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Adherence to a Smartphone Application for Weight Loss Compared to Website and Paper Diary: Pilot Randomized Controlled Trial

Open access
Carter, Michelle Clare, Burley, Victoria Jane, Nykjaer, Camilla, Cade, Janet Elizabeth·2013·Journal of Medical Internet Research
DOI 10.2196/jmir.2283PMC PMC3636323
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Abstract

BACKGROUND: There is growing interest in the use of information communication technologies to treat obesity. An intervention delivered by smartphone could be a convenient, potentially cost-effective, and wide-reaching weight management strategy. Although there have been studies of texting-based interventions and smartphone applications (apps) used as adjuncts to other treatments, there are currently no randomized controlled trials (RCT) of a stand-alone smartphone application for weight loss that focuses primarily on self-monitoring of diet and physical activity. OBJECTIVE: The aim of this pilot study was to collect acceptability and feasibility outcomes of a self-monitoring weight management intervention delivered by a smartphone app, compared to a website and paper diary. METHODS: A sample of 128 overweight volunteers were randomized to receive a weight management intervention delivered by smartphone app, website, or paper diary. The smartphone app intervention, My Meal Mate (MMM), was developed by the research team using an evidence-based behavioral approach. The app incorporates goal setting, self-monitoring of diet and activity, and feedback via weekly text message. The website group used an existing commercially available slimming website from a company called Weight Loss Resources who also provided the paper diaries. The comparator groups delivered a similar self-monitoring intervention to the app, but by different modes of delivery. Participants were recruited by email, intranet, newsletters, and posters from large local employers. Trial duration was 6 months. The intervention and comparator groups were self-directed with no ongoing human input from the research team. The only face-to-face components were at baseline enrollment and brief follow-up sessions at 6 weeks and 6 months to take anthropometric measures and administer questionnaires. RESULTS: Trial retention was 40/43 (93%) in the smartphone group, 19/42 (55%) in the website group, and 20/43 (53%) in the diary group at 6 months. Adherence was statistically significantly higher in the smartphone group with a mean of 92 days (SD 67) of dietary recording compared with 35 days (SD 44) in the website group and 29 days (SD 39) in the diary group (P<.001). Self-monitoring declined over time in all groups. In an intention-to-treat analysis using baseline observation carried forward for missing data, mean weight change at 6 months was -4.6 kg (95% CI -6.2 to -3.0) in the smartphone app group, -2.9 kg (95% CI -4.7 to -1.1) in the diary group, and -1.3 kg (95% CI -2.7 to 0.1) in the website group. BMI change at 6 months was -1.6 kg/m(2) (95% CI -2.2 to -1.1) in the smartphone group, -1.0 kg/m(2) (95% CI -1.6 to -0.4) in the diary group, and -0.5 kg/m(2) (95% CI -0.9 to 0.0) in the website group. Change in body fat was -1.3% (95% CI -1.7 to -0.8) in the smartphone group, -0.9% (95% CI -1.5 to -0.4) in the diary group, and -0.5% (95% CI -0.9 to 0.0) in the website group. CONCLUSIONS: The MMM app is an acceptable and feasible weight loss intervention and a full RCT of this approach is warranted. TRIAL REGISTRATION: ClinicalTrials.gov NCT01744535; http://clinicaltrials.gov/ct2/show/NCT01744535 (Archived by WebCite at http://www.webcitation.org/6FEtc3PVB).

AI snapshot

Written from the paper’s full text.

TL;DR

In a 6-month pilot randomized controlled trial, a stand-alone smartphone app for weight loss self-monitoring (My Meal Mate) produced higher trial retention and dietary self-monitoring adherence than a website or paper diary. The app was rated acceptable and feasible, and the authors concluded that a full RCT is warranted.

