
From Associations Between Self-Monitoring and Weight Change in Behavioral Weight Loss Interventions (2019) · cites this paper as Thomas et al., 2019
The Live SMART trial had power to examine its primary between-group weight change outcomes.
“The Live SMART trial was powered to examine proposed primary outcomes for between-groups weight change (Thomas et al., 2019).”
From Associations Between Self-Monitoring and Weight Change in Behavioral Weight Loss Interventions (2019) · cites this paper as Thomas et al., 2019
In smartphone-based BWL, participants using electronic self-monitoring tracked dietary intake more often (37.9% days monitored; 95% CI [32.6, 43.2]) than group-based BWL participants using paper-and-pencil self-monitoring (27.5%; 95% CI [23.6, 31.4]); neither group differed significantly from control (32.0%; 95% CI [24.0, 40.0]).
“Participants in smartphone-based BWL using electronic self-monitoring more frequently tracked their dietary intake (37.9% days monitored; 95% CI [32.6, 43.2]) than group-based BWL with paper-and-pencil self-monitoring (27.5%; 95% CI [23.6, 31.4]); neither differed significantly from the control condition (32.0%; 95% CI [24.0, 40.0]).”
From Associations Between Self-Monitoring and Weight Change in Behavioral Weight Loss Interventions (2019) · cites this paper as Thomas et al., 2019
The primary outcomes of Live SMART demonstrated that SMART engaged in more self-monitoring but did not demonstrate greater weight losses.
“The primary outcomes of Live SMART demonstrated that SMART engaged in more self-monitoring but did not demonstrate greater weight losses.”
From Associations Between Self-Monitoring and Weight Change in Behavioral Weight Loss Interventions (2019) · cites this paper as Thomas et al., 2019
Self-monitored physical activity did not differ significantly across groups.
“Self-monitored physical activity was not significantly different across groups.”
From Associations Between Self-Monitoring and Weight Change in Behavioral Weight Loss Interventions (2019) · cites this paper as Thomas et al., 2019
Missing data are likely confounded with an overall pattern of disengagement that could also be related to weight regain observed during the maintenance period.
“Nonetheless, conclusions should be interpreted with caution, as the missing data are likely confounded with an overall pattern of disengagement (Scherer, Ben-Zeev, Li, & Kane, 2017) that could also be related to weight regain observed during the maintenance period (Thomas et al., 2019).”
From Associations Between Self-Monitoring and Weight Change in Behavioral Weight Loss Interventions (2019) · cites this paper as Thomas et al., 2019
The Thomas et al. citation is attached to weight regain during the maintenance period, not to the sentence’s claim about missing data and disengagement. The Results (Primary Outcome: Weight Change; page unavailable) report weight loss at 18 months but do not establish whether participants regained weight during a maintenance period. Searches for “regain,” “maintenance,” and weight changes between assessments found no passage confirming that specific point. (LLM, conf=0.70)
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- Authors
- Thomas, J. G., Bond, D. S., Raynor, H. A., Papandonatos, G. D., & Wing, R. R.
- Affiliations
- Brown University (US)
- University of Tennessee at Knoxville (US)
- Corresponding author
- Thomas, J. Graham
- Venue
- Obesity
- Publisher
- Wiley
- Published
- 2019-02-19
- Volume
- 27
- Issue
- 4
- Pages
- 572-580
- ISSN
- 1930-7381 (ISSN-L)
- 1930-739X
- PMC
- PMC6430643
- OpenAlex
- W2917604440
- Cited by
- 108
- References
- 33
- Citations by year
- 2026: 10 · 2025: 10 · 2024: 14 · 2023: 17 · 2022: 17 · 2021: 12 · 2020: 25 · 2019: 3
- FWCI
- 19.43
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Obesity (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- obesity treatment, smartphone-based intervention, mobile health, behavioral weight loss, self-monitoring, weight loss, treatment retention, overweight adults
- MeSH terms
- Smartphone, Adult, Aged, Behavior Therapy, Body Weight, Female, Humans, Male, Middle Aged, Obesity, Weight Loss, Telemedicine, Overweight, Standard of Care
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