%0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e59238 %T Codevelopment of an mHealth App With Health Care Providers, Digital Health Experts, Community Partners, and Families for Childhood Obesity Management: Protocol for a Co-Design Process %A Toh,Siao Hui %A Davis,Courtney %A Bte Khaider,Khairunisa %A Ong,Zhi Quan %A Lim,Ethel Jie Kai %A Chew,Chu Shan Elaine %+ Physiotherapy Department, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore, 65 63941588, toh.siao.hui@kkh.com.sg %K childhood obesity %K mHealth %K mobile health %K co-design %K IDEAS framework %D 2025 %7 5.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Childhood obesity is increasing in Singapore, with most cases persisting into adulthood and leading to poor health outcomes. The current evidence for childhood obesity interventions shows a clear dose-response effect, where effectiveness improves with an increasing number of treatment hours. A minimum threshold of ≥26 hours over a 2- to 12-month period is required to achieve significant outcomes. The Kick Start Move Smart program is the first online community-based multidisciplinary program to treat pediatric obesity in Singapore. It has demonstrated feasibility and acceptability, with 70% of participants completing the recommended ≥26 hours of intervention. Preliminary data show significantly lower BMI and improved quality of life in participants compared to controls. Successful families are positive outliers who developed strategies for health in the context of an obesogenic environment. This positive outlier approach indicates that solutions to challenges that a community faces exist within certain individual members, and these strategies can be generalized and promoted to improve the health of others in the same community. A mobile health (mHealth) app targeting parents is a critical missing link in the currently available interventions to support parental self-management of childhood obesity. Using a combination of behavioral theory and user-centered design approaches is important for designing mHealth apps. One recommended framework is Integrate, Design, Assess, and Share (IDEAS), which aims to facilitate the development of more effective interventions by engaging perspectives from different stakeholders. Objective: This study aims to (1) describe the co-design protocol of an mHealth app using the IDEAS framework as a low-intensity intervention or as an adjunct to more intensive existing pediatric obesity interventions and (2) assess the usability, acceptability, and engagement of the app by parents. Methods: A clinician-led co-design approach will be undertaken with a multidisciplinary team using the IDEAS framework. Phase 1 involves stakeholder engagement and the formation of a core committee and a parent advisory board. Phase 2 involves developing the app content through focus group and expert panel discussions. Phase 3 involves developing a prototype app and gathering feedback. Phase 4 involves piloting the minimum viable product by parent users and evaluating its effectiveness through interviews and questionnaires. Results: In April 2023, a parent advisory board was formed, and stakeholders were engaged as part of phase 1. Phases 2 and 3 were completed in June 2024. Focus group discussions were held with the parent advisory board and stakeholders to identify family strategies and patient-centric outcomes and provide feedback on the app. As of January 2025, the app is complete, and we are now in the middle of data collection from participants. Participants will provide feedback to the research team, and the app will be updated accordingly. Conclusions: An evidence-based, theory-driven mHealth app developed using a structured design framework can bridge the gap in delivering multidisciplinary care in community settings for families with overweight children. International Registered Report Identifier (IRRID): DERR1-10.2196/59238 %M 40053786 %R 10.2196/59238 %U https://www.researchprotocols.org/2025/1/e59238 %U https://doi.org/10.2196/59238 %U http://www.ncbi.nlm.nih.gov/pubmed/40053786 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e59856 %T Auricular Acupressure Versus an Intermittent Low-Carbohydrate Diet in Children With Overweight or Obesity With Gastric-Heat and Dampness-Obstruction Syndrome: Protocol for a Randomized Controlled Trial %A Sun,Wen %A He,Jingwei %A Wang,Wenqin %A Lu,Chen %A Lin,Yating %A Dou,Yalan %A Yan,Weili %A Yu,Jian %+ Department of Clinical Epidemiology and Clinical Trial Unit, Children’s Hospital of Fudan University, National Children’s Medical Center, 399 Wanyuan Road, Shanghai, 201102, China, 86 13761794333, yanwl@fudan.edu.cn %K children with obesity %K traditional Chinese medicine %K TCM auricular acupressure treatment %K intermittent low carbohydrate diet %K study protocol %D 2025 %7 3.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Childhood obesity frequently persists into adulthood and is associated with an increased risk and earlier onset of cardiovascular disease in later life. Behavioral change strategies have been proposed as the first-line weight management approach for children and adolescents with obesity. Nonpharmacological interventions, such as traditional Chinese medicine (TCM) auricular acupressure treatment and intermittent low-carbohydrate diet (ILCD), are increasingly being investigated in the young obese population. However, there is limited high-quality evidence about effectiveness and safety in weight control and reducing cardiometabolic risk in the pediatric population. Objective: This study aimed to compare the effect of cardiometabolic risk reduction between TCM auricular acupressure treatment (TAAT) and ILCD in children with overweight or obesity with gastric-heat and dampness-obstruction syndrome. Methods: This is a randomized controlled trial. Eligible participants are children with overweight or obesity and enrolled at the obesity clinic of the department of TCM at a tertiary children’s hospital. Eligible participants must meet the following criteria: (1) be aged between 6 and 18 years, (2) be overweight, and (3) have gastric-heat and dampness-obstruction syndrome. Recruited children will be randomized 3:1 to receive either TAAT or a self-administered ILCD for 1 month: 150 in the TAAT group and 50 in the ILCD group. The primary outcome is the change in body weight from the beginning of treatment to the end of 1 month. Secondary outcomes included body weight, waist circumference, waist-to-height ratio, BMI, blood pressure, body fat content, indexes of liver and renal function, indexes of glucose metabolism, gut microbiota, and TCM syndrome scores at the end of 1 month and 3 months, respectively. Primary statistical analyses were conducted using the intention-to-treat strategy. A generalized linear model was used to compare the difference in weight change between the groups, with the baseline body weight as the covariate, to obtain the estimate of the mean difference in body weight change and its 95% CI, using Gaussian for family function and identity for link function. Results: The study protocol was approved by the institutional ethical committee and registered on ClinicalTrials.gov on May 5, 2023, before recruitment. Recruitment began in June 2023 and is expected to be completed by December 2025. As of November 2024, we have enrolled 112 participants. Conclusions: This randomized controlled trial will provide evidence on the treatment effects and safety of TAAT versus ILCD among children with overweight or obesity with gastric-heat and dampness-obstruction syndrome, in reducing body weight and improving cardiometabolic risks. Exploratory aims include potential underlying mechanisms of the 2 kinds of interventions, based on biosamples. Trial Registration: ClinicalTrials.gov NCT05847478. https://clinicaltrials.gov/study/NCT05847478 International Registered Report Identifier (IRRID): DERR1-10.2196/59856 %M 40053799 %R 10.2196/59856 %U https://www.researchprotocols.org/2025/1/e59856 %U https://doi.org/10.2196/59856 %U http://www.ncbi.nlm.nih.gov/pubmed/40053799 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e68462 %T Impact of In-Person and Mobile Exercise Coaching on Psychosocial Factors Affecting Exercise Adherence in Inactive Women With Obesity: 20-Week Randomized Controlled Trial %A Gjestvang,Christina %A Kalhovde,John Magne %A Mauseth Tangen,Elene %A Clemm,Hege %A Haakstad,Lene Annette Hagen %+ Department of Sports Medicine, Norwegian School of Sport Sciences, P.O Box 4014, Ullevål Stadion, Oslo, 0806, Norway, 47 23262119, christina.gjestvang@nih.no %K barriers %K exercise behavior %K exercise coaching %K health-related quality of life %K motivation %K obesity %K psychosocial factors %K self-efficacy %K social support %D 2025 %7 25.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Regular exercise may counteract obesity-related health risks, but adherence is low among individuals with obesity. Personal trainers may positively influence exercise behavior by providing motivational support. Individuals who receive regular exercise coaching are more likely to adhere to their exercise routine, compared with those who exercise individually. However, investing in personalized exercise guidance, such as a personal trainer, can be expensive for the individual. Thus, integrating web-based coaching could be a more economically sustainable option, offering both flexibility and reduced costs compared with in-person coaching only. Yet, research is needed to assess the effect of hybrid models in improving psychosocial factors among women with obesity. Objective: This 20-week, pragmatic randomized controlled trial aimed to investigate the effect of weekly in-person coaching compared with 2 combinations of in-person and web-based coaching on 5 psychosocial factors in women with obesity (BMI ≥30 kg/m2). Methods: Participants were invited through Facebook and Instagram advertisements posted by various fitness clubs across rural and urban locations in Norway (7 different counties and 12 different municipalities). Women with low activity (n=188; <150 minutes of moderate-intensity physical activity/week; 42.7, SD 10.5 years; mean BMI of 35.1, SD 6.9 kg/m2) were allocated into 3 groups of in-person coaching—weekly (n=47), twice weekly (n=47), and once monthly (n=47)—and as controls (n=47). Those with twice weekly and once monthly in-person coaching received web-based coaching of 15 minutes during weeks without in-person coaching. Data included background variables, motivation (Behavioral Regulation in Exercise Questionnaire-2), barriers, self-efficacy (The Self-Efficacy Survey), social support (Social Support Questionnaire), and health-related quality of life (36-Item Short Form Health Survey [SF-36]). Results: A total of 120 (64%) out of 188 participants completed baseline and postintervention assessments. A minor difference was observed in one item of the SF-36, where all intervention groups reported a greater “change in health last year” than the control group (mean difference: 14.2-17.1, 95% CI 2.04-29.5; g=0.79-1.14; P≤.01). No other effects were found on the selected psychosocial factors. It should be noted that controls reported higher intrinsic motivational regulation at baseline than intervention groups (mean difference: 0.43-0.93; P≤.05). All intervention arms exercised more frequently than controls (mean difference: 1.1-1.5; P≤.001), with no differences in weekly exercise frequency between the 3 intervention arms (P=.30). Conclusions: We found no effects on motivation, barriers, self-efficacy, perceived social support, or other health domains compared with controls. All intervention groups reported a slight improvement in self-perceived health in 1 of the 8 subscales of the SF-36. Combined in-person and web-based coaching may give a minor improvement in self-perceived health in women with obesity. However, the lack of impact on motivation, barriers, and self-efficacy warrants further research. Trial Registration: ClinicalTrials.gov NCT05792657; https://clinicaltrials.gov/study/NCT05792657 %M 39999434 %R 10.2196/68462 %U https://www.jmir.org/2025/1/e68462 %U https://doi.org/10.2196/68462 %U http://www.ncbi.nlm.nih.gov/pubmed/39999434 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e58434 %T Assessing the Uses, Benefits, and Limitations of Digital Technologies Used by Health Professionals in Supporting Obesity and Mental Health Communication: Scoping Review %A Kearns,Amanda %A Moorhead,Anne %A Mulvenna,Maurice %A Bond,Raymond %+ Life and Health Sciences, Institute for Nursing and Health Research, Ulster University, 2-24 York Street, Belfast, BT15 1AP, United Kingdom, 44 7706848477, kearns-a7@ulster.ac.uk %K digital communication %K digital technology %K digital transformation %K health professional %K mental health %K obesity %K complex needs %K artificial intelligence %K AI %K PRISMA %D 2025 %7 10.2.2025 %9 Review %J J Med Internet Res %G English %X Background: Obesity and mental health issues present interconnected public health challenges that impair physical, social, and mental well-being. Digital technologies offer potential for enhancing health care communication between health professionals (HPs) and individuals living with obesity and mental health issues, but their effectiveness is not fully understood. Objective: This scoping review aims to identify and understand the different types of technologies used by HPs in supporting obesity and mental health communication. Methods: A comprehensive scoping review, which followed a validated methodology, analyzed studies published between 2013 and 2023 across 8 databases. The data extraction focused on HPs’ use of communication technologies, intervention types, biopsychosocial considerations, and perceptions of technology use. The review was guided by the following research question: “What are the uses, benefits, and limitations of digital technologies in supporting communication between HPs and persons living with obesity and mental health issues?” Results: In total, 8 studies—featuring web-based platforms, social media, synchronous video calls, telephone calls, automated SMS text messaging, and email—met the inclusion criteria. Technologies such as virtual learning collaborative dashboards and videoconferencing, supported by automated SMS text messaging and social media (Facebook and WhatsApp groups), were commonly used. Psychologists, dietitians, social workers, and health coaches used digital tools to facilitate virtual appointments, diet and mental health monitoring, and motivational and educational support through group therapy, 1-on-1 sessions, and hybrid models. Benefits included enhanced access to care and engagement, personalized digital cognitive behavioral therapy, perceived stigma reduction, privacy, and improved physical health outcomes in weight reduction. However, improvements in mental health outcomes were not statistically significant in studies reporting P values (P≥.05). The limitations included engagement difficulties due to conflicting personal family and work commitments; variable communication mode preferences, with some preferring in-person sessions; and misinterpretations of SMS text messaging prompts. Conflicts arose from cultural and individual differences, weight stigma, and confusion over HP roles in obesity and mental health care. Conclusions: Digital technologies have diversified the approaches HPs can take in delivering education, counseling, and motivation to individuals with obesity and mental health issues, facilitating private, stigma-reduced environments for personalized care. While the interventions were effective in obesity management, the review revealed a shortfall in addressing mental health needs. This highlights an urgent need for digital tools to serve as media for a deeper engagement with individuals’ complex biopsychosocial needs. The integration of data science and technological advancements offers promising avenues for tailored digital solutions. The findings advocate the importance of continued innovation and adaptation in digital health care communication strategies, with clearer HP roles and an interdisciplinary, empathetic approach focused on individual needs. %M 39928923 %R 10.2196/58434 %U https://www.jmir.org/2025/1/e58434 %U https://doi.org/10.2196/58434 %U http://www.ncbi.nlm.nih.gov/pubmed/39928923 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e47837 %T mHealth-Based Diabetes Prevention Program for Chinese Mothers With Abdominal Obesity: Randomized Controlled Trial %A Huang,Qinyuan %A Zhong,Qinyi %A Zeng,Yanjing %A Li,Yimeng %A Wiley,James %A Wang,Man Ping %A Chen,Jyu-Lin %A Guo,Jia %+ Xiangya School of Nursing, Central South University, No.172 Tongzipo Road, Yuelu District, Changsha, 410013, China, 86 13875947418, guojia621@163.com %K type 2 diabetes %K mHealth %K obesity %K prevention %K mothers %D 2025 %7 24.1.2025 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Among people with abdominal obesity, women are more likely to develop diabetes than men. Mobile health (mHealth)–based technologies provide the flexibility and resource-saving opportunities to improve lifestyles in an individualized way. However, mHealth-based diabetes prevention programs tailored for busy mothers with abdominal obesity have not been reported yet. Objective: The aim of this study is to evaluate the feasibility and acceptability of an mHealth-based diabetes prevention program and its preliminary efficacy in reducing weight-related variables, behavioral variables, psychological variables, and diabetes risk among Chinese mothers with abdominal obesity over 6 months. Methods: A randomized controlled trial was conducted at health management centers in 2 tertiary hospitals in Changsha, China. The mHealth group (n=40) received 12 weekly web-based lifestyle modification modules for diabetes prevention, 6 biweekly individualized health education messages based on their goal settings, and a Fitbit tracker. The control group (n=40) received 12 weekly web-based general health education modules, 6 biweekly general health education messages, and a Fitbit tracker. Data were collected at baseline, 3 months, and 6 months on the feasibility and acceptability outcomes, weight-related variables (waist circumference and BMI), diabetes risk scores, glycemic levels, behavioral variables (daily step count, active minutes, fruit and vegetable intake, calorie consumption, and sleep duration), and psychological variables (self-efficacy and social support for physical activity and diet, perceived stress, and quality of life). Generalized estimating equations were used for data analysis. Results: Approximately 85% (68/80) of the participants completed 6 months of follow-up assessments. Regarding the feasibility and acceptance of the program in the mHealth group, the average number of modules reviewed was 7.9 out of 12, and the satisfaction score was 4.37 out of 5. Significant improvements at 6 months between the intervention and control groups were found in waist circumference (β=–2.24, 95% CI –4.12 to –0.36; P=.02), modifiable diabetes risk scores (β=–2.5, 95% CI –4.57 to –0.44; P=.02), daily steps (β=1.67, 95% CI 0.06-3.29; P=.04), self-efficacy for physical activity (β=1.93, 95% CI 0.44-3.43; P=.01), social support for physical activity (β=2.27, 95% CI 0.80-3.74; P=.002), and physical health satisfaction (β=0.82, 95% CI 0.08-1.55; P=.03). No differences were found in BMI, total diabetes risk score, daily active minutes, daily intake of fruits and vegetables, sleep duration, daily calorie consumption, self-efficacy, and social support for diet (P>.05). Conclusions: This study addresses the potential role of tailored lifestyle interventions based on mHealth technology by offering tailored web-based health modules and health information in managing diabetes risk among mothers with abdominal obesity. The mHealth diabetes prevention program provides a flexible, customized, and resource-saving model for busy mothers. Future research could further explore the efficacy improvement on dietary behaviors to better serve the health care needs of this population. Trial Registration: Chinese Clinical Trial Registry ChiCTR2400090554; https://www.chictr.org.cn/showproj.html?proj=226411 %M 39854072 %R 10.2196/47837 %U https://mhealth.jmir.org/2025/1/e47837 %U https://doi.org/10.2196/47837 %U http://www.ncbi.nlm.nih.gov/pubmed/39854072 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e68792 %T Quality Assessment of Medical Institutions’ Websites Regarding Prescription Drug Misuse of Glucagon-Like Peptide-1 Receptor Agonists by Off-Label Use for Weight Loss: Website Evaluation Study %A Oyama,Rie %A Okuhara,Tsuyoshi %A Furukawa,Emi %A Okada,Hiroko %A Kiuchi,Takahiro %+ Department of Health Communication, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan, 81 3 5800 6549, rooyama-oss@umin.ac.jp %K prescription drug misuse %K GLP-1 receptor agonists %K off-label use %K weight loss %K information quality %K DISCERN %K web-based information %K information provision %K misinformation %K advertising guidelines %K exaggerated advertisements %D 2025 %7 1.