Key findings

  • Trial retention at 6 months was 40/43 (93%) in the smartphone group, 19/42 (55%) in the website group, and 20/43 (53%) in the diary group.
  • Mean days of dietary recording were 92 (SD 67) in the smartphone group, 35 (SD 44) in the website group, and 29 (SD 39) in the diary group (P<.001); self-monitoring declined over time in all groups.
  • In intention-to-treat analysis with baseline observation carried forward, mean weight change at 6 months was –4.6 kg (95% CI –6.2 to –3.0) for smartphone, –2.9 kg (95% CI –4.7 to –1.1) for diary, and –1.3 kg (95% CI –2.7 to 0.1) for website.
  • Clinically significant weight loss (≥5% of initial weight) was achieved by 16/43 (37.2%) in the smartphone group, 12/43 (27.9%) in the diary group, and 7/42 (16.7%) in the website group.

Methods

  • Three-arm parallel-group pilot RCT: 128 overweight volunteers with BMI ≥27 kg/m², aged 18–65 years, recruited from large employers in Leeds, UK; randomized by minimization to smartphone app, website, or paper diary for 6 months.
  • The smartphone intervention (My Meal Mate) included goal setting, self-monitoring of diet and activity, and weekly tailored text-message feedback; comparator groups used a commercial slimming website or paper diary plus calorie-counting book, all based on the same Weight Loss Resources food database.
  • Primary outcomes were feasibility and acceptability, including trial retention and intervention adherence/frequency of use; anthropometric measures were taken at baseline, 6 weeks, and 6 months, with descriptive analyses, ANOVA/Kruskal-Wallis tests, and intention-to-treat and completer analyses.

Limitations

  • The paper states that generalizability is limited because the sample was predominantly white, female, and employed in managerial/professional occupations; the app was a prototype and participants reported frequent bugs causing it to close; and contamination occurred, with 20 participants reporting use of another intervention, including one diary-group participant who used MyFitnessPal and lost 32 kg, strongly influencing the diary-group mean.
  • The paper also states that unequal dropout among groups is a potential source of bias for a larger RCT, and that the pilot was not statistically powered to detect change in anthropometric measures.
  • Evident from the text: the small pilot sample and high overall attrition (38%) limit interpretation of weight-loss effect sizes.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.2196/jmir.2283

Cites

39 of 39 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 14 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    At 6 weeks, 86.8% reported satisfaction with the smartphone equipment, compared with 57.7% in the diary group and 50.0% in the website group (P=.02).

    “When asked about how satisfied they were with the study equipment at 6 weeks, 86.8% reported that they were satisfied or very satisfied with the smartphone, compared with 57.7% in the diary group and 50.0% in the website group (P=.02).”
    Quote in the paperSubstantial claim
  • Findingown data

    Of those who completed the 6-week questionnaires (n=93), 91.2% of smartphone participants reported initial satisfaction with group allocation at baseline, compared with 23.1% in the diary group and 71.4% in the website group (P=.01).

    “Of those who completed the 6-week questionnaires (n=93), 91.2% of smartphone participants reported that they were initially satisfied or very satisfied with their group allocation at baseline compared with 23.1% in the diary group and 71.4% in the website group (P=.01).”
    Quote in the paperNot a substantial claim
  • Findingown data

    In the smartphone group, 76.3% agreed or strongly agreed that they felt comfortable using the study equipment to record their diet in social settings, compared with 40.0% in the diary group and 21.1% in the website group (P<.001).

    “In the smartphone group, 76.3% of participants agreed or strongly agreed that they felt comfortable using the study equipment to record their diet in social settings compared with 40.0% in the diary group and 21.1% in the website group (P<.001).”
    Quote in the paperSubstantial claim
  • Findingown data

    Self-reported ease of use of study equipment did not differ statistically significantly between the smartphone, diary, and website groups (86.8% smartphone, 65.0% diary, 83.3% website; P=.63).

