Obesity is a significant public health concern in the United States, with prevalence rates increasing over the past decades. Traditional behavioral interventions for weight loss have shown mixed long-term results, highlighting the need for innovative and effective strategies. Technology-based interventions have emerged as a promising avenue for delivering weight-loss programs with greater ease and broader reach. This article explores the landscape of high-tech weight loss methods, examining their components, effectiveness, and potential limitations.
The Rise of Technology-Based Weight Loss Interventions
The increasing prevalence of obesity among American adults has led to negative health and psychosocial consequences. Physicians and health providers face the challenge of implementing programs for both immediate and long-term weight loss, which is why technology-based weight-loss interventions are becoming more popular.
The Need for Innovation
While behavioral interventions have shown encouraging short-term results, maintaining weight loss over a long period has proven difficult. Therefore, there's a critical need for better models of behavior change that can be delivered easily and sustained over long periods. The use of technology enhances ease of delivery and implementation of these models.
Key Components of Successful Technology-Based Weight Loss Programs
A qualitative review of studies published in the last 10 years focusing on technology-based interventions for weight loss identified five crucial components:
- Self-monitoring
- Counselor feedback and communication
- Social support
- Use of a structured program
- Use of an individually tailored program
Short-term results of technologically driven weight-loss interventions using these components have been promising, but long-term results have been mixed.
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Self-Monitoring: Tracking Progress with Technology
Self-monitoring involves individuals regulating and tracking their own behaviors. Studies using technology for self-monitoring have shown encouraging results. Technologies like pedometers and handheld PDAs have increased the ease and frequency of self-monitoring, leading to increased physical activity and greater weight loss. Continuous use of wearable body monitors and Internet diaries has also resulted in equivalent or greater weight loss compared with traditional pen-and-paper diaries. The effectiveness of these technologies lies in their mobility and ease of use, which facilitates continuous self-monitoring.
Counselor Feedback and Communication: Staying Connected
Feedback from a counselor regarding goals, progress, and results can encourage, motivate, and assist patients in successfully completing a weight-loss program. While face-to-face interactions can be time-consuming, technology offers solutions for convenient communication.
Social Support: Building a Community Online
Technology can create social support using online systems such as message boards, electronic bulletin boards, chat forums, and chat rooms. "Real-time" chat rooms or online meetings may be superior to message boards in fostering a perceived sense of social support and enhancing communication with a health counselor. A greater perception of social support may foster higher log-in frequencies, which, in turn, enhances behavioral changes associated with weight loss.
Structured Programs: Guiding the Way
The most successful, technology-based weight-loss programs have been structured interventions that incorporated principles of behavior therapy and change. These interventions are typically delivered online or through podcasts on a personal digital music player, consisting of structured weekly lessons on nutrition, exercise, stimulus control, self-regulation strategies, and goal-setting. Participants are often asked to submit food and exercise journals at regularly scheduled times, which may increase accountability and adherence.
Individually Tailored Programs: Personalized Approaches
Interventions that are individually tailored to participant goals have higher rates of adherence and weight loss. Participants may meet with a health coach prior to receiving the intervention and select high-priority behavior change goals that are subsequently monitored and achieved through behavior skills training. Automated, real-time SMS text messages that are specific for each participant's barrier to exercise at that moment can also be effective. Software can also develop an individually tailored, Internet-based weight-loss intervention, matching individual needs regarding nutrition, information on caloric deficits, eating cues, physical activity, body image, social support, and cognitive restructuring.
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Advantages and Limitations of Technology-Based Interventions
Technology-based models of behavior change for weight loss, using the five key components, are advantageous over traditional methods in several ways:
- The Internet can be used to deliver interventions to a wide range of individuals in a cost-effective way.
- Individuals can access weekly lessons, online diaries, feedback from their counselor, and online support at their convenience.
- This type of convenience enables individuals to incorporate weight-loss programs into busy schedules and lifestyles, thereby reducing resistance to engage in a weight-loss intervention.
However, there are some limitations to using these methods:
- Access to Internet services varies among rural and urban areas, wealthy and poor communities, as well as different regions globally.
- A minimum level of computer or electronic device literacy is needed to effectively use online or mobile device health interventions.
- Regular, in-person care may provide modest benefits over Internet programs in preventing weight gain.
- The relationship between online self-monitoring and weight loss appears to weaken over time, suggesting that a successful weight-loss and -maintenance intervention should encourage self-monitoring and treatment adherence over longer periods.
The VA Study: Mobile Technology Augments Weight Loss
A study conducted at a Midwestern VA Hospital examined the additive benefit of augmenting a system-wide group obesity program with a connective technology system that provided mobile decision support. Overweight and obese adults were randomly assigned to either standard of care group treatment alone (Standard) or Standard + connective mobile technology system (+Mobile).