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Misuse of glucagon-like peptide-1 receptor agonists (GLP-1RAs) has emerged globally as individuals increasingly use these drugs for weight loss because of unrealistic and attractive body images advertised and shared on the internet. Objective: This study assesses the quality of information and compliance with Japan’s medical advertising guidelines on the websites of medical institutions that prescribe GLP-1RAs off-label for weight loss. Methods: Websites were identified by searching Google and Yahoo! by using keywords related to GLP-1RAs and weight loss in August 2024. The quality of information on these websites was assessed using the DISCERN instrument. To comply with Japan’s medical advertising guidelines, we evaluated whether the 5 mandatory items for advertisements of self-paid medical treatments involving the off-label use of drugs were stated and whether there were any exaggerated claims. The content of the exaggerated advertisements was categorized into themes. Results: Of the 87 websites included, only 1 website stated all 5 mandatory items. Websites listing “ineligible for the relief system for sufferers from adverse drug reactions” had the lowest percentage at 9% (8/87), while 83% (72/87) of the websites listed exaggerated advertisements. Approximately 69% (60/87) of the websites suggested that no exercise or dietary therapy was required, 24% (21/87) suggested that using GLP-1RAs is a natural and healthy method, and 31% (27/87) of the websites provided the author’s personal opinions on the risks of using GLP-1RAs. The mean total DISCERN score for all 87 websites was 32.6 (SD 5.5), indicating low quality. Only 1 website achieved a good rating, and 9 websites were rated as fair. The majority of the websites were rated as poor (72 websites) or very poor (5 websites). Conclusions: We found that the quality of information provided by the websites of medical institutions prescribing GLP-1RAs off-label for weight loss was very low and that many websites violated Japan’s medical advertising guidelines. The prevalence of exaggerated advertisements, which may lead consumers to believe that they can lose weight without dietary or exercise therapy, suggests the risk of GLP-1RA misuse among consumers. Public institutions and health care providers should monitor and regulate advertisements that violate guidelines and provide accurate information regarding GLP-1RAs, obesity, and weight loss. %M 39742456 %R 10.2196/68792 %U https://formative.jmir.org/2025/1/e68792 %U https://doi.org/10.2196/68792 %U http://www.ncbi.nlm.nih.gov/pubmed/39742456 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e60838 %T Exploring Molecular Genetics Research on Obesity in Malaysia: Protocol for a Scoping Review %A Ahmad Zamri,Liyana %A Abu Seman,Norhashimah %A Zainal Abidin,Nur Azlin %A Hamzah,Siti Sarah %+ Endocrine and Metabolic Unit, Nutrition, Metabolism and Cardiovascular Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Jalan Setia Murni U13/52, Seksyen U13 Setia Alam, Selangor, 40170, Malaysia, 60 333627825, sitisarah.h@moh.gov.my %K genetics %K biomarkers %K molecular %K obesity %K Malaysia %K scoping review %K protocol %D 2024 %7 30.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Obesity presents a growing challenge to public health, and its intricate association with genetics continues to be a compelling field of study. In countries such as Malaysia, where diverse genetic backgrounds converge, exploring the molecular genetics of obesity is even more imperative. Objective: This scoping review aimed to explore the literature on molecular genetics of obesity in Malaysia. Specifically, we sought to characterize existing studies, identify the genetic determinants of obesity, and assess their association with obesity predisposition in the population. Methods: This scoping review followed the methodology of the Joanna Briggs Institute and used the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist as its guiding framework. Searches were conducted using electronic databases such as PubMed, ScienceDirect, and Scopus, filtering for human studies published until March 2024. Eligible studies included peer-reviewed articles on the Malaysian population irrespective of age or sex. This review excluded review articles, book chapters, non–peer-reviewed conference proceedings, gray literature, and preclinical studies, and the reference lists of the retrieved studies were manually examined to ensure thorough inclusion. The articles were subjected to a 2-stage screening process (title/abstract and full text) conducted by 2 reviewers to assess eligibility. Eligible articles were then extracted following a data extraction framework and organized into a charting table. Only studies investigating the genetics of obesity in Malaysian populations were included. Results: As of March 2024, our extensive search strategy has yielded 572 records. After removing 153 duplicates, 419 records were screened by title and abstract, resulting in 47 selected for full-text review. Of these, 34 were chosen for data extraction and detailed analysis. These studies predominantly involved participants from major ethnic groups (Malay, Chinese, and Indian) recruited from local health centers and university communities. The articles primarily explored the relationship between specific gene variants and obesity or obesity-related health parameters. This ongoing research is expected to be completed with a comprehensive scoping review by April 2025. Conclusions: This review provides valuable insights into the genetic determinants of obesity in Malaysia, despite limitations such as no quality appraisal being conducted for the included studies and the search strategy being restricted to selected databases, potentially omitting relevant studies. However, this review ensured reliability and reproducibility by adhering to the Joanna Briggs Institute and PRISMA-ScR guidelines. Ultimately, this study advances the understanding of local research and sets the foundation for future molecular genetic studies to improve obesity risk prediction and management in Malaysia’s multiethnic population. International Registered Report Identifier (IRRID): DERR1-10.2196/60838 %M 39753227 %R 10.2196/60838 %U https://www.researchprotocols.org/2024/1/e60838 %U https://doi.org/10.2196/60838 %U http://www.ncbi.nlm.nih.gov/pubmed/39753227 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e65323 %T Comparing Synchronous and Asynchronous Remotely Delivered Lifestyle Interventions: Protocol for a Randomized Noninferiority Trial %A Pagoto,Sherry %A Xu,Ran %A Bannor,Richard %A Idiong,Christie %A Goetz,Jared %A Fernandes,Denise %+ Department of Allied Health Sciences, University of Connecticut, Koons Hall, 358 Mansfield Rd, Storrs, CT, 06269, United States, 1 6178770923, Sherry.Pagoto@uconn.edu %K obesity %K lifestyle intervention %K digital health %K weight loss maintenance %K engagement %K mobile phone %D 2024 %7 19.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Remotely delivered lifestyle interventions have emerged to increase the reach and accessibility of traditional interventions that involve numerous in-person visits. Remote interventions can be delivered synchronously via videoconference software or phone or asynchronously via online platforms. Asynchronously delivered interventions are convenient and flexible in that they allow people to participate at any time and as such, they may be more sustainable. Evidence for asynchronous interventions is needed given their potential for convenience and sustainability, which may have implications for weight loss maintenance. Objective: This is a randomized noninferiority trial comparing 2 remotely delivered lifestyle interventions: one that is delivered synchronously via videoconference meetings and one that is delivered asynchronously through private Facebook (Meta) groups. We hypothesize that the percent weight loss difference between conditions at 6 and 12 months will be less than 2% and that the asynchronous condition will cost less to deliver per pound lost. We also hypothesize that engagement will be higher in the asynchronous condition at 12, 18, and 24 months and that the asynchronous condition will have greater weight loss at 24 months. Methods: We will randomize 328 participants with overweight or obesity to a remotely delivered lifestyle intervention that is delivered either synchronously or asynchronously. Delivery of the synchronous lifestyle intervention will be via videoconference group sessions, whereas the delivery of the asynchronous lifestyle intervention will be via private Facebook groups. The lifestyle intervention in both conditions is based on the Diabetes Prevention Program. The intervention goals are to lose 5%-10% of baseline weight and to work toward 300 minutes per week of moderate intensity physical activity. The core intervention will last for 12 months and be led by counselors in each group. This will be followed by a 12-month maintenance phase to be led by participant volunteers from each group. Participant engagement and weight loss maintenance will be assessed during this phase. The primary outcome is mean percent weight loss at 6 and 12 months. The noninferiority margin for differences in weight loss between conditions is 2% at both 6 and 12 months. We will model percent weight loss at 6 and 12 months using general linear regression models with the intent-to-treat sample. Secondary outcomes include engagement, collective efficacy, cost, and weight loss at 18 and 24 months. Results: The funding period began on August 17, 2023, and the study was approved by the University of Connecticut Institutional Review Board on August 17, 2023. Participant recruitment will begin December 2024 and the intervention will begin February 2024. Conclusions: If hypotheses are confirmed, this work will provide evidence that asynchronously delivered remote interventions are as efficacious as synchronously delivered ones and more sustainable such that people will engage in them longer and retain more weight loss for less cost. Trial Registration: ClinicalTrials.gov NCT06393725; https://tinyurl.com/4kzzwkc9 International Registered Report Identifier (IRRID): PRR1-10.2196/65323 %M 39700497 %R 10.2196/65323 %U https://www.researchprotocols.org/2024/1/e65323 %U https://doi.org/10.2196/65323 %U http://www.ncbi.nlm.nih.gov/pubmed/39700497 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53873 %T Research Trends on Metabolic Syndrome in Digital Health Care Using Topic Modeling: Systematic Search of Abstracts %A Lee,Kiseong %A Chung,Yoongi %A Kim,Ji-Su %+ Department of Nursing, Chung-Ang University, 84, Heukseok-ro, Dongjak-gu, Seoul, Republic of Korea, Seoul, 06974, Republic of Korea, 82 028205991, jisu80@cau.ac.kr %K metabolic syndrome %K digital health care %K topic modeling %K text network analysis %K research trends %K topic modeling %K prevention %K management %K telemedicine %K wearable %K devices %K apps %K applications %K methodological %K cardiovascular disease %D 2024 %7 12.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Metabolic syndrome (MetS) is a prevalent health condition that affects 20%-40% of the global population. Lifestyle modification is essential for the prevention and management of MetS. Digital health care, which incorporates technologies like wearable devices, mobile apps, and telemedicine, is increasingly becoming integral to health care systems. By analyzing existing research trends in the application of digital health care for MetS management, this study identifies gaps in current knowledge and suggests avenues for future research. Objective: This study aimed to identify core keywords, topics, and research trends concerning the use of digital health care in the management of MetS. Methods: A systematic search of abstracts from peer-reviewed papers was conducted across 6 academic databases. Following eligibility screening, 162 abstracts were selected for further analysis. The methodological approach included text preprocessing, text network analysis, and topic modeling using the BERTopic algorithm. Results: Analysis of the 162 selected abstracts yielded a keyword network comprising 1047 nodes and 34,377 edges. The top 5 core keywords were identified as “MetS,” “use,” “patient,” “health,” and “intervention.” We identified 12 unique topics, with topic 1 focusing on the use of telehealth for self-management of diabetes. The diversity of the 12 topics reflected various aspects of digital health care, including telehealth for diabetes management, electronic health records for MetS complications, and wearable devices for monitoring metabolic status. Research trends showed an expanding field of precision medicine driven by the demand for tailored interventions and the significant impact of the COVID-19 pandemic. Conclusions: By analyzing past research trends and extracting data from scholarly databases, this study has provided valuable insights that can guide future investigations in the field of digital health care and MetS management. %M 39666378 %R 10.2196/53873 %U https://www.jmir.org/2024/1/e53873 %U https://doi.org/10.2196/53873 %U http://www.ncbi.nlm.nih.gov/pubmed/39666378 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e51701 %T Uncovering the Top Nonadvertising Weight Loss Websites on Google: A Data-Mining Approach %A Almenara,Carlos A %A Gulec,Hayriye %+ School of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Av. Alameda San Marcos 11, Lima, 15067, Peru, 51 3133333 ext 2803, carlos.almenara@upc.pe %K consumer health informatics %K cyberattack risk %K data mining %K Google %K information seeking %K weight loss %K online health information %K website analysis %K digital health %K internet search %D 2024 %7 11.12.2024 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Online weight loss information is commonly sought by internet users, and it may impact their health decisions and behaviors. Previous studies examined a limited number of Google search queries and relied on manual approaches to retrieve online weight loss websites. Objective: This study aimed to identify and describe the characteristics of the top weight loss websites on Google. Methods: This study gathered 432 Google search queries collected from Google autocomplete suggestions, “People Also Ask” featured questions, and Google Trends data. A data-mining software tool was developed to retrieve the search results automatically, setting English and the United States as the default criteria for language and location, respectively. Domain classification and evaluation technologies were used to categorize the websites according to their content and determine their risk of cyberattack. In addition, the top 5 most frequent websites in nonadvertising (ie, nonsponsored) search results were inspected for quality. Results: The results revealed that the top 5 nonadvertising websites were healthline.com, webmd.com, verywellfit.com, mayoclinic.org, and womenshealthmag.com. All provided accuracy statements and author credentials. The domain categorization taxonomy yielded a total of 101 unique categories. After grouping the websites that appeared less than 5 times, the most frequent categories involved “Health” (104/623, 16.69%), “Personal Pages and Blogs” (91/623, 14.61%), “Nutrition and Diet” (48/623, 7.7%), and “Exercise” (34/623, 5.46%). The risk of being a victim of a cyberattack was low. Conclusions: The findings suggested that while quality information is accessible, users may still encounter less reliable content among various online resources. Therefore, better tools and methods are needed to guide users toward trustworthy weight loss information. %M 39661980 %R 10.2196/51701 %U https://infodemiology.jmir.org/2024/1/e51701 %U https://doi.org/10.2196/51701 %U http://www.ncbi.nlm.nih.gov/pubmed/39661980 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e50754 %T Weight and Lifestyle Behavior Changes in Chinese Health Care Workers During the COVID-19 Pandemic: 3-Year Retrospective Survey %A Guo,Xinyue %A Gong,Shaoqing %A Chen,Ying %A Hou,Xiaohui %A Sun,Tong %A Wen,Jianqiang %A Wang,Zhiyao %A He,Jingyang %A Sun,Xuezhu %A Wang,Sufang %A Chen,Zhixin %A Feng,Xue %A Tian,Xiangyang %+ Chinese Center for Health Education, Building 12, District 1, Anhua Xili, outside Andingmen, Beijing, Beijing, China, 1 01064263018, healthtian@163.com %K COVID-19 %K healthcare workers %K lifestyle behavior %K overweight %K obesity %K physical activity %K mental health %K stress %K anxiety,depression %K pandemic %D 2024 %7 10.12.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Health care workers (HCWs) played a key role in preventing and controlling COVID-19. Higher infection risks and intensive work led to occupational burnout for many HCWs, which may affect their lifestyle behaviors and weight. Objective: This study aimed to assess HCWs’ self-rated health status, overweight and obesity rates, lifestyle behaviors, and psychoemotional changes from 2019 to 2022 across China and to analyze the factors associated with changes from underweight or normal weight in 2019 to overweight or obese in 2022. Methods: In this retrospective study, 100 health care institutions were randomly selected from 5 provinces or regions in China. All HCWs who worked in the institutions for at ≥3 years were invited to complete the electronic questionnaire and participate in the online survey from August 1, 2022, to August 31, 2022. Collected data included changes in lifestyle behaviors (dietary habits, physical activity, sleep quality, smoking, alcohol consumption), psychoemotional conditions (persistent stress or recurrent anxiety or depressed mood), health status, and chronic disease control from December 2019 to August 2022. Height and weight in 2019 and 2022 were retrieved from annual physical examination records. Overweight and obesity were defined as 24.0 kg/m2≤BMI<28.0 kg/m2 (overweight) and BMI≥28.0 kg/m2 (obesity). Chi square tests and ANOVAs were used to assess the associations between groups. Logistic regression models were used to analyze the factors associated with HCWs becoming overweight or obese from 2019 to 2022. Results: The questionnaire was submitted by 23,234 HCWs. Of the underweight or normal weight HCWs in 2019, 12.67% (1486/23,234) became overweight or obese in 2022; this change was associated with the following factors: 34-43 years old (OR 0.843, 95% CI 0.740-0.960), 44-53 years old (OR 0.738, 95% CI 0.635-0.960), and 54-63 years old (OR 0.503, 95% CI 0.368-0.685; reference: 24-33 years old), reduction in or never or rarely engaging in physical activity (OR 1.201, 95% CI 1.055-1.368; reference: increase in physical activity; P=.006), increased appetite (OR 2.043, 95% CI 1.788-2.034; reference: reduction or no change in appetite; P<.001). From 2019 to 2022, 51.29% (11,917/23,234) of the respondents experienced increased persistent stress or recurrent anxiety or depressed mood; 44.38% (10,311/23,234) stayed up late more often. Increased persistent stress or recurrent anxiety or depressed mood was associated with physical activity (OR 0.421, 95% CI 0.398-0.447; P<.001) and appetite (OR 1.601, 95% CI 1.483-1.728; P<.001). Conclusions: The pandemic was associated with overweight and obesity for HCWs due to changes in lifestyle behaviors, especially reduced physical activity and increased appetite related to increased persistent stress or recurrent anxiety or depressed mood caused by excessive workload. An integrated approach is needed to address overweight and obesity and lifestyle changes among HCWs by releasing negative psychoemotional conditions through workload reduction in future stressful events. %M 39657182 %R 10.2196/50754 %U https://www.i-jmr.org/2024/1/e50754 %U https://doi.org/10.2196/50754 %U http://www.ncbi.nlm.nih.gov/pubmed/39657182 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55243 %T Effects of 10 Weeks of Walking With Mobile Step-Tracking Apps on Body Composition, Fitness, and Psychological State in Adolescents Who Are Overweight and Obese: Randomized Controlled Trial %A Mateo-Orcajada,Adrián %A Ponce-Ramírez,Cristina M %A Abenza-Cano,Lucía %A Vaquero-Cristóbal,Raquel %+ Facultad de Deporte, Universidad Católica de Murcia (UCAM), Avenida de los Jerónimos, Murcia, 30107, Spain, 34 968 278 824, labenza@ucam.edu %K adolescents %K obesity %K physical activity %K overweight %K mobile app %K physical education %D 2024 %7 10.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: In recent decades, physical activity intervention programs have been developed to reduce overweight and obesity in adolescents. However, this population is considered hard to reach in physical activity programs due to lack of adherence and poor results. Interventions with mobile phones in the adolescent population with normal weight have shown benefits, so this line of research may provide benefits in adolescents with overweight or obesity, although it has not yet been explored in the scientific literature. Objective: This study aims to determine the changes produced by a 10-week intervention promoted during school lessons on physical education using step tracker mobile apps in out-of-school hours on physical activity, adherence to the Mediterranean diet, body composition, and the physical condition of adolescents who are overweight and obese, and to analyze the changes achieved by the 10-week intervention on the psychological state of adolescents who are overweight and obese. Methods: The study was based on a randomized controlled trial with an initial sample of 50 adolescents aged between 12 and 16 years (from the first to the fourth years of compulsory secondary education), whose body composition, physical activity level, physical condition, and psychological state were measured. Participants were divided into an experimental group (EG) and a control group (CG), where the EG performed a series of walking steps with a mobile app in their free time outside physical education classes. Adolescents in the CG continued to perform their physical activities as normal but did not use any mobile apps. Inclusion in the EG and CG was randomized, and the researchers were blinded. Results: An increase was found in the EG in corrected arm girth (mean difference –0.46; P=.05), curl-up repetitions (mean difference –6.35; P=.02) and push-up repetitions (mean difference –2.27; P=.04) after the intervention. In the CG, there was a significant increase in hip girth (mean difference –1.37; P=.05), corrected thigh girth (mean difference –1.28; P=.04), and muscle mass (mean difference –0.87; P=.04), as well as a significant decrease in competence (mean difference 3.08; P=.03). The covariates gender and age showed an effect on corrected arm girth (gender: P=.04), curl-up repetitions (gender: P=.04) and push-up repetitions (gender: P=.04) in the EG; while in the CG it affected corrected thigh girth (gender: P=.04), adherence to the Mediterranean diet (gender: P=.04 and age: P=.047) competence (gender: P=.04 and age: P=.04) and relatedness (gender: P=.05 and age: P=.04). No significant differences were found when comparing changes in the CG and EG. Conclusions: A 10-week program of mobile app use by adolescents who are overweight and obese for physical activity outside of school hours does not appear effective in producing improvements in body composition, physical fitness, or adequate psychological state as it does not appear to significantly increase physical activity. Trial Registration: ClinicalTrials.gov NCT06089876; http://clinicaltrials.gov/ct2/show/NCT06089876 %M 39656510 %R 10.2196/55243 %U https://www.jmir.org/2024/1/e55243 %U https://doi.org/10.2196/55243 %U http://www.ncbi.nlm.nih.gov/pubmed/39656510 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56573 %T Association Between Patient Portal Engagement and Weight Loss Outcomes in Patients After Bariatric Surgery: Longitudinal Observational Study Using Electronic Health Records %A Zhang,Xinmeng %A Kang,Kaidi %A Yan,Chao %A Feng,Yubo %A Vandekar,Simon %A Yu,Danxia %A Rosenbloom,S Trent %A Samuels,Jason %A Srivastava,Gitanjali %A Williams,Brandon %A Albaugh,Vance L %A English,Wayne J %A Flynn,Charles R %A Chen,You %+ Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End Ave., Nashville, TN, 37203, United States, 1 615 343 1939, you.chen@vumc.org %K patient portal %K patient engagement %K bariatric surgery %K retrospective %K longitudinal study %K data-driven %K weight loss %K obesity %K electronic health records %K postoperative care %D 2024 %7 9.