    “No statistically significant difference was seen between the groups for self-reported ease of use of study equipment. In the smartphone group, 86.8% reported that they found their study equipment easy to use, compared with 65.0% in the diary group and 83.3% in the website group (P=.63).”
    Quote in the paperNot a substantial claim
  • Findingown data

    At 6 months, weight change over time was statistically significantly greater in the smartphone group compared to the website group (-3.3 kg, 95% CI -5.4 to 1.2).

    “At 6 months, weight change over time was statistically significantly greater in the smartphone group compared to the website group (–3.3 kg, 95% CI –5.4 to 1.2), but not when the smartphone group was compared to the diary group (P=.12).”
    Quote in the paperNot a substantial claim
  • May combine two claims. 34
  • Classified as probably not a substantial claim. 18
  • The quote only partly states this claim. 1

  • May combine two claims.

    Findingown data

    In trial completers, mean weight change at 6 months was -5.0 kg (95% CI -6.7 to -3.3) in the smartphone group, -6.2 kg (95% CI -9.8 to -2.7) in the diary group, and -2.8 kg (95% CI -5.9 to 0.2) in the website group.

    “In those who completed the trial, the mean weight change was –5.0 kg (95% CI –6.7 to –3.3) in the smartphone group, –6.2 kg (95% CI –9.8 to –2.7) in the diary group, and –2.8 kg (95% CI –5.9 to 0.2) in the website group.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    In total, 128 people were randomly allocated to 1 of 3 groups, representing 38.1% of those who originally expressed interest and 70.3% of eligible invited participants.

    “In total, 128 people were randomly allocated to 1 of the 3 groups. These 128 represented 38.1% of those who had originally expressed an interest in taking part, and 70.3% of those who had been invited to take part who met the eligibility criteria.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In an intention-to-treat analysis using baseline observation carried forward for missing data, mean weight change at 6 months was -4.6 kg (95% CI -6.2 to -3.0) in the smartphone app group, -2.9 kg (95% CI -4.7 to -1.1) in the diary group, and -1.3 kg (95% CI -2.7 to 0.1) in the website group.

    “In an intention-to-treat analysis using baseline observation carried forward for missing data, mean weight change at 6 months was -4.6 kg (95% CI –6.2 to –3.0) in the smartphone app group, –2.9 kg (95% CI –4.7 to –1.1) in the diary group, and –1.3 kg (95% CI –2.7 to 0.1) in the website group.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    BMI change at 6 months was -1.6 kg/m2 (95% CI -2.2 to -1.1) in the smartphone group, -1.0 kg/m2 (95% CI -1.6 to -0.4) in the diary group, and -0.5 kg/m2 (95% CI -0.9 to 0.0) in the website group.

    “BMI change at 6 months was –1.6 kg/m2 (95% CI –2.2 to –1.1) in the smartphone group, –1.0 kg/m2 (95% CI –1.6 to –0.4) in the diary group, and –0.5 kg/m2 (95% CI –0.9 to 0.0) in the website group.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Assuming baseline observation carried forward, 35/128 (27.3%) of all participants randomized achieved a clinically significant weight loss (≥5% of initial weight), including 16/43 (37.2%) in the smartphone group, 12/43 (27.9%) in the diary group, and 7/42 (16.7%) in the website group.

    “Assuming baseline observation carried forward for those who did not return for follow-up at 6 months, 35/128 (27.3% of all participants randomized) achieved a clinically significant weight loss (≥5% of initial weight). This included 16/43 participants (37.2%) in the smartphone group, 12/43 (27.9%) participants in the diary group, and 7/42 (16.7%) participants in the website group.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The pilot trial recruited 128 participants, which was 95% of the original recruitment target.

    “In terms of recruitment and response, we were able to recruit 128 participants to the pilot, which was 95% of the original recruitment target.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The sample was 77% women and 91% white.

    “As is common to many weight loss trials, a large proportion of the sample (77%) were women and white (91%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Change in body fat at 6 months was -1.3% (95% CI -1.7 to -0.8) in the smartphone group, -0.9% (95% CI -1.5 to -0.4) in the diary group, and -0.5% (95% CI -0.9 to 0.0) in the website group.