Study Design and Methods
The standard of care was the MOVE! group weight loss program, offered at all Veteran’s Affairs Medical Centers. Participants completed a technology fluency assessment and received a brief training session on how to use a personal digital assistant (PDA) to record food intake, weight, and physical activity. They were loaned a PDA for two weeks and asked to upload their data daily. Those who entered their weight and ≥ 2 meals (with ≥2 items per meal) per day for at least 7 days underwent an equipoise induction which detailed the procedures and highlighted the pros and cons of both groups to equalize their desirability and prevent dropout after randomization. Participants were then randomly assigned to either standard of care group treatment alone (Standard) or Standard + connective mobile technology system (+Mobile).
Results
Participants assigned to +Mobile lost on average 8.6 lbs more (3.1% more weight loss relative to the control group) than participants in the Standard group at each post-baseline time point. In terms of 5% or more weight loss (Y/N), a significant group effect favoring the +Mobile intervention was observed. There was no difference in how frequently participants assigned to +Mobile attended MOVE! groups, as compared to those assigned to Standard MOVE! group treatment alone.
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Conclusions
The study demonstrated the feasibility of using mobile connective technology to interface with a hospital-based, standard of care weight loss treatment. Adding technology and coaching to the available group obesity treatment significantly enhanced weight loss outcomes. The current results are, to the authors' knowledge, the first to demonstrate that use of a mobile technology system and remote coaching can significantly augment weight loss and maintenance when added to an existing standard of care obesity treatment program.
Non-Surgical Fat Reduction Technologies
Beyond technology-enhanced behavioral interventions, various non-surgical fat reduction technologies have emerged. These treatments selectively break down fat cells in specific areas to reduce the size of subcutaneous fat pockets.
Cryolipolysis: Freezing Away Fat
Cryolipolysis is a noninvasive technology that uses extreme cold to dismantle fat cells and help reduce a fat pocket. A paneled or cupped device is placed on top of the skin in the treatment area, where it transmits temperatures that are just low enough to freeze fat cells, essentially destroying them.
Laser Fat Reduction: Melting Fat with Heat
Laser fat reduction works by dismantling subcutaneous fat using controlled heat. A specific laser wavelength is delivered through the skin, heating fatty tissues to the point where fat cells begin to break down. A constant cooling mechanism ensures that skin is not damaged in the process.
Deoxycholic Acid Injections: Breaking Down Fat
Deoxycholic acid is a naturally occurring substance in the body that helps break down fat for digestion. In injectable form, deoxycholic acid can break down fat cells on contact for isolated reduction of a fat pocket.
Ultrasound Fat Reduction: Shattering Fat Cells with Sound
Ultrasound fat reduction uses highly focused sonic waves to break down fat cell walls in the treatment area, thereby releasing the fat inside to be metabolized by the body and reducing the size of a fat deposit.
Red Light Therapy: Shrinking Fat Cells
One of the newest technologies to be FDA cleared for non-surgical fat reduction uses red light therapy to reduce the volume of subcutaneous fat cells. Instead of removing or destroying fat cells, photonic lypolysis, or “red light therapy,” delivers specific wavelengths of light through the skin using a specialized lamp. This light triggers selected fat cells to create small openings and release some of their contents, thus helping them shrink in size.
Other Emerging Weight Loss Technologies
In addition to the core strategies, some more novel approaches have emerged in recent years:
Gastric Balloon: Feeling Full
A silicone balloon is placed into your stomach endoscopically through a tube, or you swallow it in a pill that's tethered to a small catheter. It gives the sensation of feeling full, which can help reduce food intake. The balloon comes out after six months, and patients are encouraged to keep meeting with their program dietitian to reinforce the healthy behaviors they learned.
Vaping: Curbing Hunger Cravings
Diet programs like Slissie and the Vapor Diet promise to curb hunger cravings with artificial flavor vapors. Vaping may help smokers who've recently quit cigarettes avoid weight gain, but more research is needed. However, the long-term health risks of vaping are yet to emerge, and it's not recommended for nonsmokers.
AspireAssist: Draining Calories
A tube is surgically inserted into your abdomen, with a port valve remaining outside your body. About a half hour after you eat, you just open up a tube and pour out a third of the contents-about 30 percent of the calories-from your stomach into the toilet bowl.
Body Wrap: Sweating Away Pounds
The Thermojet Morfologic is a body wrap treatment purported to help you burn thousands of calories by emitting infrared rays that stimulate your metabolism. However, there is likely no scientific basis for this claim, and vigorous exercise is a much better choice for weight loss.
The Future of High-Tech Weight Loss
Despite certain limitations, technology has provided health professionals with an opportunity to improve behavior change models by making them more convenient, accessible, and continuous. Technology that incorporates the five components is likely to facilitate behavior change that has a substantial impact on public health. Future research should evaluate the efficacy of booster sessions that incorporate the five key components. Research has also shown a strong correlation between online self-monitoring and weight loss only in the first 3-6 months of the intervention. The strength of the relationship appears to weaken over time, suggesting that a successful weight-loss and -maintenance intervention should encourage self-monitoring and treatment adherence over longer periods of time. This could be accomplished with booster sessions that incorporate the five key components. Only two studies on Internet-based weight-maintenance programs have followed participants longer than 18 months, and results have not suggested that Internet-based weight-maintenance programs are more successful than in-person or active comparison programs.