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Bariatric surgery is an effective intervention for obesity, but comprehensive postoperative self-management is essential for optimal outcomes. While patient portals are generally seen as beneficial in engaging patients in health management, the link between their use and post–bariatric surgery weight loss remains unclear. Objective: This study aimed to investigate the association between patient portal engagement and postoperative BMI reduction among patients after bariatric surgery. Methods: This retrospective longitudinal study included patients who underwent Roux-en-Y gastric bypass or sleeve gastrectomy at Vanderbilt University Medical Center between January 2018 and March 2021. Patient portal engagement was measured during 4 stages: early (within 3 months after surgery), early midterm (3-6 months), late midterm (6-9 months), and late (9-12 months). Using generalized estimating equations, we estimated the associations between patients’ portal engagements at these stages and the percentage of BMI reduction (%BMIR) at 3, 6, and 12 months after surgery. Covariates included duration since surgery, patient’s age at the time of surgery, sex, race and ethnicity, type of bariatric surgery, severity of comorbid conditions, and socioeconomic disadvantage. Results: The study included 1415 patients, predominantly female (n=1145, 80.9%), with a racial composition of 76.9% (n=1088) White and 19.9% (n=282) Black. Overall, 805 (56.9%) patients underwent Roux-en-Y gastric bypass and 610 (43.1%) underwent sleeve gastrectomy. By 1 year after surgery, the median %BMIR was 31.5% (IQR 25.2%-36.8%), and the median number of active days on the patient portal was 54 (IQR 33-80). Early portal engagement was significantly associated with %BMIR at various postoperative times. Specifically, each additional 10 days of early portal engagement was associated with a 0.37% (95% CI –0.55% to –0.18%; P<.001) lower expected %BMIR at 3 months, a 1.11% (95% CI 0.82%-1.41%; P<.001) higher expected %BMIR at 6 months, and a 0.78% (95% CI 0.25%-1.31%; P=.004) higher expected %BMIR at 12 months. Furthermore, early midterm portal engagement was associated with a 0.36% (95% CI –0.69 to –0.03; P=.03) lower expected %BMIR at 6 months, but it was not significant at 12 months (P=.88). Late midterm and late portal engagement were not significantly associated with %BMIR at 12 months (P=.27 and P=.12, respectively). Furthermore, early engagement in various portal functions, such as messaging and accessing medical records, was significantly associated with a lower %BMIR at 3 months and a higher %BMIR at both 6 and 12 months (all P<.05). Conclusions: Higher patient portal engagement within 3 months after surgery—suggestive of stronger adherence to postoperative instructions and improved communication with care teams—is associated with less favorable weight loss immediately after surgery but enhanced postoperative weight loss outcomes at 6 and 12 months. However, the limitations of retrospective data-driven studies highlight the need for future intervention-based studies to validate these associations and establish causality. %M 39652378 %R 10.2196/56573 %U https://www.jmir.org/2024/1/e56573 %U https://doi.org/10.2196/56573 %U http://www.ncbi.nlm.nih.gov/pubmed/39652378 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58682 %T An Image-Recognition Dietary Assessment App for Adolescents With Obesity: Pilot Randomized Controlled Trial %A Oei,Krista %A Choi,Elizabeth EY %A Bar-Dayan,Alisa %A Stinson,Jennifer N %A Palmert,Mark R %A Alfonsi,Jeffrey E %A Hamilton,Jill %+ Division of Endocrinology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G1X8, Canada, 1 4168131500, krista.oei@sickkids.ca %K obesity %K weight management %K dietary assessment %K nutrition %K adolescent %K digital health app %K mHealth %K mobile health %K image recognition %K teens %K weight %K youth %K diet %K dietary %K dietary app %K usability %K feasibility %K pilot randomized controlled trial %K obesity management %K nutritional %K user %K patient engagement %K mobile phone %D 2024 %7 2.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Adolescence is a period of increased susceptibility to developing obesity-related health issues due to poor eating patterns and increased sedentary behaviors. Recommendations for pediatric obesity management include dietary assessments. However, adolescents often avoid food logging through traditional methods. The use of image-recognition dietary assessment apps in adolescents with obesity is not well studied. Eating for Wellness (E4W) is a mobile app that determines the nutritional content of meals from photos and incorporates nutritional goal setting. Nutritional data can be displayed for health care providers (HCPs) via the Clinician Portal, while the data are presented to the user in a manner that minimizes the focus on calorie counting. Objective: This study aims to evaluate the usability and feasibility of E4W, a mobile health app designed to improve dietary intake in adolescents with obesity attending an obesity clinic, using a phased approach. Methods: The overall study was conducted in 2 phases to refine and evaluate E4W. In Phase 1, usability was tested through 3 iterative cycles of patient interviews. A total of 14 patient participants, aged 12-18 years with a BMI≥97th percentile, were included. Participants performed standardized scenario-based tasks in E4W and provided feedback on the app. Two iterative cycles were conducted for HCPs (n=4). Refinements were made during each cycle based on issues encountered and feedback provided. In Phase 2, a pilot randomized controlled trial of 32 adolescents (16 adolescents enrolled in the experimental group for 1 month, and 16 controls enrolled for 1 month) was completed. Both groups met with their dietitian at baseline, midstudy, and 1 month following their baseline visit to discuss goals and eating patterns. The control group was instructed to take photos of all intake using their default phone camera, without access to E4W, while those in the experimental group received full access to E4W. The primary outcome was the feasibility of implementation. Secondary outcomes examined overall change in dietary intake and achievement of nutritional goals. Results: Usability testing demonstrated that E4W and the Clinician Portal were easy to use, efficient, and well-liked by patients and HCPs. Feasibility testing revealed high patient acceptability scores. However, significant technical challenges were encountered. Although the use of E4W did not significantly impact patient engagement (control: mean 0.9, SD 0.7; experimental: mean 1.7, SD 1.9; P=.14), there were outliers in the experimental group with very high engagement and improved self-reported efficacy. Overall, there was no improvement in dietary intake, although assessment was hindered by poor adherence to traditional methods of food logging. Conclusions: E4W and the Clinician Portal were well-received by patients and HCPs. Further research is warranted and planned to determine if E4W can improve dietary intake and achievement of nutritional goals in adolescents with obesity. Trial Registration: ClinicalTrials.gov NCT05548868; https://clinicaltrials.gov/study/NCT05548868 %M 39621405 %R 10.2196/58682 %U https://formative.jmir.org/2024/1/e58682 %U https://doi.org/10.2196/58682 %U http://www.ncbi.nlm.nih.gov/pubmed/39621405 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e59455 %T Developing a Weight-Neutral Health Intervention in Denmark: Protocol for a Co-Design Process %A Meyer,Lene %A Køster-Rasmussen,Rasmus %A Christiansen,Ann-Kathrin Lindahl %A Heitmann,Berit Lilienthal %A Vesterlund,Gitte Kingo %A Larsen,Sofus Christian %A Specht,Ina Olmer %A Thorsteinsdottir,Fanney %A Steinbo,Emma Katrine Frøhlke %A Appel,Clara Lundmark %A Sigurdardottir,Gudrun Agusta %A Reventlow,Susanne %A Waldorff,Frans Boch %A Sandholdt,Catharina Thiel %K obesity %K weight management %K complex intervention %K patient engagement %K health intervention %K Denmark %K Danish %K lifestyle %K weight loss %K weight reduction %K stigma %K neutral health %K human-centered design %K dissemination %K podcast %K social media %K feasibility study %K public health %K surveillance %D 2024 %7 29.11.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Lifestyle interventions for weight loss are generally ineffective in achieving clinically meaningful long-term reductions in body weight and may contribute to negative behavior such as weight cycling or disordered eating. Negative focus on high weight may also contribute to weight stigma. Weight stigma includes negative attitudes and discriminatory behavior toward people with big bodies and can result in psychological stress and unfavorable health outcomes. Taken together, it is possible that the potential harms of lifestyle-based weight loss interventions may exceed the potential benefits. Weight-neutral health (WNH) has emerged as an alternative strategy advocating for size diversity, intuitive eating, and joyful physical movement, all without placing emphasis on weight reduction. Objective: This protocol outlines the study design for the co-design process of developing a WNH complex intervention, engaging relevant stakeholders in Denmark. Methods: We base our understanding of WNH on the principles from Health at Every Size: body acceptance, joyful movement, intuitive eating, and weight stigma reduction. The co-design development process is based on the Medical Research Council’s framework for complex interventions and applies methods from human-centered design through 4 iterative design phases of engaging stakeholders—discover: search existing literature, and conduct interviews with Danish municipal stakeholders working with WNH and other expert stakeholders; define: coproduction of seminars with health professionals (HPs) with knowledge of WNH, and semistructured interviews with people with BMI≥30 kg/m2 who have participated in existing WNH interventions; design: content-creating workshops with HPs and people with BMI≥30 kg/m2; and validate: evaluate seminars, plan feasibility, and produce materials. The data will be analyzed thematically to build a scaffold for the intervention activities and components. In further analysis, we will explore how health is performed, meaning the actions and dialogues that arise when dealing with health guidelines, the societal body, weight, and health expectations, in the context of the intervention. Results: The project is fully funded. As of August 2024, the co-design process was in the closing phase. In total, 15 HPs were included, some of whom have larger body sizes. This provides a dual perspective, combining their personal experiences of living with a high BMI with their professional expertise. In total, 16 people with BMI≥30 kg/m2 have generously shared their experiences with WNH programs, including the difficulties of moving away from external demands and personal wishes for weight loss. Their contributions have nuanced and unfolded our understanding of the principles of WNH in a Danish setting. Conclusions: The intervention designed in and from the co-design process will be tested for feasibility in 2025. The findings from the feasibility study will inform a future randomized controlled trial and present novel findings in the field of health management. The long-term goal is to implement the intervention in a Danish municipal setting free of charge. %R 10.2196/59455 %U https://publichealth.jmir.org/2024/1/e59455 %U https://doi.org/10.2196/59455 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e57799 %T Utility of Anthropometric Indexes for Detecting Metabolic Syndrome in Resource-Limited Regions of Northwestern China: Cross-Sectional Study %A Yang,Danyu %A Ma,Ling %A Cheng,Yin %A Shi,Hongjuan %A Liu,Yining %A Shi,Chao %K metabolic syndrome %K MetS %K anthropometric indexes %K lipid accumulation product %K LAP %K waist-to-height ratio %K WHtR %K anthropometric %K adult %K aging %K NingXia %K China %K cross-sectional study %K population-based survey %K logistic regression %K waist-to-height %K threshold %K diagnosis %K public health %D 2024 %7 29.11.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Anthropometric indexes offer a practical approach to identifying metabolic syndrome (MetS) and its components. However, there is a scarcity of research on anthropometric indexes tailored to predict MetS in populations from resource-limited regions. Objective: This study aimed to examine the association between 8 easy-to-collect anthropometric indexes and MetS, and determine the most appropriate indexes to identify the presence of MetS for adults in resource-limited areas. Methods: A total of 10,520 participants aged 18‐85 years from Ningxia Hui Autonomous Region, China, were included in this cross-sectional study. Participants were recruited through a stratified sampling approach from January 1, 2020, to December 31, 2021. MetS was defined using the International Diabetes Federation (IDF) criteria. Eight anthropometric indexes were examined, including BMI, waist-to-height ratio (WHtR), weight-adjusted waist index (WWI), conicity index, a body shape index (ABSI), lipid accumulation products (LAP), visceral obesity index (VAI), and the triglyceride-glucose (TyG) index. Logistic regression analysis and restricted cubic splines (RCSs) were applied to identify the association between the anthropometric indexes. The receiver operating characteristic curve and the area under the curve (AUC) were analyzed to identify and compare the discriminative power of anthropometric indexes in identifying MetS. The Youden index was used to determine a range of optimal diagnostic thresholds. Logistic regression analysis was applied to identify the association between the anthropometric indexes. Results: A total of 3324 (31.60%) participants were diagnosed with MetS. After adjusting for age, ethnicity, current residence, education level, habitual alcohol consumption, and tobacco use, all the 8 indexes were positively correlated with the risks of MetS (P<.05). LAP presented the highest adjusted odds ratios (adjOR 35.69, 95% CI 34.59‐36.80), followed by WHtR (adjOR 29.27, 95% CI 28.00‐30.55), conicity index (adjOR 11.58, 95% CI 10.95‐12.22), TyG index (adjOR 5.53, 95% CI 5.07‐6.04), BMI (adjOR 3.88, 95% CI 3.71‐4.05), WWI (adjOR 3.23, 95% CI 3.02‐3.46), VAI (adjOR 2.11, 95% CI 2.02‐2.20), and ABSI (adjOR 1.71, 95% CI 1.62‐1.80). Significantly nonlinear associations between the 8 indexes and the risk of MetS (all Pnonlinear<.001) were observed in the RCSs. WHtR was the strongest predictor of MetS for males (AUC 0.91, 95% CI 0.90-0.92; optimal cutoff 0.53). LAP were the strongest predictor of MetS for females (AUC 0.89, 95% CI 0.89-0.90; optimal cutoff 28.67). Statistical differences were present between WHtR and all other 7 anthropometric indexes among males and overall (all P<.05). In females, the AUC values between LAP and BMI, WWI, ABSI, conicity index, VAI, and TyG index were significantly different (P<.001). No statistical difference was observed between LAP and WHtR among females. Conclusions: According to 8 anthropometric and lipid-related indices, it is suggested that WHtR and LAP are the most appropriate indexes for identifying the presence of MetS in resource-limited areas. %R 10.2196/57799 %U https://publichealth.jmir.org/2024/1/e57799 %U https://doi.org/10.2196/57799 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53140 %T Preferences of Individuals With Obesity for Online Medical Consultation in Different Demand Scenarios: Discrete Choice Experiments %A Hu,Yaolin %A Wang,Jian %A Zhou,Jianbo %A Gu,Yuanyuan %A Nicholas,Stephen %A Maitland,Elizabeth %+ School of Economics, Peking University, No. 5 Yiheyuan Road, Haidian District, Beijing, 100871, China, 86 13522596266, huyaolin@pku.edu.cn %K online medical consultation %K obesity %K discrete choice experiments %K telehealth %K telemedicine %D 2024 %7 27.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Obesity is a unique chronic disease, with China having the largest number of people living with overweight and obesity in the world. There has been little research from the demand perspective for online medical consultation (OMC) by individuals living with obesity. With the growing demand for obesity OMC, especially due to the emergence of new pharmacotherapies, such as glucagon-like peptide-1 receptor agonists, individuals living with obesity are seeking both advice on obesity management and the prescription of obesity drugs. Therefore, our demand scenarios defined 2 OMC motivations to manage obesity: “For-Drugs” use and “For-Advice” use. Objective: This study aims to assess and compare the preferences for For-Drugs and For-Advice OMC among individuals living with obesity in China. Methods: Following the International Society for Pharmacoeconomics and Outcomes Research’s checklist and comprising 400 participants assigned to the For-Drugs scenario and 400 to the For-Advice scenario, the For-Drugs and For-Advice preferences were estimated through discrete choice experiments. The groups in the 2 scenarios followed a similar distribution, and the 2 different demand scenarios shared the same discrete choice experiment design, comprising 16 choice sets with 6 representative attributes. Mixed logit modeling was used to estimate the willingness to pay and relative importance scores. Results: Doctors with well-known and general expert titles, versus ordinary doctors; doctors from high-level, provincial, tertiary, and municipal hospitals, versus lower-level county hospitals; less waiting time; and lower OMC fees were preferred in both the For-Drugs and For-Advice scenarios. The differences between the 2 scenarios lay in the consultation format, consultation duration, and the relative importance of consultation duration versus waiting time. The For-Advice group preferred telephone consultations, while the For-Drugs group did not; the For-Drugs group preferred longer consultation duration (β=.029), while the For-Advice group preferred shorter consultation duration (β=–.030); and the For-Drugs group rated consultation duration higher than waiting time, while the For-Advice group rated the waiting time as more important than consultation duration. Combined with our qualitative research, the differences can be explained by the different consultation needs in the 2 scenarios, where longer patient consultations were preferred by the For-Drugs patients who sought detailed advice on drug side effects, while quick and direct responses were preferred by the For-Advice participants. Conclusions: By revealing user preferences on costs, doctors’ titles and hospital level, wait time, and consultation duration and format, our research informs OMC platforms, OMC regulators, and doctors on market segmentation and service differentiation strategies. %M 39602197 %R 10.2196/53140 %U https://www.jmir.org/2024/1/e53140 %U https://doi.org/10.2196/53140 %U http://www.ncbi.nlm.nih.gov/pubmed/39602197 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e57964 %T Experiences of a Digital Behavior Change Intervention to Prevent Weight Gain and Promote Risk-Reducing Health Behaviors for Women Aged 18 to 35 Years at Increased Risk of Breast Cancer: Qualitative Interview Study %A Hawkes,Rhiannon E %A Pegington,Mary %A Davies,Alan %A Mueller,Julia %A Howell,Anthony %A Evans,D Gareth %A Howell,Sacha J %A French,David P %A Harvie,Michelle %+ Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Coupland 1 Building, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 0161 275 2584, rhiannon.hawkes@manchester.ac.uk %K breast cancer %K health behavior %K weight gain %K weight control %K BMI %K app %K acceptability %K feasibility %D 2024 %7 25.11.