    “Change in body fat was –1.3% (95% CI –1.7 to –0.8) in the smartphone group, –0.9% (95% CI –1.5 to –0.4) in the diary group, and –0.5% (95% CI –0.9 to 0.0) in the website group.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Of those screened, 49 (21.2%) were excluded for not meeting inclusion criteria, and almost half (49.0%) were excluded because their self-reported BMI was less than 27 kg/m2.

    “Of those screened, 49 (21.2%) were excluded for not meeting the inclusion criteria, and almost half (49.0%) were excluded because their self-reported BMI was less than 27 kg/m2.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In the intention-to-treat analysis with baseline observation carried forward, change in BMI at 6 months was -1.6 kg/m2 (95% CI -2.2 to -1.1) in the smartphone group, -1.0 kg/m2 (95% CI -1.6 to -0.4) in the diary group, and -0.5 kg/m2 (95% CI -0.9 to 0.0) in the website group.

    “In the intention-to-treat analysis with baseline observation carried forward, change in BMI at 6 months was –1.6 kg/m2 (95% CI –2.2 to –1.1) in the smartphone group, –1.0 kg/m2 (95% CI –1.6 to –0.4) in the diary group, and –0.5 kg/m2 (95% CI –0.9 to 0.0).”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    A similar trend in results was seen for BMI and BF in trial completers.

    “A similar trend in results was seen for BMI and BF.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Most participants (83.6%) heard about the study from an electronic source, either by email (61.7%) or intranet (21.9%).

    “Most participants (83.6%) heard about the study from an electronic source, either by email (61.7%) or intranet (21.9%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Pairwise comparison showed the difference in number of days usage at 6 months lies between the smartphone and diary groups (P<.001), between the smartphone and website groups (P<.001), but not between the website and diary groups (P=.14).

    “Pairwise comparison showed that this difference lies between the smartphone group and the diary group (P<.001), between the smartphone group and the website group (P<.001), but not between the website group and the diary group (P=.14).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In trial completers, there were no statistically significant differences in follow-up weight between the groups at 6 months (P=.63) or in difference in change over time (smartphone-diary P=.99; smartphone-website P=.40; diary-website P=.47).

    “There were not found to be statistically significant differences in follow-up weight between the groups at 6 months (P=.63) or in difference in change over time (smartphone-diary, P=.99; smartphone-website, P=.40; diary-website, P=.47).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Trial retention at 6 months was 40/43 (93%) in the smartphone group, 19/42 (55%) in the website group, and 20/43 (53%) in the diary group.

    “Trial retention was 40/43 (93%) in the smartphone group, 19/42 (55%) in the website group, and 20/43 (53%) in the diary group at 6 months.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In the intention-to-treat analysis with baseline observation carried forward, mean weight change at 6 months was -4.6 kg (95% CI -6.2 to -3.0) in the smartphone group, -2.9 kg (95% CI -4.7 to -1.1) in the diary group, and -1.3 kg (95% CI -2.7 to 0.1) in the website group.

    “In the intention-to-treat analysis using all of the participants assigned to their original group, the mean weight change was –4.6 kg (95% CI –6.2 to –3.0) in the smartphone group, –2.9 kg (95% CI –4.7 to –1.1) in the diary group, and –1.3 kg (95% CI –2.7 to 0.1) in the website group.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Recruitment to the trial took 3 months between March and May 2011.

    “Recruitment to the trial took 3 months between March and May 2011.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The smartphone group had 93% retention at 6 months, compared with 53% in the diary group and 55% in the website group.

    “In fact, the smartphone group had extremely high retention with 93% returning for follow-up at 6 months (compared with 53% in the diary group and 55% in the website group).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    One participant allocated to the diary group reported using a commercially available weight loss smartphone app during the trial and lost 32 kg; excluding this participant, the mean weight change in completers was -4.8 kg (95% CI -7.1 to -2.7).