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Breast cancer is the most common form of cancer in women. Adult weight gain and modifiable health behaviors, including smoking, alcohol intake, and lack of physical activity, are well-known risk factors. Most weight gain in women occurs between the ages of 18 and 35 years. Digital interventions have the potential to address logistical challenges that arise in reaching women in this age range. We designed a digital intervention targeting weight gain prevention and other modifiable health behaviors for young women at increased risk of breast cancer. Women aged 18 to 35 years were recruited to this single-arm intervention study over 2 months to test the acceptability and usability of the intervention, which comprised a group welcome event held via videoconferencing, app, and private Facebook group. Objective: This nested qualitative substudy explored women’s views and experiences of being part of the digital health intervention to inform future intervention development for a feasibility study. Methods: A total of 20 women aged 23 to 35 years who were at increased risk of breast cancer were interviewed via telephone within 1 month after completing the intervention, between February 2023 and March 2023. The women were asked about their experiences of the digital intervention and the extent to which it may have influenced their health behaviors. Data were analyzed thematically and organized using the framework approach. Results: The interviews lasted for a median of 37 (IQR 30-46) minutes. Overall, the women perceived the digital health intervention comprising education, tracking, and support to be acceptable for weight gain prevention. In total, 4 themes were generated. A “missed opportunity” in breast cancer prevention services encompasses the lack of services that currently exist for young women at increased risk of breast cancer. The pros and cons of being part of a community encompasses the divergent views that the women had regarding engaging with other women at increased risk. The importance of an interactive app focuses on features that the women would want from the app to promote engagement with the intervention. The different wants and needs of different age groups highlights that an intervention such as this one would need to be customizable to suit the needs of women at different life stages. Conclusions: There is an unmet need in prevention services for young women aged 18 to 35 years at increased risk of breast cancer. The women perceived the app to be an acceptable intervention for weight gain prevention but emphasized that the intervention would need to be customizable to meet the needs of different age groups within the group of women aged 18 to 35 years. The digital intervention could be a scalable behavior change strategy for UK family history clinics. %M 39586077 %R 10.2196/57964 %U https://cancer.jmir.org/2024/1/e57964 %U https://doi.org/10.2196/57964 %U http://www.ncbi.nlm.nih.gov/pubmed/39586077 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e60942 %T Whole-Body Cryotherapy Reduces Systemic Inflammation in Healthy Adults: Pilot Cohort Study %A Chun,Elizabeth %A Joseph,Richard %A Pojednic,Rachele %+ Stanford Lifestyle Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, 3180 Porter Drive, Palo Alto, CA, 94304, United States, 1 6178337372, rpojedni@stanford.edu %K cold therapy %K C-reactive protein %K fasting glucose %K HbA1c %K inflammation %K lipid metabolism %K whole-body cryotherapy %K cryotherapy %K retrospective %K reactive protein %K biomarker %K adult %K systemic inflammation %D 2024 %7 22.11.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Chronically elevated inflammation is implicated in many conditions, including obesity, metabolic syndrome, and cardiovascular disease, and has been associated with increased mortality risk. Whole-body cryotherapy (W-BC) is a promising modality to treat inflammation with demonstrated benefits for clinical subpopulations including those with arthritis, obesity, and type 2 diabetes. However, it is unclear whether the benefit from W-BC extends to healthy individuals prior to chronic disease–related inflammation. In addition, the long-term durability of W-BC effect is unknown. Objective: This study investigates the inflammatory response to W-BC in healthy adults with a biomarker of inflammation, high-sensitivity C-reactive protein (hsCRP), and clinical biomarkers of metabolism including fasting glucose, hemoglobin A1c (HbA1c), low-density lipoprotein (LDL) and high-density lipoprotein (HDL), and triglycerides. Methods: Fifteen individuals (n=9 female) participated in frequent recreational W-BC (3 minutes of cold exposure at –110 ℃) over approximately 9 months and had blood draws at baseline plus follow-up visits. Biomarkers were modeled as linear functions of W-BC sessions received in the month prior to blood draw. Results: The mean amount of W-BC received was 6.78 (SD 4.26) times per month with the cumulative total ranging from 13 to 157 W-BC sessions over the course of the study. On average, participants completed 1-2 sessions per week throughout the intervention. The number of W-BC sessions were associated with decreased hsCRP (–0.14 mg/L in hsCRP per W-BC session; P<.01) and with durability of up to 9 months. Increased W-BC was also associated with a downward trend in fasting glucose. This trend failed to reach significance at 1 month (–0.73 mg/dL in fasting glucose per W-BC session; P<.10) but was significant for 2- and 3-month windows (P<.05). HbA1c was increased significantly after 9 months (P<.01); however, the change occurred within normal ranges (difference=0.13% and <5.7%) and was not clinically significant. There was no association between W-BC and LDL cholesterol, HDL cholesterol, or triglycerides (P>.10), although LDL trended lower over the time period examined (P=.07). Conclusions: These results suggest that W-BC beneficially impacts systemic inflammation by lowering hsCRP levels in healthy individuals and may also have some modulating effect on fasting glucose. %M 39576692 %R 10.2196/60942 %U https://www.i-jmr.org/2024/1/e60942 %U https://doi.org/10.2196/60942 %U http://www.ncbi.nlm.nih.gov/pubmed/39576692 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55088 %T An Online Multimodal Food Data Exploration Platform for Specific Population Health: Development Study %A Yang,Lin %A Guo,Zhen %A Xu,Xiaowei %A Kang,Hongyu %A Lai,Jianqiang %A Li,Jiao %+ Institute of Medical Information and Library, Chinese Academy of Medical Sciences/Peking Union Medical College, No. 3, Yabao Rd, Chaoyang District, Beijing, 100020, China, 86 18618461596, li.jiao@imicams.ac.cn %K Chinese food data %K multimodal knowledge graph %K online platform %K population health promotion %K health promotion %K nutrients %K diet %K pregnant women %D 2024 %7 15.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Nutrient needs vary over the lifespan. Improving knowledge of both population groups and care providers can help with healthier food choices, thereby promoting population health and preventing diseases. Providing evidence-based food knowledge online is credible, low cost, and easily accessible. Objective: This study aimed to develop an online multimodal food data exploration platform for easy access to evidence-based diet- and nutrition-related data. Methods: We developed an online platform named Food Atlas in collaboration with a multidisciplinary expert group from the National Institute for Nutrition and Health and Peking Union Medical College Hospital in China. To demonstrate its feasibility for Chinese food for pregnant women, a user-friendly and high-quality multimodal food knowledge graph was constructed, and various interactions with graph-structured data were developed for easy access, including graph-based interactive visualizations, natural language retrieval, and image-text retrieval. Subsequently, we evaluated Food Atlas from both the system perspective and the user perspective. Results: The constructed multimodal food knowledge graph contained a total of 2011 entities, 10,410 triplets, and 23,497 images. Its schema consisted of 11 entity types and 26 types of semantic relations. Compared with 5 other online dietary platforms (Foodwake, Boohee, Xiachufang, Allrecipes, and Yummly), Food Atlas offers a distinct and comprehensive set of data content and system functions desired by target populations. Meanwhile, a total of 28 participants representing 4 different user groups were recruited to evaluate its usability: preparing for pregnancy (n=8), pregnant (n=12), clinicians (n=5), and dietitians (n=3). The mean System Usability Scale index of our platform was 82.5 (SD 9.94; range 40.0-82.5). This above-average usability score and the use cases indicated that Food Atlas is tailored to the needs of the target users. Furthermore, 96% (27/28) of the participants stated that the platform had high consistency, illustrating the necessity and effectiveness of health professionals participating in online, evidence-based resource development. Conclusions: This study demonstrates the development of an online multimodal food data exploration platform and its ability to meet the rising demand for accessible, credible, and appropriate evidence-based online dietary resources. Further research and broader implementation of such platforms have the potential to popularize knowledge, thereby helping populations at different life stages make healthier food choices. %M 39547662 %R 10.2196/55088 %U https://formative.jmir.org/2024/1/e55088 %U https://doi.org/10.2196/55088 %U http://www.ncbi.nlm.nih.gov/pubmed/39547662 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51432 %T Advancements in Using AI for Dietary Assessment Based on Food Images: Scoping Review %A Chotwanvirat,Phawinpon %A Prachansuwan,Aree %A Sridonpai,Pimnapanut %A Kriengsinyos,Wantanee %+ Human Nutrition Unit, Food and Nutrition Academic and Research Cluster, Institute of Nutrition, Mahidol University, 999 Phutthamonthon 4 Rd., Salaya, Nakhon Pathom, 73170, Thailand, 66 2 800 2380, wantanee.krieng@mahidol.ac.th %K image-assisted dietary assessment %K artificial intelligence %K dietary assessment %K mobile phone %K food intake %K image recognition %K portion size %D 2024 %7 15.11.2024 %9 Review %J J Med Internet Res %G English %X Background: To accurately capture an individual’s food intake, dietitians are often required to ask clients about their food frequencies and portions, and they have to rely on the client’s memory, which can be burdensome. While taking food photos alongside food records can alleviate user burden and reduce errors in self-reporting, this method still requires trained staff to translate food photos into dietary intake data. Image-assisted dietary assessment (IADA) is an innovative approach that uses computer algorithms to mimic human performance in estimating dietary information from food images. This field has seen continuous improvement through advancements in computer science, particularly in artificial intelligence (AI). However, the technical nature of this field can make it challenging for those without a technical background to understand it completely. Objective: This review aims to fill the gap by providing a current overview of AI’s integration into dietary assessment using food images. The content is organized chronologically and presented in an accessible manner for those unfamiliar with AI terminology. In addition, we discuss the systems’ strengths and weaknesses and propose enhancements to improve IADA’s accuracy and adoption in the nutrition community. Methods: This scoping review used PubMed and Google Scholar databases to identify relevant studies. The review focused on computational techniques used in IADA, specifically AI models, devices, and sensors, or digital methods for food recognition and food volume estimation published between 2008 and 2021. Results: A total of 522 articles were initially identified. On the basis of a rigorous selection process, 84 (16.1%) articles were ultimately included in this review. The selected articles reveal that early systems, developed before 2015, relied on handcrafted machine learning algorithms to manage traditional sequential processes, such as segmentation, food identification, portion estimation, and nutrient calculations. Since 2015, these handcrafted algorithms have been largely replaced by deep learning algorithms for handling the same tasks. More recently, the traditional sequential process has been superseded by advanced algorithms, including multitask convolutional neural networks and generative adversarial networks. Most of the systems were validated for macronutrient and energy estimation, while only a few were capable of estimating micronutrients, such as sodium. Notably, significant advancements have been made in the field of IADA, with efforts focused on replicating humanlike performance. Conclusions: This review highlights the progress made by IADA, particularly in the areas of food identification and portion estimation. Advancements in AI techniques have shown great potential to improve the accuracy and efficiency of this field. However, it is crucial to involve dietitians and nutritionists in the development of these systems to ensure they meet the requirements and trust of professionals in the field. %M 39546777 %R 10.2196/51432 %U https://www.jmir.org/2024/1/e51432 %U https://doi.org/10.2196/51432 %U http://www.ncbi.nlm.nih.gov/pubmed/39546777 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58363 %T A Novel Web App for Dietary Weight Management: Development, Implementation, and Usability Study %A Oliveira,Ashleigh %A Wolff,John %A Alfouzan,Nouf %A Yu,Jin %A Yahya,Asma %A Lammy,Kayla %A Nakamura,Manabu T %+ Division of Nutritional Sciences, University of Illinois at Urbana Champaign, 905 S Goodwin Ave, Urbana, IL, 61801, United States, 1 217 333 1267, oliveira.ashleigh@gmail.com %K health application %K weight loss %K behavior change technique %K BCT %K online weight loss program %K weight monitoring %K meal planning %K sustainable weight loss %K dietary fiber %K mHealth %K mobile health %D 2024 %7 11.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Online weight loss programs have ambiguous efficacy. There is a growing body of evidence that weight loss programs when combined with apps have better outcomes; however, many apps lack an evidence-based approach to dietary changes for weight loss and do not rely on a theoretical framework for behavior change. Objective: This study aimed to describe the development and the preliminary usability and acceptability testing of a web app that uses behavior change techniques (BCTs) to support users of a comprehensive online weight loss program. Methods: The weight loss program intervention components were nutrient and weight tracking charts that needed a remotely accessible and online format. The app was designed by nutrition researchers and developers in a collaborative effort. A review of BCTs in weight loss and web apps was performed as well as an assessment of user needs to inform the initial prototype. A preliminary app prototype, version 1.0, was provided to participants of a weight loss trial (N=30) to assess for feasibility of its use. A full app prototype, version 2.0, was feasibility and acceptability tested by trial participants (n=11) with formal feedback by Likert-scale survey and open-ended questions. In the final round of testing, a user group of scientists and developers (n=11) was selected to provide a structured 3-month review through which the group met weekly for collective feedback sessions. Results: The process resulted in a fully developed web app, MealPlot, by the Applied Research Institute, for meal planning and weight tracking that can be used by weight loss users and health professionals to track their patients. MealPlot includes a weight chart, a protein-fiber chart, and a chat feature. In addition, MealPlot has 2 distinct platforms, 1 for weight loss users and 1 for health professionals. Selected BCTs for incorporation into the app were goal setting, feedback, problem-solving, self-monitoring, and social support. Version 1.0 was used successfully to provide a functioning, online weight chart over the course of a 1-year trial. Version 2.0 provided a functional weight chart and meal planning page, but 8 out of 11 participants indicated MealPlot was difficult to use. Version 3.0 was developed based on feedback and strategies provided from user group testing. Conclusions: The web app, MealPlot, was developed to improve outcomes and functionality of an online weight loss program by providing a remote method of tracking weight, food intake, and connecting users to health professionals for consistent guidance that is not otherwise available in a traditional in-person health care setting. The final version 3.0 of the web app will be refined based on findings of a review study gathering feedback from health professionals and from actual weight loss users who are part of a clinical weight loss trial. %M 39527795 %R 10.2196/58363 %U https://formative.jmir.org/2024/1/e58363 %U https://doi.org/10.2196/58363 %U http://www.ncbi.nlm.nih.gov/pubmed/39527795 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e65440 %T Multifactor Quality and Safety Analysis of Semaglutide Products Sold by Online Sellers Without a Prescription: Market Surveillance, Content Analysis, and Product Purchase Evaluation Study %A Ashraf,Amir Reza %A Mackey,Tim Ken %A Vida,Róbert György %A Kulcsár,Győző %A Schmidt,János %A Balázs,Orsolya %A Domián,Bálint Márk %A Li,Jiawei %A Csákó,Ibolya %A Fittler,András %+ Department of Pharmaceutics, Faculty of Pharmacy, University of Pécs, Rókus str. 4., Pécs, H-7624, Hungary, 36 (72) 503 650 ext 28841, ashraf.amir.reza@pte.hu %K semaglutide %K Ozempic %K Wegovy %K search engines %K online pharmacies %K patient safety %K medication safety %K nondelivery schemes %K counterfeit %K substandard and falsified medical products %D 2024 %7 7.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Over the past 4 decades, obesity has escalated into a global epidemic, with its worldwide prevalence nearly tripling. Pharmacological treatments have evolved with the recent development of glucagon-like peptide 1 agonists, such as semaglutide. However, off-label use of drugs such as Ozempic for cosmetic weight loss has surged in popularity, raising concerns about potential misuse and the emergence of substandard and falsified products in the unregulated supply chain. Objective: This study aims to conduct a multifactor investigation of product quality and patient safety risks associated with the unregulated online sale of semaglutide by examining product availability and vendor characteristics and assessing product quality through test purchases. Methods: We used a complex risk and quality assessment methodology combining online market surveillance, search engine results page analysis, website content assessment, domain traffic analytics, conducting targeted product test purchases, visual quality inspection of product packaging, microbiological sterility and endotoxin contamination evaluation, and quantitative sample analysis using liquid chromatography coupled with mass spectrometry. Results: We collected and evaluated 1080 links from search engine results pages and identified 317 (29.35%) links belonging to online pharmacies, of which 183 (57.7%) led to legal pharmacies and 134 (42.3%) directed users to 59 unique illegal online pharmacy websites. Web traffic data for the period between July and September 2023 revealed that the top 30 domains directly or indirectly affiliated with illegal online pharmacies accumulated over 4.7 million visits. Test purchases were completed from 6 illegal online pharmacies with the highest number of links offering semaglutide products for sale without prescription at the lowest price range. Three injection vial purchases were delivered; none of the 3 Ozempic prefilled injection pens were received due to nondelivery e-commerce scams. All purchased vials were considered probable substandard and falsified products, as visual inspection indicated noncompliance in more than half (59%-63%) of the evaluated criteria. The semaglutide content of samples substantially exceeded labeled amounts by 28.56%-38.69%, although no peptide-like impurities were identified. The lyophilized peptide samples were devoid of viable microorganisms at the time of testing; however, endotoxin was detected in all samples with levels ranging between 2.1645 EU/mg and 8.9511 EU/mg. Furthermore, the measured semaglutide purity was significantly low, ranging between 7.7% and 14.37% and deviating from the 99% claimed on product labels by manufacturers. Conclusions: Glucagon-like peptide 1 agonist drugs promoted for weight loss, similar to erectile dysfunction medications more than 2 decades ago, are becoming the new blockbuster lifestyle medications for the illegal online pharmacy market. Protecting the pharmaceutical supply chain from substandard and falsified weight loss products and raising awareness regarding online medication safety must be a public health priority for regulators and technology platforms alike. %M 39509151 %R 10.2196/65440 %U https://www.jmir.org/2024/1/e65440 %U https://doi.org/10.2196/65440 %U http://www.ncbi.nlm.nih.gov/pubmed/39509151 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57509 %T Multidimensional School-Based and Family-Involved Interventions to Promote a Healthy and Sustainable Lifestyle (LIVELY) for Childhood Obesity Prevention: Study Protocol %A Basilico,Sara %A Conti,Maria Vittoria %A Ardoino,Ilaria %A Breda,Chiara %A Loperfido,Federica %A Klaic,Elena %A Spialtini,Linda %A Foresta,Andreana %A Orsini,Francesca %A Ojeda Fernandez,Maria Luisa %A Conca Bonizzoni,Stefano %A Modena,Elisabetta %A Tootoonchi Hamedani,Yasamin %A Villa,Federica %A Cena,Hellas %A Baviera,Marta %A Franchi,Carlotta %+ Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Agostino Bassi 21, Pavia, 27100, Italy, 39 0382987536, sara.basilico01@universitadipavia.it %K childhood obesity %K school education %K family education %K healthy lifestyle %K sustainability %K primary prevention %K nutritional intervention %K physical activity %K community engagement %K lifestyle habits %K socio-economic status %K LIVELY study %D 2024 %7 30.