    “One person allocated to the diary group reported that they had actually used a commercially available weight loss smartphone app during the trial rather than the paper diary. This person lost 32 kg overall; if they are excluded from the diary group analysis, the mean weight change in completers is –4.8 kg (95% CI –7.1 to –2.7).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In the intention-to-treat analysis with baseline observation carried forward, change in body fat at 6 months was -1.3% (95% CI -1.7 to -0.8) in the smartphone group, -0.9% (95% CI -1.5 to -0.4) in the diary group, and -0.5% (95% CI -0.9 to 0.0) in the website group.

    “Change in BF was –1.3% (95% CI –1.7 to –0.8) in the smartphone group, –0.9% (95% CI –1.5 to –0.4) in the diary group, and –0.5% (95% CI –0.9 to 0.0) in the website group.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The noncompleters in the trial were more likely to have a higher BMI at baseline and report poorer health status.

    “The noncompleters in the trial were more likely to have a higher BMI at baseline and report poorer health status.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In all 3 groups, self-monitoring declined over time, so that by 6 months only 7 participants (16%) in the smartphone group had recorded their dietary intake every day, and no participants in the diary and Web groups had done this.

    “In all 3 groups, self-monitoring declined over time so that by 6 months only 7 participants (16% of the group) in the smartphone group had managed to record their dietary intake every day (no participants in the diary and Web group had done this).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The MMM app was a prototype app and participants reported that they frequently encountered bugs that caused the app to close.

    “The MMM app was a prototype app and participants reported that they frequently encountered bugs that caused the app to close.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    This was not a phase III trial; a formal sample size calculation was not appropriate, and the trial aimed to recruit 135 based partly on available study equipment.

    “This was not a phase III trial; therefore, a formal sample size calculation was not appropriate and there are few published guidelines on recommended sample sizes for pilot trials. The trial aimed to recruit a sample size of 135, which was a pragmatic decision based partly on the amount of available study equipment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    Randomization was by minimization using the Minim software package, balanced equally at the medians on starting BMI, age, and gender.

    “After measurements were taken, participants were randomized by a process of minimization using the Minim software package [31] to 1 of 3 groups. The minimization balanced equally at the medians on 3 factors: starting BMI, age, and gender.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] EvansSRoystonPDaySMinim: allocation by minimisation in clinical trials2013-02-08http://www-users.york.ac.uk/~mb55/guide/minim.htm6EHn7EFx0

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Fieldworkers carrying out measurements were blinded to group assignment and participants were asked not to discuss their group allocation when measurements were taken.

    “Fieldworkers carrying out measurements on participants were blinded to group assignment and participants were asked not to discuss their group allocation when measurements were taken.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    There were no statistically significant differences among the 3 intervention groups for the factors balanced at minimization: gender (P=.97), age (P=.82), and BMI (P=.74).

    “There were no statistically significant differences found among the 3 intervention groups for the factors balanced at minimization: gender (P=.97), age (P=.82), and BMI (P=.74).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    An intention-to-treat analysis was completed with baseline observations carried forward for missing data.

    “As there is a proportion of missing data and unequal dropout, an intention-to-treat analysis was completed with baseline observations carried forward for missing data (Table 5).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Current UK evidence-based obesity guidelines advocate a lifestyle change approach to treatment; therefore, the key behavioral strategies of goal setting, self-monitoring, and feedback underpin the MMM app.

    “Current UK evidence-based obesity guidelines advocate a lifestyle change approach to treatment [23]; therefore, in-line with this, the key behavioral strategies of goal setting, self-monitoring, and feedback underpin the MMM app.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] National Institute for Health and Clinical ExcellenceNational Collaborating Centre for Primary CareObesity: the prevention, identification, assessment and management of overweight and obesity in adults and children2006122013-02-08http://www.ncbi.nlm.nih.gov/books/NBK63696/pdf/TOC.pdf6EHmUsiDu

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Attrition is a serious difficulty in weight loss trials because of its potential to bias results.