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Childhood obesity has become a significant public health concern over the past 2 decades, posing multifactorial challenges, including modifiable factors like dietary habits, physical activity, screen time, and sleeping habits. Prevention efforts require a comprehensive approach comprising educational interventions, collaboration among multidisciplinary teams, and community engagement. Since schools play a central role in children's lives, they are the ideal setting for promoting healthy habits. Objective: The LIVELY (Multidimensional School-Based and Family-Involved Interventions to Promote a Healthy and Sustainable Lifestyle) study will assess the prevalence of overweight and obesity in primary school children and identify contributing factors within families. Additionally, it aims to implement and evaluate a multidimensional, multidisciplinary intervention to foster a sustainable and healthy lifestyle, ultimately working toward preventing obesity in school-aged children. Methods: During the school year, each class will be individually involved in a multidimensional educational intervention covering the topics of healthy, sustainable nutrition and lifestyle. Children will also participate in a multimedia lab where they will create an animated cartoon. The lectures will engage them through various methods, including direct instructions, games, and drawing activities, to stimulate and enhance their learning and involvement. Results: Data collection began in October 2023 and will last until the end of October 2024. A sample of 227 children from 14 classes was included in the study. The mean age was 8.9 (SD 1.2) years, and 48% (n=110) were males. Among the overall sample, 18.1% (n=41; 95% CI 13.7%-23.7%) were overweight, while 5.3% (n=12; 95% CI 3%-9%) had obesity. Males had a higher prevalence of obesity than females (9.1%, n=10 vs 1.7%, n=3, P=.03, respectively). Otherwise, the prevalence of central obesity was similar between the two (P=.329). Data analysis and the presentation of the complete results will be available after the end of 2024. Conclusions: The study could lead to the structuring of an educational intervention model in school settings aimed at preventing childhood obesity. Moreover, it could help raise awareness of childhood obesity and help prevent this public health issue. Trial Registration: ClinicalTrials.gov NCT05966051; https://clinicaltrials.gov/study/NCT05966051 International Registered Report Identifier (IRRID): DERR1-10.2196/57509 %M 39475855 %R 10.2196/57509 %U https://www.researchprotocols.org/2024/1/e57509 %U https://doi.org/10.2196/57509 %U http://www.ncbi.nlm.nih.gov/pubmed/39475855 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52142 %T Exploring Public Emotions on Obesity During the COVID-19 Pandemic Using Sentiment Analysis and Topic Modeling: Cross-Sectional Study %A Correia,Jorge César %A Ahmad,Sarmad Shaharyar %A Waqas,Ahmed %A Meraj,Hafsa %A Pataky,Zoltan %+ Unit of Therapeutic Patient Education, WHO Collaborating Center, University Hospitals of Geneva and University of Geneva, Chemin Venel 7, Geneva, 1206, Switzerland, 41 (0)22 372 9722, JorgeCesar.Correia@hcuge.ch %K obesity %K Twitter %K infodemic %K attitude %K opinion %K perception %K perspective %K obese %K weight %K overweight %K social media %K tweet %K sentiment %K topic modeling %K BERT %K Bidirectional Encoder Representations from Transformers %K NLP %K natural language processing %K general public %K celebrities %D 2024 %7 11.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Obesity is a chronic, multifactorial, and relapsing disease, affecting people of all ages worldwide, and is directly related to multiple complications. Understanding public attitudes and perceptions toward obesity is essential for developing effective health policies, prevention strategies, and treatment approaches. Objective: This study investigated the sentiments of the general public, celebrities, and important organizations regarding obesity using social media data, specifically from Twitter (subsequently rebranded as X). Methods: The study analyzes a dataset of 53,414 tweets related to obesity posted on Twitter during the COVID-19 pandemic, from April 2019 to December 2022. Sentiment analysis was performed using the XLM-RoBERTa-base model, and topic modeling was conducted using the BERTopic library. Results: The analysis revealed that tweets regarding obesity were predominantly negative. Spikes in Twitter activity correlated with significant political events, such as the exchange of obesity-related comments between US politicians and criticism of the United Kingdom’s obesity campaign. Topic modeling identified 243 clusters representing various obesity-related topics, such as childhood obesity; the US President’s obesity struggle; COVID-19 vaccinations; the UK government’s obesity campaign; body shaming; racism and high obesity rates among Black American people; smoking, substance abuse, and alcohol consumption among people with obesity; environmental risk factors; and surgical treatments. Conclusions: Twitter serves as a valuable source for understanding obesity-related sentiments and attitudes among the public, celebrities, and influential organizations. Sentiments regarding obesity were predominantly negative. Negative portrayals of obesity by influential politicians and celebrities were shown to contribute to negative public sentiments, which can have adverse effects on public health. It is essential for public figures to be mindful of their impact on public opinion and the potential consequences of their statements. %M 39393064 %R 10.2196/52142 %U https://www.jmir.org/2024/1/e52142 %U https://doi.org/10.2196/52142 %U http://www.ncbi.nlm.nih.gov/pubmed/39393064 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e57803 %T National Trends in the Prevalence of Self-Perceived Overweight Among Adolescents Between 2005 and 2022: Nationwide Representative Study %A Jeong,Jinyoung %A Lee,Seungjun %A Lee,Kyeongmin %A Kim,Seokjun %A Park,Jaeyu %A Son,Yejun %A Lee,Hyeri %A Lee,Hayeon %A Kang,Jiseung %A Rahmati,Masoud %A Pizzol,Damiano %A Smith,Lee %A López Sánchez,Guillermo F %A Dragioti,Elena %A Fond,Guillaume %A Boyer,Laurent %A Woo,Selin %A Rhee,Sang Youl %A Yon,Dong Keon %+ Department of Medicine, Kyung Hee University College of Medicine, 26, Kyungheedae-ro, Seoul, 02447, Republic of Korea, 82 2 6935 2476, yonkkang@gmail.com %K self-perceived overweight %K trend %K prevalence %K South Korea %K adolescent %D 2024 %7 9.10.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Despite several studies on self-evaluation of health and body shape, existing research on the risk factors of self-perceived overweight is insufficient, especially during the COVID-19 pandemic. Objective: This study aims to identify the risk factors affecting self-perceived overweight and examine how the prevalence of self-perceived overweight has changed before and during the COVID-19 pandemic. Specifically, we analyzed the impact of altered lifestyles due to COVID-19 on this phenomenon. Methods: The data used in the study were obtained from middle and high school students who participated in the Korean Youth Risk Behavior Web-based Survey (N=1,189,586). This survey was a 2-stage stratified cluster sampling survey representative of South Korean adolescents. We grouped the survey results by year and estimated the slope in the prevalence of self-perceived overweight before and during the pandemic using weighted linear regression, as well as the prevalence tendencies of self-perceived overweight according to various risk factors. We used prevalence ratios to identify the risk factors for self-perceived overweight. In addition, we conducted comparisons of risk factors in different periods to identify their associations with the COVID-19 pandemic. Results: The prevalence of self-perceived overweight was much higher than BMI-based overweight among 1,189,586 middle and high school participants (grade 7-12) from 2005 to 2022 (female participants: n=577,102, 48.51%). From 2005 to 2019 (prepandemic), the prevalence of self-perceived overweight increased (β=2.80, 95% CI 2.70-2.90), but from 2020 to 2022 (pandemic) it decreased (β=–0.53, 95% CI –0.74 to –0.33). During the pandemic, individuals with higher levels of stress or lower household economic status exhibited a more substantial decrease in the rate of self-perceived overweight. The prevalence of self-perceived overweight tended to be higher among individuals with poor academic performance, lower economic status, poorer subjective health, and a higher stress level. Conclusions: Our nationwide study, conducted over 18 years, indicated that self-perceived overweight decreased during the COVID-19 period while identifying low academic performance and economic status as risk factors. These findings suggest the need for policies and facilities to address serious dieting and body dissatisfaction resulting from self-perceived overweight by developing counseling programs for adolescents with risk factors such as lower school performance and economic status. %M 39382947 %R 10.2196/57803 %U https://publichealth.jmir.org/2024/1/e57803 %U https://doi.org/10.2196/57803 %U http://www.ncbi.nlm.nih.gov/pubmed/39382947 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63858 %T Supporting Weight Loss Among Parents of Children With a Disability: Lessons Learned From a Single-Arm Pilot Study %A Wisniewski,Payson %A Depuy,Julia %A Kim,Cassandra %A Garrison,Olivia %A Jerome,Gerald J %+ Department of Kinesiology, Towson University, 8000 York Road, Towson, MD, 21252, United States, 1 4107045283, gjerome@towson.edu %K weight loss %K obesity %K disability %K parent %K family %K child %K weight loss intervention %D 2024 %7 7.10.2024 %9 Research Letter %J JMIR Form Res %G English %X This study assessed weight change in the parents of children with disabilities following a 12-week, remotely delivered weight loss program focused on lifestyle modifications and found a significant median weight reduction of 3 kg from baseline to week 12. %M 39374058 %R 10.2196/63858 %U https://formative.jmir.org/2024/1/e63858 %U https://doi.org/10.2196/63858 %U http://www.ncbi.nlm.nih.gov/pubmed/39374058 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e60361 %T Neural Conversational Agent for Weight Loss Counseling: Protocol for an Implementation and Feasibility Study %A Kotov,Alexander %A Idalski Carcone,April %A Towner,Elizabeth %+ Department of Computer Science, College of Engineering, Wayne State University, Suite 14001.6, 5057 Woodward Ave, Detroit, MI, 48202, United States, 1 3135779307, kotov@wayne.edu %K conversational agents %K artificial intelligence %K behavior change %K weight loss %K obesity %K motivational interviewing %K web-based application %K deep learning %K transformers %K large language models %K feasibility study %D 2024 %7 20.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Obesity is a common, serious and costly chronic disease. Current clinical practice guidelines recommend that providers augment the longitudinal care of people living with obesity with consistent support for the development of self-efficacy and motivation to modify their lifestyle behaviors. Lifestyle behavior change aligns with the goals of motivational interviewing (MI), a client-centered yet directive counseling modality. However, training health care providers to be proficient in MI is expensive and time-consuming, resulting in a lack of trained counselors and limiting the widespread adoption of MI in clinical practice. Artificial intelligence (AI) counselors accessible via the internet can help circumvent these barriers. Objective: The primary objective is to explore the feasibility of conducting unscripted MI-consistent counseling using Neural Agent for Obesity Motivational Interviewing (NAOMI), a large language model (LLM)–based web app for weight loss counseling. The secondary objectives are to test the acceptability and usability of NAOMI’s counseling and examine its ability to shift motivational precursors in a sample of patients with overweight and obesity recruited from primary care clinics. Methods: NAOMI will be developed based on recent advances in deep learning in four stages. In stages 1 and 2, NAOMI will be implemented using an open-source foundation LLM and (1) few-shot learning based on a prompt with task-specific instructions and (2) domain adaptation strategy based on fine-tuning LLM using a large corpus of general psychotherapy and MI treatment transcripts. In stages 3 and 4, we will refine the best of these 2 approaches. Each NAOMI version will be evaluated using a mixed methods approach in which 10 adults (18-65 years) meeting the criteria for overweight or obesity (25.0≥BMI≤39.9) interact with NAOMI and provide feedback. NAOMI’s fidelity to the MI framework will be assessed using the Motivational Interviewing Treatment Integrity scale. Participants’ general perceptions of AI conversational agents and NAOMI specifically will be assessed via Pre- and Post-Interaction Questionnaires. Motivational precursors, such as participants’ confidence, importance, and readiness for changing lifestyle behaviors (eg, diet and activity), will be measured before and after the interaction, and 1 week later. A qualitative analysis of changes in the measures of perceptions of AI agents and counselors and motivational precursors will be performed. Participants will rate NAOMI’s usability and empathic skills post interaction via questionnaire-based assessments along with providing feedback about their experience with NAOMI via a qualitative interview. Results: NAOMI (version 1.0) has been developed. Participant recruitment will commence in September 2024. Data collection activities are expected to conclude in May 2025. Conclusions: If proven effective, LLM-based counseling agents can become a cost-effective approach for addressing the obesity epidemic at a public health level. They can also have a broad, transformative impact on the delivery of MI and other psychotherapeutic treatment modalities extending their reach and broadening access. International Registered Report Identifier (IRRID): PRR1-10.2196/60361 %M 39303273 %R 10.2196/60361 %U https://www.researchprotocols.org/2024/1/e60361 %U https://doi.org/10.2196/60361 %U http://www.ncbi.nlm.nih.gov/pubmed/39303273 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56962 %T A Clinician and Electronic Health Record Wearable Device Intervention to Increase Physical Activity in Patients With Obesity: Formative Qualitative Study %A Ayyaswami,Varun %A Subramanian,Jeevarathna %A Nickerson,Jenna %A Erban,Stephen %A Rosano,Nina %A McManus,David D %A Gerber,Ben S %A Faro,Jamie M %+ Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States, 1 508 856 3898 ext 63898, varun.ayyaswami@umassmed.edu %K remote patient monitoring %K physical activity %K electronic health record %K wearable device %K patient monitoring %K health monitoring %K health monitor %K patient monitor %K remote patient monitor %K exercise %K exercises %K electronic health records %K patient record %K health record %K health records %K wearable devices %D 2024 %7 2.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The number of individuals using digital health devices has grown in recent years. A higher rate of use in patients suggests that primary care providers (PCPs) may be able to leverage these tools to effectively guide and monitor physical activity (PA) for their patients. Despite evidence that remote patient monitoring (RPM) may enhance obesity interventions, few primary care practices have implemented programs that use commercial digital health tools to promote health or reduce complications of the disease. Objective: This formative study aimed to assess the perceptions, needs, and challenges of implementation of an electronic health record (EHR)–integrated RPM program using wearable devices to promote patient PA at a large urban primary care practice to prepare for future intervention. Methods: Our team identified existing workflows to upload wearable data to the EHR (Epic Systems), which included direct Fitbit (Google) integration that allowed for patient PA data to be uploaded to the EHR. We identified pictorial job aids describing the clinical workflow to PCPs. We then performed semistructured interviews with PCPs (n=10) and patients with obesity (n=8) at a large urban primary care clinic regarding their preferences and barriers to the program. We presented previously developed pictorial aids with instructions for (1) providers to complete an order set, set step-count goals, and receive feedback and (2) patients to set up their wearable devices and connect them to their patient portal account. We used rapid qualitative analysis during and after the interviews to code and develop key themes for both patients and providers that addressed our research objective. Results: In total, 3 themes were identified from provider interviews: (1) providers’ knowledge of PA prescription is focused on general guidelines with limited knowledge on how to tailor guidance to patients, (2) providers were open to receiving PA data but were worried about being overburdened by additional patient data, and (3) providers were concerned about patients being able to equitably access and participate in digital health interventions. In addition, 3 themes were also identified from patient interviews: (1) patients received limited or nonspecific guidance regarding PA from providers and other resources, (2) patients want to share exercise metrics with the health care team and receive tailored PA guidance at regular intervals, and (3) patients need written resources to support setting up an RPM program with access to live assistance on an as-needed basis. Conclusions: Implementation of an EHR-based RPM program and associated workflow is acceptable to PCPs and patients but will require attention to provider concerns of added burdensome patient data and patient concerns of receiving tailored PA guidance. Our ongoing work will pilot the RPM program and evaluate feasibility and acceptability within a primary care setting. %M 39221852 %R 10.2196/56962 %U https://formative.jmir.org/2024/1/e56962 %U https://doi.org/10.2196/56962 %U http://www.ncbi.nlm.nih.gov/pubmed/39221852 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59227 %T Effects of Defatted Rice Bran–Fortified Bread on the Gut Microbiota Composition of Healthy Adults With Low Dietary Fiber Intake: Protocol for a Crossover Randomized Controlled Trial %A Ng,Hwei Min %A Maggo,Jasjot %A Wall,Catherine Louisa %A Bayer,Simone Brigit %A McNabb,Warren C %A Mullaney,Jane Adair %A Foster,Meika %A Cabrera,Diana L %A Fraser,Karl %A Cooney,Janine %A Trower,Tania %A Günther,Catrin S %A Frampton,Chris %A Gearry,Richard Blair %A Roy,Nicole Clemence %+ Department of Human Nutrition, University of Otago, 362 Leith Street, Dunedin North, Dunedin, 9016, New Zealand, 64 4797000, nicole.roy@otago.ac.nz %K dietary fiber %K defatted rice bran %K bread %K healthy adults %K gut microbiota %K metabolites %K gut physiome %K randomized controlled trial %K mobile phone %D 2024 %7 29.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Inadequate dietary fiber (DF) intake is associated with several human diseases. Bread is commonly consumed, and its DF content can be increased by incorporating defatted rice bran (DRB). Objective: This first human study on DRB-fortified bread primarily aims to assess the effect of DRB-fortified bread on the relative abundance of a composite of key microbial genera and species in fecal samples. Secondary outcomes include clinical (cardiovascular risk profile), patient-reported (daily bread consumption and bowel movement, gut comfort, general well-being, and total DF intake), biological (fecal microbiota gene abundances, and fecal and plasma metabolites), and physiome (whole-gut and regional transit time and gas fermentation profiles) outcomes in healthy adults with low DF intake. Methods: This is a 2-armed, placebo-controlled, double-blinded, crossover randomized controlled trial. The study duration is 14 weeks: 2 weeks of lead-in, 4 weeks of intervention per phase, 2 weeks of washout, and 2 weeks of follow-up. Overall, 60 healthy adults with low DF intake (<18 g [female individuals] or <22 g [male individuals] per day) were recruited in Christchurch, New Zealand, between June and December 2022. Randomly assigned participants consumed 3 (female individuals) or 4 (male individuals) slices of DRB-fortified bread per day and then placebo bread, and vice versa. The DRB-fortified bread provided 8 g (female individuals) or 10.6 g (male individuals) of total DF, whereas the placebo (a matched commercial white toast bread) provided 2.7 g (female individuals) or 3.6 g (male individuals) of total DF. Before and after each intervention phase, participants provided fecal and blood samples to assess biological responses; completed a 3-day food diary to assess usual intakes and web-based questionnaires to assess gut comfort, general and mental well-being, daily bread intake, and bowel movement via an app; underwent anthropometry and blood pressure measurements; and drank blue food dye to assess whole-gut transit time. Additionally, 25% (15/60) of the participants ingested Atmo gas-sensing capsules to assess colonic gas fermentation profile and whole-gut and regional transit time. Mean differences from baseline will be compared between the DRB and placebo groups, as well as within groups (after the intervention vs baseline). For metabolome analyses, comparisons will be made within and between groups using postintervention values. Results: Preliminary analysis included 56 participants (n=33, 59% female; n=23, 41% male). Due to the large dataset, data analysis was planned to be fully completed by the last quarter of 2024, with full results expected to be published in peer-reviewed journals by the end of 2024. Conclusions: This first human study offers insights into the prospect of consuming DRB-fortified bread to effectively modulate health-promoting gut microbes, their metabolism, and DF intake in healthy adults with low DF intake. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12622000884707; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=383814 International Registered Report Identifier (IRRID): DERR1-10.2196/59227 %M 39207833 %R 10.2196/59227 %U https://www.researchprotocols.org/2024/1/e59227 %U https://doi.org/10.2196/59227 %U http://www.ncbi.nlm.nih.gov/pubmed/39207833 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e56035 %T Establishment and Evaluation of a Noninvasive Metabolism-Related Fatty Liver Screening and Dynamic Monitoring Model: Cross-Sectional Study %A Ni,Jiali %A Huang,Yong %A Xiang,Qiangqiang %A Zheng,Qi %A Xu,Xiang %A Qin,Zhiwen %A Sheng,Guoping %A Li,Lanjuan %+ State Key Laboratory for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd, Hangzhou, 310058, China, 86 571 87236458, ljli@zju.edu.cn %K metabolic-associated fatty liver disease %K nonalcoholic fatty liver disease %K nonalcoholic steatohepatitis %K body fat mass %K waist-height ratio %K basal metabolic rate %K liver %D 2024 %7 22.8.