    “Attrition is a serious difficulty in weight loss trials because of its potential to bias results [35].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [35] source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Trial dropout differed statistically significantly among the groups (P=.001), with 3 nonattendees at 6-month follow-up in the smartphone group compared with 23 in the diary group and 23 in the website group.

    “Trial dropout was statistically significantly different among the groups (P=.001) with 3 people not attending 6-month follow-up in the smartphone group compared with 23 people not attending 6-month follow-up in the diary group and 23 people not attending 6-month follow-up in the website group.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    Most analyses are descriptive because this was a pilot trial and not powered to detect weight change.

    “Most analyses are descriptive because this was a pilot trial and not powered to detect weight change.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    Two analyses were conducted because of missing data and unequal dropout: an intention-to-treat analysis using baseline weight carried forward for missing data, and an analysis of completers at 6-month follow-up.

    “Two analyses were conducted because there was a proportion of missing data and unequal dropout between groups: an intention-to-treat analysis in which all are included but using baseline weight carried forward for missing data, and an analysis in just those who completed 6-month follow-up.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The MMM app is an acceptable and feasible weight loss intervention.

    “The MMM app is an acceptable and feasible weight loss intervention and a full RCT of this approach is warranted.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    A large community-based survey showed that individuals desire alternatives to face-to-face weight loss treatments and some would be interested in minimal contact weight management programs.

    “A large community-based survey showed that individuals desire alternatives to face-to-face weight loss treatments and, if given the choice, some would be interested in engaging with minimal contact weight management programs [5].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] Sherwood, NE, 1998, Am J Health Promot source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The diet measures captured on MMM have been found to correlate well with a reference measure of diet.

    “The diet measures captured on MMM have been found to correlate well with a reference measure of diet [24].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The MMM app is a feasible and acceptable weight loss intervention.

    “This pilot trial has shown the MMM app to be a feasible and acceptable weight loss intervention.”
    • Also stated in: § Conclusion · boosted
      “This pilot trial of a smartphone app for weight loss has shown that it is both an acceptable and feasible intervention.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Premisecitation

    Mobile phones are an intuitively appealing intervention platform given that they are ubiquitous, engaging, and portable.

    “Mobile phones, in particular, are an intuitively appealing intervention platform given that they are ubiquitous, engaging, and portable [6].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    This pilot trial has a randomized design.

    “This pilot trial has several strengths including its randomized design.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    The degree of contamination seen in the trial is a serious issue and has implications for the design of a definitive RCT.

    “The degree of contamination seen in the trial is a serious issue and has implications for the design of a definitive RCT.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    The app used in the trial is up-to-date and comparable in appearance and functionality to commercial diet tracking apps.

    “Another strength of the trial is the up-to-date app for tracking diet and physical activity which is comparable in appearance and functionality to commercial diet tracking apps.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Unequal dropout is a potential source of bias in a large RCT.

    “Unequal dropout is a potential source of bias in a large RCT so this will need to be considered for the full trial.”
    Quote in the paperSubstantial claim
42 of 42

  • The paper relies on this without support.

    Smartphone apps are likely to be used as a stand-alone intervention rather than as an adjunct to another intervention.

    “A trial of this type is necessary because smartphone apps are readily available to the public to download and likely to be used as a stand-alone intervention rather than as an adjunct to another intervention (such as podcasts or face-to-face advice).”

  • The paper relies on this without support.

    Commercial diet tracking apps have not been comprehensively evaluated to date.

    “Despite their apparent popularity, these commercial apps have not been comprehensively evaluated to date.”

  • The paper relies on this without support.

    There have been no large RCTs of smartphone apps for weight loss.