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Metabolically associated fatty liver disease (MAFLD) insidiously affects people's health, and many models have been proposed for the evaluation of liver fibrosis. However, there is still a lack of noninvasive and sensitive models to screen MAFLD in high-risk populations. Objective: The purpose of this study was to explore a new method for early screening of the public and establish a home-based tool for regular self-assessment and monitoring of MAFLD. Methods: In this cross-sectional study, there were 1758 eligible participants in the training set and 200 eligible participants in the testing set. Routine blood, blood biochemistry, and FibroScan tests were performed, and body composition was analyzed using a body composition instrument. Additionally, we recorded multiple factors including disease-related risk factors, the Forns index score, the hepatic steatosis index (HSI), the triglyceride glucose index, total body water (TBW), body fat mass (BFM), visceral fat area, waist-height ratio (WHtR), and basal metabolic rate. Binary logistic regression analysis was performed to explore the potential anthropometric indicators that have a predictive ability to screen for MAFLD. A new model, named the MAFLD Screening Index (MFSI), was established using binary logistic regression analysis, and BFM, WHtR, and TBW were included. A simple rating table, named the MAFLD Rating Table (MRT), was also established using these indicators. Results: The performance of the HSI (area under the curve [AUC]=0.873, specificity=76.8%, sensitivity=81.4%), WHtR (AUC=0.866, specificity=79.8%, sensitivity=80.8%), and BFM (AUC=0.842, specificity=76.9%, sensitivity=76.2%) in discriminating between the MAFLD group and non-fatty liver group was evaluated (P<.001). The AUC of the combined model including WHtR, HSI, and BFM values was 0.900 (specificity=81.8%, sensitivity=85.6%; P<.001). The MFSI was established based on better performance at screening MAFLD patients in the training set (AUC=0.896, specificity=83.8%, sensitivity=82.1%) and was confirmed in the testing set (AUC=0.917, specificity=89.8%, sensitivity=84.4%; P<.001). Conclusions: The novel MFSI model was built using WHtR, BFM, and TBW to screen for early MAFLD. These body parameters can be easily obtained using a body fat scale at home, and the mobile device software can record specific values and perform calculations. MFSI had better performance than other models for early MAFLD screening. The new model showed strong power and stability and shows promise in the area of MAFLD detection and self-assessment. The MRT was a practical tool to assess disease alterations in real time. %M 39172506 %R 10.2196/56035 %U https://www.i-jmr.org/2024/1/e56035 %U https://doi.org/10.2196/56035 %U http://www.ncbi.nlm.nih.gov/pubmed/39172506 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e54302 %T Association of Cellulitis With Obesity: Systematic Review and Meta-Analysis %A Taira,Kimi Gabriella %A Wang,Madelyn %A Guo,William %A Kam,Olivia %A Kaufmann,Tara %+ Mayo Clinic School of Graduate Medical Education, Siebens Building, Floor 12, 200 First Street SW, Rochester, MN, 55905, United States, 1 6314444200, taira.kimi@mayo.edu %K cellulitis %K obesity %K overweight %K systematic review %K meta-analysis %K skin infection %K body mass index %K BMI %D 2024 %7 20.8.2024 %9 Review %J JMIR Dermatol %G English %X Background: Cellulitis is a bacterial skin infection that tends to recur. Previous studies have identified several risk factors that may contribute to its pathogenesis. Obesity is an increasingly prevalent worldwide disease that has been associated with skin and soft tissue infections. Objective: The aim of our systematic review and meta-analysis was to investigate the association of cellulitis with obesity. Methods: The Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science databases were searched for the relevant studies from the inception of each respective database to March 13, 2021. Case-control, cross-sectional, or cohort studies that examined the odds or risk of increased BMI in patients with cellulitis were included. This study was carried out in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The Newcastle-Ottawa scale (NOS) was used to evaluate the risk of bias in included studies. Results: In total, 9 case-control studies were included in our quantitative meta-analysis with a total of 68,148 study participants. A significant association was found between cellulitis and obesity (pooled odds ratio [OR] 2.67, 95% CI 1.91-3.71). No significant association was observed between cellulitis and being overweight (pooled OR 1.69, 95% CI 0.99-2.88). Patients with cellulitis were also found to have 1.63-fold increased odds of being male (pooled OR 1.63, 95% CI 1.12-2.38). Conclusions: Our findings suggest that cellulitis is significantly associated with obesity. Maintaining a healthy BMI may be indicated for patients presenting with cellulitis. %M 39163102 %R 10.2196/54302 %U https://derma.jmir.org/2024/1/e54302 %U https://doi.org/10.2196/54302 %U http://www.ncbi.nlm.nih.gov/pubmed/39163102 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e50143 %T Nutrition, Obesity, and Seborrheic Dermatitis: Systematic Review %A Woolhiser,Emily %A Keime,Noah %A Patel,Arya %A Weber,Isaac %A Adelman,Madeline %A Dellavalle,Robert P %+ Department of Dermatology, University of Minnesota, 420 Delaware St SE, Minneapolis, MN, 55455, United States, 1 7208480500, robert.dellavalle@cuanschutz.edu %K seborrheic dermatitis %K systematic review %K diet %K nutritional supplements %K alcohol %K BMI %K body mass index %K skin %K review methods %K review methodology %K nutrition %K nutritional %K supplement %K supplements %K dermatology %K dermatitis %K skin %K nutrient %K nutrients %K micronutrient %K micronutrients %K vitamin %K vitamins %K mineral %K minerals %K obesity %K obese %K weight %D 2024 %7 5.8.2024 %9 Review %J JMIR Dermatol %G English %X Background: Pathogenesis of seborrheic dermatitis involves lipid secretion by sebaceous glands, Malassezia colonization, and an inflammatory response with skin barrier disruption. Each of these pathways could be modulated by diet, obesity, and nutritional supplements. Current treatment options provide only temporary control of the condition; thus, it is essential to recognize modifiable lifestyle factors that may play a role in determining disease severity. Objective: This study aimed to summarize published evidence on diet, nutritional supplements, alcohol, obesity, and micronutrients in patients with seborrheic dermatitis and to provide useful insights into areas of further research. Methods: A literature search of Scopus, PubMed, and MEDLINE (Ovid interface) for English language papers published between 1993 and 2023 was conducted on April 16, 2023. Case-control studies, cohort studies, and randomized controlled trials with 5 or more subjects conducted on adult participants (>14 years) were included, case reports, case series, and review papers were excluded due to insufficient level of evidence. Results: A total of 13 studies, 8 case-control, 3 cross-sectional, and 2 randomized controlled trials, involving 13,906 patients were included. Seborrheic dermatitis was correlated with significantly increased copper, manganese, iron, calcium, and magnesium concentrations and significantly lower serum zinc and vitamin D and E concentrations. Adherence to the Western diet was associated with a higher risk for seborrheic dermatitis in female patients and an increased consumption of fruit was associated with a lower risk of seborrheic dermatitis in all patients. The prebiotic Triphala improved patient satisfaction and decreased scalp sebum levels over 8 weeks. Most studies find associations between regular alcohol use and seborrheic dermatitis, but the association between BMI and obesity on seborrheic dermatitis severity and prevalence is mixed. Conclusions: This review sheds light on specific promising areas of research that require further study, including the need for interventional studies evaluating serum zinc, vitamin D, and vitamin E supplementation for seborrheic dermatitis. The negative consequences of a Western diet, alcohol use, obesity, and the benefits of fruit consumption are well known; however, to fully understand their specific relationships to seborrheic dermatitis, further cohort or interventional studies are needed. Trial Registration: PROSPERO CRD42023417768; https://tinyurl.com/bdcta893 %M 39102684 %R 10.2196/50143 %U https://derma.jmir.org/2024/1/e50143 %U https://doi.org/10.2196/50143 %U http://www.ncbi.nlm.nih.gov/pubmed/39102684 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e52103 %T Predicting the Transition to Metabolically Unhealthy Obesity Among Young Adults With Metabolically Healthy Obesity in South Korea: Nationwide Population-Based Study %A Lee,HyunHae %A Kim,Ji-Su %A Shin,Hyerine %+ Department of Nursing, Chung-Ang University, 84 Heukseok-ro Dongjak-Gu, Seoul, 06974, Republic of Korea, 82 2 820 5991, jisu80@cau.ac.kr %K metabolically healthy obesity %K metabolic syndrome %K metabolically unhealthy obesity %K nomogram %K obesity %K young adult %K male %K noncommunicable disease %K South Korea %K population-based study %K intervention %D 2024 %7 28.6.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Globally, over 39% of individuals are obese. Metabolic syndrome, usually accompanied by obesity, is regarded as a major contributor to noncommunicable diseases. Given this relationship, the concepts of metabolically healthy and unhealthy obesity, considering metabolic status, have been evolving. Attention is being directed to metabolically healthy people with obesity who have relatively low transition rates to noncommunicable diseases. As obesity rates continue to rise and unhealthy behaviors prevail among young adults, there is a growing need for obesity management that considers these metabolic statuses. A nomogram can be used as an effective tool to predict the risk of transitioning to metabolically unhealthy obesity from a metabolically healthy status. Objective: The study aimed to identify demographic factors, health behaviors, and 5 metabolic statuses related to the transition from metabolically healthy obesity to unhealthy obesity among people aged between 20 and 44 years and to develop a screening tool to predict this transition. Methods: This secondary analysis study used national health data from the National Health Insurance System in South Korea. We analyzed the customized data using SAS (SAS Institute Inc) and conducted logistic regression to identify factors related to the transition from metabolically healthy to unhealthy obesity. A nomogram was developed to predict the transition using the identified factors. Results: Among 3,351,989 people, there was a significant association between the transition from metabolically healthy to unhealthy obesity and general characteristics, health behaviors, and metabolic components. Male participants showed a 1.30 higher odds ratio for transitioning to metabolically unhealthy obesity than female participants, and people in the lowest economic status were also at risk for the transition (odds ratio 1.08, 95% CI 1.05-1.1). Smoking status, consuming >30 g of alcohol, and insufficient regular exercise were negatively associated with the transition. Each relevant variable was assigned a point value. When the nomogram total points reached 295, the shift from metabolically healthy to unhealthy obesity had a prediction rate of >50%. Conclusions: This study identified key factors for young adults transitioning from healthy to unhealthy obesity, creating a predictive nomogram. This nomogram, including triglycerides, waist circumference, high-density lipoprotein-cholesterol, blood pressure, and fasting glucose, allows easy assessment of obesity risk even for the general population. This tool simplifies predictions amid rising obesity rates and interventions. %M 38941611 %R 10.2196/52103 %U https://publichealth.jmir.org/2024/1/e52103 %U https://doi.org/10.2196/52103 %U http://www.ncbi.nlm.nih.gov/pubmed/38941611 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50149 %T Comparing Human-Smartphone Interactions and Actigraphy Measurements for Circadian Rhythm Stability and Adiposity: Algorithm Development and Validation Study %A Chuang,Hai-Hua %A Lin,Chen %A Lee,Li-Ang %A Chang,Hsiang-Chih %A She,Guan-Jie %A Lin,Yu-Hsuan %+ Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County, 35053, Taiwan, 886 37 206 166 ext 36383, yuhsuanlin@nhri.edu.tw %K actigraphy %K body composition %K circadian rhythm %K human-smartphone interaction %K interdaily stability %K obesity %D 2024 %7 5.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: This study aimed to investigate the relationships between adiposity and circadian rhythm and compare the measurement of circadian rhythm using both actigraphy and a smartphone app that tracks human-smartphone interactions. Objective: We hypothesized that the app-based measurement may provide more comprehensive information, including light-sensitive melatonin secretion and social rhythm, and have stronger correlations with adiposity indicators. Methods: We enrolled a total of 78 participants (mean age 41.5, SD 9.9 years; 46/78, 59% women) from both an obesity outpatient clinic and a workplace health promotion program. All participants (n=29 with obesity, n=16 overweight, and n=33 controls) were required to wear a wrist actigraphy device and install the Rhythm app for a minimum of 4 weeks, contributing to a total of 2182 person-days of data collection. The Rhythm app estimates sleep and circadian rhythm indicators by tracking human-smartphone interactions, which correspond to actigraphy. We examined the correlations between adiposity indices and sleep and circadian rhythm indicators, including sleep time, chronotype, and regularity of circadian rhythm, while controlling for physical activity level, age, and gender. Results: Sleep onset and wake time measurements did not differ significantly between the app and actigraphy; however, wake after sleep onset was longer (13.5, SD 19.5 minutes) with the app, resulting in a longer actigraphy-measured total sleep time (TST) of 20.2 (SD 66.7) minutes. The obesity group had a significantly longer TST with both methods. App-measured circadian rhythm indicators were significantly lower than their actigraphy-measured counterparts. The obesity group had significantly lower interdaily stability (IS) than the control group with both methods. The multivariable-adjusted model revealed a negative correlation between BMI and app-measured IS (P=.007). Body fat percentage (BF%) and visceral adipose tissue area (VAT) showed significant correlations with both app-measured IS and actigraphy-measured IS. The app-measured midpoint of sleep showed a positive correlation with both BF% and VAT. Actigraphy-measured TST exhibited a positive correlation with BMI, VAT, and BF%, while no significant correlation was found between app-measured TST and either BMI, VAT, or BF%. Conclusions: Our findings suggest that IS is strongly correlated with various adiposity indicators. Further exploration of the role of circadian rhythm, particularly measured through human-smartphone interactions, in obesity prevention could be warranted. %M 38838328 %R 10.2196/50149 %U https://www.jmir.org/2024/1/e50149 %U https://doi.org/10.2196/50149 %U http://www.ncbi.nlm.nih.gov/pubmed/38838328 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e51734 %T Association Between Early-Life Exposure to Antibiotics and Development of Child Obesity: Population-Based Study in Italy %A Cantarutti,Anna %A Rescigno,Paola %A Da Borso,Claudia %A Gutierrez de Rubalcava Doblas,Joaquin %A Bressan,Silvia %A Barbieri,Elisa %A Giaquinto,Carlo %A Canova,Cristina %+ Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Via Bicocca degli Arcimboldi, 8, Milano, 20126, Italy, 39 0264485828, anna.cantarutti@unimib.it %K childhood obesity %K BMI z score %K pediatric population-based %K antibiotics %K real-world data %K association %K exposure %K child obesity %K obesity %K population-based %K gut microbiome %K early life %K pediatric %K prescription %D 2024 %7 31.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Childhood obesity is a significant public health problem representing the most severe challenge in the world. Antibiotic exposure in early life has been identified as a potential factor that can disrupt the development of the gut microbiome, which may have implications for obesity. Objective: This study aims to evaluate the risk of developing obesity among children exposed to antibiotics early in life. Methods: An Italian retrospective pediatric population-based cohort study of children born between 2004 and 2018 was adopted using the Pedianet database. Children were required to be born at term, with normal weight, and without genetic diseases or congenital anomalies. We assessed the timing of the first antibiotic prescription from birth to 6, 12, and 24 months of life and the dose-response relationship via the number of antibiotic prescriptions recorded in the first year of life (none, 1, 2, and ≥3 prescriptions). Obesity was defined as a BMI z score >3 for children aged ≤5 years and >2 for children aged >5 years, using the World Health Organization growth references. The obese incidence rate (IR) × 100 person-years and the relative 95% CI were computed using infant sex, area of residence, preschool and school age, and area deprivation index, which are the covariates of interest. A mixed-effect Cox proportional hazards model was used to estimate the hazard ratio and 95% CI for the association between antibiotic exposure in early life and child obesity between 24 months and 14 years of age, considering the family pediatricians as a random factor. Several subgroup and sensitivity analyses were performed to assess the robustness of our results. Results: Among 121,540 children identified, 54,698 were prescribed at least an antibiotic within the first year of life and 26,990 were classified as obese during follow-up with an incidence rate of 4.05 cases (95% CI 4.01-4.10) × 100 person-year. The risk of obesity remained consistent across different timings of antibiotic prescriptions at 6 months, 1 year, and 2 years (fully adjusted hazard ratio [aHR] 1.07, 95% CI 1.04-1.10; aHR 1.06, 95% CI 1.03-1.09; and aHR 1.07, 95% CI 1.04-1.10, respectively). Increasing the number of antibiotic exposures increases the risk of obesity significantly (P trend<.001). The individual-specific age analysis showed that starting antibiotic therapy very early (between 0 and 5 months) had the greatest impact (aHR 1.12, 95% CI 1.08-1.17) on childhood obesity with respect to what was observed among those who were first prescribed antibiotics after the fifth month of life. These results were consistent across subgroup and sensitivity analyses. Conclusions: The results from this large population-based study support the association between early exposure to antibiotics and an increased risk of childhood obesity. This association becomes progressively stronger with both increasing numbers of antibiotic prescriptions and younger age at the time of the first prescription. %M 38820573 %R 10.2196/51734 %U https://publichealth.jmir.org/2024/1/e51734 %U https://doi.org/10.2196/51734 %U http://www.ncbi.nlm.nih.gov/pubmed/38820573 %0 Journal Article %@ 2563-6316 %I %V 5 %N %P e55976 %T Thyroid Hyperplasia and Neoplasm Adverse Events Associated With Glucagon-Like Peptide-1 Receptor Agonists in the Food and Drug Administration Adverse Event Reporting System: Retrospective Analysis %A Makunts,Tigran %A Joulfayan,Haroutyun %A Abagyan,Ruben %K GLP-1 %K FDA %K averse event reporting %K cancer %K oncology %K neoplasm %K drugs %K pharmacy %K pharmacology %K pharmaceutics %K medication %K medications %K glucagon-like peptide-1 %K Food and Drug Administration %K weight loss %K diabetes %K obesity %K thyroid hyperplasia %K FAERS %K FDA Adverse Event Reporting System %D 2024 %7 1.5.2024 %9 %J JMIRx Med %G English %X Background: Glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) are one of the most commonly used drugs for type 2 diabetes mellitus. Clinical guidelines recommend GLP-1 RAs as an adjunct to diabetes therapy in patients with chronic kidney disease, presence or risk of atherosclerotic cardiovascular disease, and obesity. The weight loss observed in clinical trials has been explored further in healthy individuals, putting GLP-1 RAs on track to be the next weight loss treatment. Objective: Although the adverse event profile is relatively safe, most GLP-1 RAs come with a labeled boxed warning for the risk of thyroid cancers, based on animal models and some postmarketing case reports in humans. Considering the increasing popularity of this drug class and its expansion into a new popular indication, a further review of the most recent postmarketing safety data was warranted to quantify thyroid hyperplasia and neoplasm instances. Methods: GLP-1 RA patient reports from the US Food and Drug Administration (FDA) Adverse Event Reporting System database were analyzed using reporting odds ratios and 95% CIs. Results: In this study, we analyzed over 18 million reports from the US FDA Adverse Event Reporting System and provided evidence of significantly increased propensity for thyroid hyperplasias and neoplasms in patients taking GLP-1 RA monotherapy when compared to patients taking sodium-glucose cotransporter-2 (SGLT-2) inhibitor monotherapy. Conclusions: GLP-1 RAs, regardless of indication, are associated with an over 10-fold increase in thyroid neoplasm and hyperplasia adverse event reporting when compared to SGLT-2 inhibitors. %R 10.2196/55976 %U https://xmed.jmir.org/2024/1/e55976 %U https://doi.org/10.2196/55976 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 8 %N %P e42402 %T Effects of a Web-based Weight Management Education Program on Various Factors for Overweight and Obese Women: Randomized Controlled Trial %A Han,Yunmin %A Sung,Hoyong %A Kim,Geonhui %A Ryu,Yeun %A Yoon,Jiyeon %A Kim,Yeon Soo %+ Department of Physical Education, Seoul National University, Seoul, Gawnak Gu, Gawankro 1, 71-1, 408, Seoul, 08826, Republic of Korea, 82 2 880 7894, kys0101@snu.ac.kr %K weight loss %K obesity %K health education %K self-management %K health promotion %K tailored feedback %K web-based intervention %K behavior change %D 2024 %7 18.4.2024 %9 Original Paper %J JMIR Cardio %G English %X Background: Mediated diet and exercise methods yield effective short-term weight loss but are costly and hard to manage. However, web-based programs can serve many participants, offering ease of access and cost-efficiency. Objective: This study aimed to compare the effectiveness of a web-based weight management program through web-based education alone (MINE) or combined with tailored video feedback (MINE Plus) with a control (CO) group. Methods: This intervention included 60 Korean women with overweight and obesity (BMI≥23 kg/m2) aged 19 years to 39 years old. We randomly allocated 60 participants to each of 3 groups: (1) MINE group (web-based education video and self-monitoring app), (2) MINE Plus group (web-based education video, self-monitoring app, and 1:1 tailored video feedback), and (3) CO group (only self-monitoring app). Web-based education included nutrition, physical activity, psychological factors, medical knowledge for weight loss, goal setting, and cognitive and behavioral strategies. Tailored feedback aimed to motivate and provide solutions via weekly 10-minute real-time video sessions. The intervention lasted 6 weeks, followed by a 6-week observation period to assess the education's lasting effects, with evaluations at baseline, 6 weeks, and 12 weeks. A generalized linear mixed model was used to evaluate time and group interactions. Results: In the intention-to-treat analysis including all 60 participants, there were significant differences in weight change at 6 weeks in the MINE and MINE Plus groups, with mean weight changes of –0.74 (SD 1.96) kg (P=.03) and –1.87 (SD 1.8) kg (P<.001), respectively, while no significant change was observed in the CO group, who had a mean weight increase of 0.03 (SD 1.68) kg (P=.91). After 12 weeks, changes in body weight were –1.65 (SD 2.64) kg in the MINE group, –1.59 (SD 2.79) kg in the MINE Plus group, and 0.43 (SD 1.42) kg in the CO group. There was a significant difference between the MINE and MINE Plus groups (P<.001). Significant group × time effects were found for body weight in the MINE and CO groups (P<.001) and in the MINE Plus and CO groups (P<.001), comparing baseline and 12 weeks. Regarding physical activity and psychological factors, only body shape satisfaction and health self-efficacy were associated with improvements in the MINE and MINE Plus groups (P<.001). Conclusions: This study found that the group receiving education and tailored feedback showed significant weight loss and improvements in several psychological factors, though there were differences in the sustainability of the effects. Trial Registration: Korea Disease Control and Prevention Agency (KDCA) KCT0007780: https://cris.nih.go.kr/cris/search/detailSearch.do/22861 %M 38635975 %R 10.2196/42402 %U https://cardio.jmir.org/2024/1/e42402 %U https://doi.org/10.2196/42402 %U http://www.ncbi.nlm.nih.gov/pubmed/38635975 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e47517 %T Association Between Adherence to 24-Hour Movement Guidelines and Noncommunicable Disease Risk in Chinese Adults: Prospective Cohort Study %A Huang,Siyi %A Gu,Yuxuan %A Ali,Shahmir H %A Xue,Jingjing %A Zhang,Ronghua %A Wen,Xu %+ Department of Nutrition and Food Safety, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Hangzhou, China, 86 13958109105, rhzhang@cdc.zj.cn %K chronic diseases %K 24-hour movement guidelines %K obesity %K noncommunicable disease %K sleep %K risk %K overweight %D 2024 %7 27.3.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The increasing annual global deaths are attributable to noncommunicable chronic diseases (NCDs). Adhering to healthy lifestyle behaviors is associated with lower NCD risk, particularly among individuals with ample movement, enough sleep, and reduced sedentariness. Nevertheless, there are only few prospective assessments on the association of interactions between daily activities with NCD prevention, while the associations between adhering to Canadian 24-Hour Movement Guidelines (24HGs) for adults and NCD risks are still unknown. Compared to the general population, obese and overweight populations are at a higher risk of developing NCDs. Currently, it is unclear whether the health benefits of adhering to 24HGs differ between the general population and the obese population. Objective: This study explores prospective associations between adherence to 24HGs and NCD risks by weight status among overweight and obese adults in China. Methods: This decadal study consists of 9227 adults aged 35 years and older without any major NCDs at enrolment in the China Health and Nutrition Survey (2004-2011) and followed up until 2015. The exposure of interest was the overall score of compliance with 24HGs measured by participants’ self-report, wherein 1 point was assigned for compliance to each component, resulting in an aggregated score ranging from 0 to 3. The primary outcome was the first occurrence of major NCDs (high blood pressure, stroke, diabetes, cancer, and acute myocardial infarction). Log-binomial regression models were used to evaluate the associations. Results: : Overall, 4315 males and 4912 females, with 25,175 person-years of follow-up, were included in our analyses. The average baseline age was 50.21 (SD 11.04) years. Among the overweight and obese groups, those adhering to 1 (risk ratio [RR] 0.37, 95% CI 0.19-0.74; P=.004), 2 (RR 0.37, 95% CI 0.19-0.72; P=.003), and 3 (RR 0.32, 95% CI 0.14-0.73; P=.006) recommendations of 24HGs had a significantly lower NCD risk than those not adhering to any of the activity guidelines. Among the normal or underweight groups, those adhering to 1 (RR 0.49, 95% CI 0.27-0.96; P=.03) and 3 (RR 0.40, 95% CI 0.17-0.94; P=.03) components had a significantly lower NCD risk than those not adhering to any of the activity guidelines. Conclusions: In this prospective study, we found that active adherence to recommendations of 24HGs was associated with lower risks of NCDs, especially among overweight and obese participants. Additionally, overweight and obese individuals who met at least 1 component of 24HGs were at a significantly lower risk for NCDs, but this protective effect was not found among individuals in the normal and underweight groups. Individuals with excess body weight who tend to be more susceptible to health risks may gain greater health benefits than the general population by adhering to the recommendations of 24HGs. %M 38536210 %R 10.2196/47517 %U https://publichealth.jmir.org/2024/1/e47517 %U https://doi.org/10.2196/47517 %U http://www.ncbi.nlm.nih.gov/pubmed/38536210 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44955 %T An Evaluation of a Personalized Multicomponent Commercial Digital Weight Management Program: Single-Arm Behavioral Trial %A Pagoto,Sherry %A Xu,Ran %A Bullard,Tiffany %A Foster,Gary D %A Bannor,Richard %A Arcangel,Kaylei %A DiVito,Joseph %A Schroeder,Matthew %A Cardel,Michelle I %+ Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Rd, Unit 1101, Storrs, CT, 06269-1101, United States, 1 617 877 0923, sherry.pagoto@uconn.edu %K weight loss %K digital behavioral weight management program %K single-arm behavioral trial %K personalized weight loss program %K ZeroPoint foods %K weight management %K digital intervention %K diet management %K exercise %D 2023 %7 29.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital behavioral weight loss programs are scalable and effective, and they provide an opportunity to personalize intervention components. However, more research is needed to test the acceptability and efficacy of personalized digital behavioral weight loss interventions. Objective: In a 6-month single-arm trial, we examined weight loss, acceptability, and secondary outcomes of a digital commercial weight loss program (WeightWatchers). This digital program included a personalized weight loss program based on sex, age, height, weight, and personal food preferences, as well as synchronous (eg, virtual workshops and individual weekly check-ins) and asynchronous (eg, mobile app and virtual group) elements. In addition to a personalized daily and weekly PersonalPoints target, the program provided users with personalized lists of ≥300 ZeroPoint foods, which are foods that do not need to be weighed, measured, or tracked. Methods: We conducted a pre-post evaluation of this 6-month, digitally delivered, and personalized WeightWatchers weight management program on weight loss at 3 and 6 months in adults with overweight and obesity. The secondary outcomes included participation, satisfaction, fruit and vegetable intake, physical activity, sleep quality, hunger, food cravings, quality of life, self-compassion, well-being, and behavioral automaticity. Results: Of the 153 participants, 107 (69.9%) were female, and 65 (42.5%) identified as being from a minoritized racial or ethnic group. Participants’ mean age was 41.09 (SD 13.78) years, and their mean BMI was 31.8 (SD 5.0) kg/m2. Participants had an average weight change of −4.25% (SD 3.93%) from baseline to 3 months and −5.05% (SD 5.59%) from baseline to 6 months. At 6 months, the percentages of participants who experienced ≥3%, ≥5%, and ≥10% weight loss were 63.4% (97/153), 51% (78/153), and 14.4% (22/153), respectively. The mean percentage of weeks in which participants engaged in ≥1 aspects of the program was 87.53% (SD 23.40%) at 3 months and 77.67% (SD 28.69%) at 6 months. Retention was high (132/153, 86.3%), and more than two-thirds (94/140, 67.1%) of the participants reported that the program helped them lose weight. Significant improvements were observed in fruit and vegetable intake, physical activity, sleep quality, hunger, food cravings, quality of life, and well-being (all P values <.01). Conclusions: This personalized, digital, and scalable behavioral weight management program resulted in clinically significant weight loss in half (78/153, 51%) of the participants as well as improvements in behavioral and psychosocial outcomes. Future research should compare personalized digital weight loss programs with generic programs on weight loss, participation, and acceptability. %M 37642986 %R 10.2196/44955 %U https://www.jmir.org/2023/1/e44955 %U https://doi.org/10.2196/44955 %U http://www.ncbi.nlm.nih.gov/pubmed/37642986 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e41256 %T Implementation of a Digital Health Tool for Patients Awaiting Input From a Specialist Weight Management Team: Observational Study %A Hanson,Petra %A Summers,Charlotte %A Panesar,Arjun %A Liarakos,Alexandros Leonidas %A Oduro-Donkor,Dominic %A Whyte Oshodi,Danniella %A Hailston,Luke %A Randeva,Harpal %A Menon,Vinod %A de la Fosse,Michaela %A Kaura,Amit %A Shuttlewood,Emma %A Loveder,Mark %A Poole,Donna %A Barber,Thomas M %+ National Heart & Lung Institute, Imperial College London, 9th Floor, Building E - Sir Michael Uren, White City Campus, London, W12 7ED, United Kingdom, 44 (0)20 7594 5735, a.kaura@imperial.ac.uk %K weight management %K precision health %K digital health, hospital %K secondary care %K tier 3 weight management %K National Health Service %K weight %K obese %K obesity %K focus group %K perspective %K opinion %K attitude %K behavior change %K behavior change %K mHealth %K mobile health %K health app %D 2023 %7 31.5.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Digital tools are increasingly used on a population level as a weight loss strategy for people living with overweight and obesity. Evidence supports the feasibility of digital tools for the management of obesity in a community setting, but there is only emerging evidence for the feasibility of such tools in specialist weight management services. No study has assessed the uptake of digital tools among patients awaiting their first appointment with a specialist weight management service. Objective: The objective of this study was to understand interest, acceptance, and engagement with a digital behavioral change platform to support specialist weight management. Methods: This was an observational study registered as a service innovation. All patients on the waiting list for a first appointment in the tier 3 weight management service at University Hospitals Coventry and Warwickshire National Health Service (NHS) Trust were eligible to access the NHS-approved digital tool. Data on interest and engagement with the digital tool were collected. Routine clinical data were used to describe patient demographics. Focus groups were held to explore patients’ views on the use of digital tools as part of a specialist weight management service. Results: A total of 199 patients on the waiting list were informed about the available digital tool. Just over a half (n=102, 51.3%) of patients were interested in using the app, with over one-third (n=68, 34%) of all patients engaging with the app. Overall, a third of patients on the waiting list (n=63, 32%) did not respond to the invite and 34 (17%) of patients expressed no interest in the app. Emotional eating and higher BMI was associated with interest in the Gro Health app. Male gender was associated with reduced engagement with the app. There were no differences in interest in the Gro Health app according to age, ethnicity, metabolic measures of glycemia, and lipid profile. Conclusions: It is feasible to offer digital tools such as Gro Health to patients awaiting their first appointment with specialist weight management services. Future research should explore barriers and facilitators of engagement with digital tools. Additionally, there is a need to further evaluate the effectiveness of such tools in specialist weight management services. %M 37256653 %R 10.2196/41256 %U https://humanfactors.jmir.org/2023/1/e41256 %U https://doi.org/10.2196/41256 %U http://www.ncbi.nlm.nih.gov/pubmed/37256653 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e42001 %T Triggering Weight Management Using Digital Avatars: Prospective Cohort Study %A Jiwa,Moyez %A Nyanhanda,Tafadzwa %A Dodson,Michael %+ School of Medicine, Melbourne Clinical School, The University of Notre Dame Australia, 300 Princes Highway, Werribee, 3030, Australia, 61 282044259, moyez.jiwa@nd.edu.au %K weight management %K digital avatar, behavior change, calorie awareness, obesity, health promotion, motivation, processes of change %K stages of change %K BMI %K weight %K body dysmorphia %K diet %K exercise %K calorie %K tool %K weight management %K digital %D 2023 %7 29.5.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: There is evidence that showing motivated people with a less-than-ideal BMI (>25 kg/m2) digital and personalized images of their future selves with reduced body weight will likely trigger them to achieve that new body weight. Objective: The purpose of this study is to assess whether digital avatars can trigger weight management action and identify some of the measurable factors that distinguish those who may be triggered. Methods: A prospective cohort study followed participants for 12 weeks through 5 recorded interviews. Participants were screened for suitability for the study using the Cosmetic Procedure Screening Questionnaire as a measure of body dysmorphia. At interview 1, participants were shown 10 images from a “Food-pics” database and invited to estimate their calorie value. The intervention, the FutureMe app, delivered at interview 2, provided each participant an opportunity to see and take away a soft copy of an avatar of themselves as they might appear in the future depending on their calorie consumption and exercise regimen. Participants completed the readiness for change (S-Weight) survey based on Prochaska Stages of Change Model and the processes of change (P-Weight) survey. Any changes in diet, exercise, or weight were self-reported. Results: A total of 87 participants were recruited, and 42 participants completed the study (48% of recruited participants). Body dysmorphia was a rare but possible risk to participation. The majority (88.5%) of the participants were female and older than 40 years. The average BMI was 34.1 (SD 4.8). Most people wanted to reduce to a BMI of 30 kg/m2 or lose on average 10.5 kg within 13 weeks (–0.8 kg per week). Most participants stated that they would achieve these results by limiting their calorie intake to 1500 calories per day and taking the equivalent of 1 hour of bicycling per day. At interview 1, more participants were in the preparation stage of behavior change than in subsequent interviews. By interview 5, most of the participants were at the maintenance stage. Participants who overestimated the recommended number of calories were more likely to be in the contemplation stage (P=.03). Conclusions: Volunteers who participated in the study were mainly women older than 40 years and beyond the contemplation stage of change for weight management, and those who took weight management action were demonstrated to have a more accurate idea of the calorie content of different foods. Most participants set ambitious targets for weight loss, but few, if any, achieve these goals. However, most people who completed this study were actively taking action to manage their weight. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001481167; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378055&isReview=true %M 37247208 %R 10.2196/42001 %U https://www.i-jmr.org/2023/1/e42001 %U https://doi.org/10.2196/42001 %U http://www.ncbi.nlm.nih.gov/pubmed/37247208 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e41280 %T “An Ounce of Prevention is Worth a Pound of Cure”: Proposal for a Social Prescribing Strategy for Obesity Prevention and Improvement in Health and Well-being %A Jayasinghe,Sisitha %A Holloway,Timothy P %A Soward,Robert %A Patterson,Kira A E %A Ahuja,Kiran D K %A Dalton,Lisa %A Murray,Sandra %A Hughes,Roger %A Byrne,Nuala M %A Hills,Andrew P %+ School of Health Sciences, College of Health and Medicine, University of Tasmania, Locked Bag 1322, Newnham Drive, Launceston, 7250, Australia, 61 36323147, Sisitha.Jayasinghe@utas.edu.au %K capacity building %K community development %K determinants of health %K health care delivery %K health care management %K obese %K obesity %K patient education %K peer education %K prevention %K screening %K service delivery %K social prescribing %K social prescription %K weight %D 2023 %7 17.2.2023 %9 Proposal %J JMIR Res Protoc %G English %X Background: Social and behavioral determinants of health are increasingly recognized as central to effective person-centered intervention in clinical practice, disease management, and public health. Accordingly, social prescribing (SP) has received increased attention in recent times. The rampant global prevalence of obesity indicates that the customary, reductionistic, and disease-oriented biomedical approach to health service delivery is inadequate/ineffective at arresting the spread and mitigating the damaging consequences of the condition. There is an urgent need to shift the focus from reactive downstream disease-based treatments to more proactive, upstream, preventive action. In essence, this requires more effort to affect the paradigm shift from the traditional “biomedical approach of care” to a “biopsychosocial model” required to arrest the increasing prevalence of obesity. To this end, an SP approach, anchored in systems thinking, could be an effective means of moderating prevalence and consequences of obesity at a community level. Objective: The proposed SP intervention has the following three key objectives: (1) build a sustainable program for Circular Head based on SP, peer education, and health screening to minimize the incidence of obesity and related lifestyle diseases; (2) increase service and workforce connectivity and collaboration and initiate the introduction of new services and activities for obesity prevention and community health promotion; and (3) enhance health and well-being and minimize preventable adverse health outcomes of obesity and related lifestyle diseases through enhancement of food literacy and better nutrition, enhancement of physical literacy and habitual personal activity levels, and improvement of mental health, community connectedness, and reduction of social isolation. Methods: This paper describes a prospective SP strategy aimed at obesity prevention in Circular Head, a local government area in Northwest (NW) Tasmania. SP is a prominent strategy used in the Critical Age Periods Impacting the Trajectory of Obesogenic Lifestyles Project, which is an initiative based in NW Tasmania focused on assessing obesity prevention capacity. A social prescription model that facilitates the linkage of primary health screening with essential health care, education, and community resources through a dedicated “navigator” will be implemented. Four interlinked work packages will be implemented as part of the initial plan with each either building on existing resources or developing new initiatives. Results: A multimethod approach to triangulate insights from quantitative and qualitative research that enables the assessment of impact on individuals, community groups, and the health care system will be implemented within the initial pilot phase of the project. Conclusions: Literature is replete with rhetoric advocating complex system approaches to curtail obesity. However, real-life examples of whole-of-systems interventions operationalized in ways that generate relevant evidence or effective policies are rare. The diverse approach for primary prevention of obesity-related lifestyle diseases and strategies for improvement of health and well-being described in this instance will contribute toward closing this evidence gap. International Registered Report Identifier (IRRID): PRR1-10.2196/41280 %M 36800232 %R 10.2196/41280 %U https://www.researchprotocols.org/2023/1/e41280 %U https://doi.org/10.2196/41280 %U http://www.ncbi.nlm.nih.gov/pubmed/36800232 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 12 %P e36729 %T Characterizing the Prevalence of Obesity Misinformation, Factual Content, Stigma, and Positivity on the Social Media Platform Reddit Between 2011 and 2019: Infodemiology Study %A Pollack,Catherine C %A Emond,Jennifer A %A O'Malley,A James %A Byrd,Anna %A Green,Peter %A Miller,Katherine E %A Vosoughi,Soroush %A Gilbert-Diamond,Diane %A Onega,Tracy %+ Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Rubin 833, 1 Medical Center Drive, Lebanon, NH, 03756, United States, 1 540 497 3419, Catherine.c.pollack.gr@dartmouth.edu %K obesity %K misinformation %K social stigma %K social media %K Reddit %K natural language processing %D 2022 %7 30.12.