    “To our knowledge, there have been no large RCTs of smartphone apps for weight loss and this pilot trial provides valuable data that could be used to inform such a trial.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Diary retention percentage is incorrect

    Major

    At 6 months, 20 of 43 diary participants were retained, or 46.5%, not 53%. The stated 53% is approximately the percentage who did not return.

    Reported 53 · recomputed 46.511628

  • Website retention percentage is incorrect

    Major

    At 6 months, 19 of 42 website participants were retained, or 45.2%, not 55%. The stated 55% is approximately the percentage who did not return.

    Reported 55 · recomputed 45.238095

  • Smartphone baseline weight differs between tables

    Minor

    Tables 1 and 5 both give baseline weight for all 43 smartphone participants, but report means of 96.4 kg and 96.8 kg, respectively.

  • Six-week follow-up count differs between text and Table 6

    Minor

    The text says 94 participants returned for six-week follow-up measurements, but Table 6 describes recorded anthropometric measures at six weeks for 95 participants.

  • Six-month intervention-use P value differs between text and table

    Minor

    The text reports P=.001 for the between-group difference at 6 months, whereas Table 4 reports P<.001.

  • Percentage for 31 diary participants does not match group size

    Minor

    Table 4 labels the diary group as n=43. Thus 31 participants represent 72.1%, not the reported 78%; no different denominator is specified for this row.

    Reported 78 · recomputed 72.093023

  • Six-week intervention-use P value differs between text and table

    Minor

    The text reports P<.001 for the between-group difference at 6 weeks, whereas Table 4 reports .004 for that comparison.

  • Claimed significant weight difference has a confidence interval crossing zero

    Minor

    The reported 95% confidence interval for the smartphone-website difference extends from a negative value to a positive value, contradicting the statement that this difference was statistically significant.

8 of 8

Cites

Flagged first, then by citations

1 of the 40 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. National Institute for Health and Clinical ExcellenceNational Collaborating Centre for Primary CareObesity: the prevention, identification, assessment and management of overweight and obesity in adults and children2006122013-02-08http://www.ncbi.nlm.nih.gov/books/NBK63696/pdf/TOC.pdf6EHmUsiDu
  2. Kellow, J, 2011, Calorie, Carb & Fat Bible
  3. 10.1038/oby.2010.208 · DOI · Paper page

Cited by

Sorted by citations

Related

Authors
Carter, M. C., Burley, V. J., Nykjaer, C., & Cade, J. E.
Affiliations
University of Leeds (GB)
Corresponding author
Carter, Michelle Clare
ORCID
Venue
Journal of Medical Internet Research
Publisher
JMIR Publications Inc.
Published
2013-04-15
Volume
15
Issue
4
Pages
e32
ISSN
1438-8871 (ISSN-L)
DOI
10.2196/jmir.2283
PMC
PMC3636323
OpenAlex
W2016679476
Cited by
666
References
40
Citations by year
2026: 20 · 2025: 19 · 2024: 29 · 2023: 30 · 2022: 53 · 2021: 36 · 2020: 66 · 2019: 72 · 2018: 63 · 2017: 76 · 2016: 85 · 2015: 71 · 2014: 40 · 2013: 6
FWCI
121.96
Type
journal article
Language
en
Open access
Licence
public-domain
Locations
  • Journal of Medical Internet Research (publishedVersion, public-domain)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Physical Sciences › Computer Science › Information Systems › Mobile Learning in Education
Keywords
mobile application, weight loss, obesity, self-monitoring, dietary self-monitoring, paper diaries, intervention adherence, acceptability, feasibility, weight management, goal setting, overweight adults, trial retention, weight change, physical activity, self-guided intervention, information and communication technologies
MeSH terms
Adult, Female, Humans, Male, Middle Aged, Obesity, Patient Acceptance of Health Care, Patient Compliance, Pilot Projects, Diet Records, Telemedicine, Internet, Cell Phone, Weight Reduction Programs, Mobile Applications

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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