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Reddit is a popular social media platform that has faced scrutiny for inflammatory language against those with obesity, yet there has been no comprehensive analysis of its obesity-related content. Objective: We aimed to quantify the presence of 4 types of obesity-related content on Reddit (misinformation, facts, stigma, and positivity) and identify psycholinguistic features that may be enriched within each one. Methods: All sentences (N=764,179) containing “obese” or “obesity” from top-level comments (n=689,447) made on non–age-restricted subreddits (ie, smaller communities within Reddit) between 2011 and 2019 that contained one of a series of keywords were evaluated. Four types of common natural language processing features were extracted: bigram term frequency–inverse document frequency, word embeddings derived from Bidirectional Encoder Representations from Transformers, sentiment from the Valence Aware Dictionary for Sentiment Reasoning, and psycholinguistic features from the Linguistic Inquiry and Word Count Program. These features were used to train an Extreme Gradient Boosting machine learning classifier to label each sentence as 1 of the 4 content categories or other. Two-part hurdle models for semicontinuous data (which use logistic regression to assess the odds of a 0 result and linear regression for continuous data) were used to evaluate whether select psycholinguistic features presented differently in misinformation (compared with facts) or stigma (compared with positivity). Results: After removing ambiguous sentences, 0.47% (3610/764,179) of the sentences were labeled as misinformation, 1.88% (14,366/764,179) were labeled as stigma, 1.94% (14,799/764,179) were labeled as positivity, and 8.93% (68,276/764,179) were labeled as facts. Each category had markers that distinguished it from other categories within the data as well as an external corpus. For example, misinformation had a higher average percent of negations (β=3.71, 95% CI 3.53-3.90; P<.001) but a lower average number of words >6 letters (β=−1.47, 95% CI −1.85 to −1.10; P<.001) relative to facts. Stigma had a higher proportion of swear words (β=1.83, 95% CI 1.62-2.04; P<.001) but a lower proportion of first-person singular pronouns (β=−5.30, 95% CI −5.44 to −5.16; P<.001) relative to positivity. Conclusions: There are distinct psycholinguistic properties between types of obesity-related content on Reddit that can be leveraged to rapidly identify deleterious content with minimal human intervention and provide insights into how the Reddit population perceives patients with obesity. Future work should assess whether these properties are shared across languages and other social media platforms. %M 36583929 %R 10.2196/36729 %U https://www.jmir.org/2022/12/e36729 %U https://doi.org/10.2196/36729 %U http://www.ncbi.nlm.nih.gov/pubmed/36583929 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 12 %P e40589 %T Applications of Artificial Intelligence to Obesity Research: Scoping Review of Methodologies %A An,Ruopeng %A Shen,Jing %A Xiao,Yunyu %+ Department of Physical Education, China University of Geosciences, No. 29, Xueyuan Road, Haidian District, Beijing, 100083, China, 86 010 82322397, shenjing@cugb.edu.cn %K artificial intelligence %K deep learning %K machine learning %K obesity %K scoping review %D 2022 %7 7.12.2022 %9 Review %J J Med Internet Res %G English %X Background: Obesity is a leading cause of preventable death worldwide. Artificial intelligence (AI), characterized by machine learning (ML) and deep learning (DL), has become an indispensable tool in obesity research. Objective: This scoping review aimed to provide researchers and practitioners with an overview of the AI applications to obesity research, familiarize them with popular ML and DL models, and facilitate the adoption of AI applications. Methods: We conducted a scoping review in PubMed and Web of Science on the applications of AI to measure, predict, and treat obesity. We summarized and categorized the AI methodologies used in the hope of identifying synergies, patterns, and trends to inform future investigations. We also provided a high-level, beginner-friendly introduction to the core methodologies to facilitate the dissemination and adoption of various AI techniques. Results: We identified 46 studies that used diverse ML and DL models to assess obesity-related outcomes. The studies found AI models helpful in detecting clinically meaningful patterns of obesity or relationships between specific covariates and weight outcomes. The majority (18/22, 82%) of the studies comparing AI models with conventional statistical approaches found that the AI models achieved higher prediction accuracy on test data. Some (5/46, 11%) of the studies comparing the performances of different AI models revealed mixed results, indicating the high contingency of model performance on the data set and task it was applied to. An accelerating trend of adopting state-of-the-art DL models over standard ML models was observed to address challenging computer vision and natural language processing tasks. We concisely introduced the popular ML and DL models and summarized their specific applications in the studies included in the review. Conclusions: This study reviewed AI-related methodologies adopted in the obesity literature, particularly ML and DL models applied to tabular, image, and text data. The review also discussed emerging trends such as multimodal or multitask AI models, synthetic data generation, and human-in-the-loop that may witness increasing applications in obesity research. %M 36476515 %R 10.2196/40589 %U https://www.jmir.org/2022/12/e40589 %U https://doi.org/10.2196/40589 %U http://www.ncbi.nlm.nih.gov/pubmed/36476515 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 8 %P e37039 %T Association Between Neighborhood Factors and Adult Obesity in Shelby County, Tennessee: Geospatial Machine Learning Approach %A Brakefield,Whitney S %A Olusanya,Olufunto A %A Shaban-Nejad,Arash %+ Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, 50 N Dunlap Street, 491R, Memphis, TN, 38103, United States, 1 901 287 5836, ashabann@uthsc.edu %K obesity %K obesity surveillance %K disease surveillance %K machine learning %K geographic information systems %K social determinants of health %K SDOH %K disparities %D 2022 %7 9.8.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Obesity is a global epidemic causing at least 2.8 million deaths per year. This complex disease is associated with significant socioeconomic burden, reduced work productivity, unemployment, and other social determinants of health (SDOH) disparities. Objective: The objective of this study was to investigate the effects of SDOH on obesity prevalence among adults in Shelby County, Tennessee, the United States, using a geospatial machine learning approach. Methods: Obesity prevalence was obtained from the publicly available 500 Cities database of Centers for Disease Control and Prevention, and SDOH indicators were extracted from the US census and the US Department of Agriculture. We examined the geographic distributions of obesity prevalence patterns, using Getis-Ord Gi* statistics and calibrated multiple models to study the association between SDOH and adult obesity. Unsupervised machine learning was used to conduct grouping analysis to investigate the distribution of obesity prevalence and associated SDOH indicators. Results: Results depicted a high percentage of neighborhoods experiencing high adult obesity prevalence within Shelby County. In the census tract, the median household income, as well as the percentage of individuals who were Black, home renters, living below the poverty level, 55 years or older, unmarried, and uninsured, had a significant association with adult obesity prevalence. The grouping analysis revealed disparities in obesity prevalence among disadvantaged neighborhoods. Conclusions: More research is needed to examine links between geographical location, SDOH, and chronic diseases. The findings of this study, which depict a significantly higher prevalence of obesity within disadvantaged neighborhoods, and other geospatial information can be leveraged to offer valuable insights, informing health decision-making and interventions that mitigate risk factors of increasing obesity prevalence. %M 35943795 %R 10.2196/37039 %U https://publichealth.jmir.org/2022/8/e37039 %U https://doi.org/10.2196/37039 %U http://www.ncbi.nlm.nih.gov/pubmed/35943795 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 8 %P e33801 %T Cardiometabolic and Anthropometric Outcomes of Intermittent Fasting Among Civil Servants With Overweight and Obesity: Study Protocol for a Nonrandomized Controlled Trial %A Abdullah,Shazana Rifham %A Azizul,Nur Hayati %A Wan Mohd Zin,Ruziana Mona %A Sulaiman,Nur Suffia %A Mustafa Khalid,Norhayati %A Mohd Salim Mullahi Jahn,Roshan Jahn %A Khalil,Muhamad Khairul Nazrin %A Abu Seman,Norhashimah %A Zainal Abidin,Nur Azlin %A Ali,Azizan %A Tan,You Zhuan %A Omar,Azahadi %A Johari,Mohammad Zabri %A Abdul Aziz,Nur Shahida %A Baharudin,Azli %A Seman,Zamtira %A Ibrahim Wong,Norazizah %A Md Rasip,Mona Lisa %A Yusof,Hayati Mohd %A Md Noh,Mohd Fairulnizal %+ Nutrition, Metabolism and Cardiovascular Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health, Jalan Setia Murni U13/52, Setia Alam, Shah Alam, Selangor, 40170, Malaysia, 60 333628888 ext 7487, shazana.a@moh.gov.my %K intermittent fasting %K dry fasting %K obesity %K overweight %K healthy plate %D 2022 %7 5.8.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Overweight and obesity among adults are a growing global public health threat and an essential risk factor for various noncommunicable diseases. Although intermittent fasting is a generally new dietary approach to weight management that has been increasingly practiced worldwide, the effectiveness of 2 days per week dry fasting remains unclear. Objective: The Cardiometabolic and Anthropometric Outcomes of Intermittent Fasting study aims to determine the cardiometabolic, anthropometric, dietary intake, and quality of life changes among civil servants with overweight and obesity, following combined intermittent fasting and healthy plate (IFHP) and healthy plate (HP) and explore the participants’ experiences. Methods: We designed a mixed methods quasi-experimental study to evaluate the effectiveness of the IFHP and HP methods among adults with overweight and obesity. A total of 177 participants were recruited for this study, of which 91 (51.4%) were allocated to the IFHP group and 86 (48.6%) to the HP group. The intervention comprised 2 phases: supervised (12 weeks) and unsupervised (12 weeks). Data collection was conducted at baseline, after the supervised phase (week 12), and after the unsupervised phase (week 24). Serum and whole blood samples were collected from each participant for analysis. Data on sociodemographic factors, quality of life, physical activity, and dietary intake were also obtained using questionnaires during data collection. Results: Most of the participants were female (147/177, 83.1%) and Malay (141/177, 79.7%). The expected outcomes of this study are changes in body weight, body composition, quality of life, physical activity, dietary intake, and cardiometabolic parameters such as fasting blood glucose, 2-hour postprandial blood glucose, hemoglobin A1c, fasting insulin, and lipid profile. Conclusions: The Cardiometabolic and Anthropometric Outcomes of Intermittent Fasting study is a mixed methods study to evaluate the effectiveness of combined IFHP and HP interventions on cardiometabolic and anthropometric parameters and explore participants’ experiences throughout the study. Trial Registration: ClinicalTrials.gov NCT05034653; https://clinicaltrials.gov/ct2/show/NCT05034653 International Registered Report Identifier (IRRID): RR1-10.2196/33801 %M 35930331 %R 10.2196/33801 %U https://www.researchprotocols.org/2022/8/e33801 %U https://doi.org/10.2196/33801 %U http://www.ncbi.nlm.nih.gov/pubmed/35930331 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e39717 %T Authors’ Reply to: To Screen or Not to Screen? At Which BMI Cut Point? Comment on “Obesity and BMI Cut Points for Associated Comorbidities: Electronic Health Record Study” %A Funk,Luke %A Liu,Natalie %+ Department of Surgery, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI, 53597, United States, 1 608 263 1036, funk@surgery.wisc.edu %K obesity %K body mass index %K BMI %K risk factors %K screening %K health services %K chronic disease %K heart disease %K myocardial perfusion imaging %K anxiety %K depression %D 2022 %7 29.6.2022 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 35767330 %R 10.2196/39717 %U https://www.jmir.org/2022/6/e39717 %U https://doi.org/10.2196/39717 %U http://www.ncbi.nlm.nih.gov/pubmed/35767330 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e37267 %T To Screen or Not to Screen? At Which BMI Cut Point? Comment on “Obesity and BMI Cut Points for Associated Comorbidities: Electronic Health Record Study” %A Sioka,Chrissa %+ Department of Nuclear Medicine, University Hospital of Ioannina, 1 Stavrou Niarhos Street, Ioannina, 45500, Greece, 30 2651099375, csioka@yahoo.com %K obesity %K body mass index %K BMI %K risk factors %K screening %K health services %K chronic disease %K heart disease %K myocardial perfusion imaging %K anxiety %K depression %D 2022 %7 29.6.2022 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 35767333 %R 10.2196/37267 %U https://www.jmir.org/2022/6/e37267 %U https://doi.org/10.2196/37267 %U http://www.ncbi.nlm.nih.gov/pubmed/35767333 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 5 %P e15719 %T The Quality of Indian Obesity-Related mHealth Apps: PRECEDE-PROCEED Model–Based Content Analysis %A Selvaraj,Shanmuga Nathan %A Sriram,Arulchelvan %+ Department of Media Sciences, College of Engineering, Anna University, No 12 Sardar Patel Rd, Guindy, Chennai, 600025, India, 91 99946 63036, shunmu.nathu@gmail.com %K obesity %K mHealth apps %K PRECEDE-PROCEED Model %K Mobile App Rating Scale %K health communication %K health behavior change techniques %K health information %D 2022 %7 11.5.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The prevalence of obesity in India is increasing at an alarming rate. Obesity-related mHealth apps have proffered an exciting opportunity to remotely deliver obesity-related information. This opportunity raises the question of whether such apps are truly effective. Objective: The aim of this study was to identify existing obesity-related mHealth apps in India and evaluate the potential of the apps’ contents to promote health behavior change. This study also aimed to discover the general quality of obesity-related mHealth apps. Methods: A systematic search for obesity-related mHealth apps was conducted in both the Google Play Store and the Apple App Store. The features and quality of the sample apps were assessed using the Mobile Application Rating Scale (MARS) and the potential of the sample apps’ contents to promote health behavior change was assessed using the PRECEDE-PROCEED Model (PPM). Results: A total of 13 apps (11 from the Google Play Store and 2 from the Apple App Store) were considered eligible for the study. The general quality of the 13 apps assessed using MARS resulted in mean scores ranging from 1.8 to 3.7. The bivariate Pearson correlation between the MARS rating and app user rating failed to establish statistically significant results. The multivariate regression analysis result indicated that the PPM factors are significant determinants of health behavior change (F3,9=63.186; P<.001) and 95.5% of the variance (R2=0.955; P<.001) in the dependent variable (health behavior change) can be explained by the independent variables (PPM factors). Conclusions: In general, mHealth apps are found to be more effective when they are based on theory. The presence of PPM factors in an mHealth app can greatly influence the likelihood of health behavior change among users. So, we suggest mHealth app developers consider this to develop efficient apps. Also, mHealth app developers should consider providing health information from credible sources and indicating the sources of the information, which will increase the perceived credibility of the apps among the users. We strongly recommend health professionals and health organizations be involved in the development of mHealth apps. Future research should include mHealth app users to understand better the apps’ effectiveness in bringing about health behavior change. %M 35544318 %R 10.2196/15719 %U https://mhealth.jmir.org/2022/5/e15719 %U https://doi.org/10.2196/15719 %U http://www.ncbi.nlm.nih.gov/pubmed/35544318 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e36753 %T Stigma Toward Bariatric Surgery in the Netherlands, France, and the United Kingdom: Protocol for a Cross-cultural Mixed Methods Study %A Garcia,Franshelis K %A Verkooijen,Kirsten T %A Veen,Esther J %A Mulder,Bob C %A Koelen,Maria A %A Hazebroek,Eric J %+ Health and Society, Department of Social Sciences, Wageningen University, Hollandseweg 1, Wageningen, 6706 KN, Netherlands, 31 (0) 317480292, franshelis.garcia@wur.nl %K bariatric surgery %K obesity surgery %K weight loss surgery %K stigma %K cross-cultural study %K France %K the Netherlands %K the United Kingdom %D 2022 %7 28.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Bariatric surgery is an effective procedure for the treatment of obesity. Despite this, only 0.1% to 2% of eligible individuals undergo surgery worldwide. The stigma surrounding surgery might be a reason for this. Thus far, no research has systematically studied the nature and implications of bariatric surgery stigma. The limited studies on bariatric surgery stigma are often conducted from the perspective of the public or health care professions and either use small and nonrepresentative samples or fail to capture the full essence and implications of the stigma altogether, including attitudes toward patients and perpetrators of the stigma. In addition, studies from patients’ perspectives are limited and tend to address bariatric surgery stigma superficially or implicitly. Finally, the extent to which cultural factors shape and facilitate this stigma and the experiences of patients have not yet been researched. Objective: This study aimed to explore the perceptions, experiences, and consequences of bariatric surgery stigma from the perspective of the public, health care professionals, and patients before and after bariatric surgery. Furthermore, although the concept of stigma is universal, every society has specific cultural norms and values that define acceptable attributes and behaviors for its members. Therefore, this study also aimed to explore the extent to which cultural factors influence bariatric surgery stigma by comparing the Netherlands, France, and the United Kingdom. Methods: This paper describes the protocol for a multiphase mixed methods research design. In the first part, we will conduct a scoping review to determine the current knowledge on bariatric surgery stigma and identify knowledge gaps. In the second part, semistructured interviews among patients before and after bariatric surgery will be conducted to explore their experiences and consequences of bariatric surgery stigma. In the third part, surveys will be conducted among both the public and health care professionals to determine the prevalence, nature, and impact of bariatric surgery stigma. Surveys and interviews will be conducted in the Netherlands, France, and the United Kingdom. Finally, data integration will be conducted at the interpretation and reporting levels. Results: The study began in September 2020 and will continue through September 2025. With the results of the review, we will create an overview of the current knowledge regarding bariatric surgery stigma from patients’ perspectives. Qualitative data will provide insights into patients’ experiences with bariatric surgery stigma. Quantitative data will provide information related to the prevalence and nature of bariatric surgery stigma from the perspective of the public and health care professionals. Both qualitative and quantitative data will be compared for each country. Conclusions: The findings from this study will lead to new insights that can be used to develop strategies to reduce bariatric surgery stigma and improve access, use, and outcomes of bariatric surgery. International Registered Report Identifier (IRRID): PRR1-10.2196/36753 %M 35482364 %R 10.2196/36753 %U https://www.researchprotocols.org/2022/4/e36753 %U https://doi.org/10.2196/36753 %U http://www.ncbi.nlm.nih.gov/pubmed/35482364 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 6 %N 1 %P e32348 %T Relations Between BMI Trajectories and Habitual Physical Activity Measured by a Smartwatch in the Electronic Cohort of the Framingham Heart Study: Cohort Study %A Hammond,Michael M %A Zhang,Yuankai %A Pathiravasan,Chathurangi H. %A Lin,Honghuang %A Sardana,Mayank %A Trinquart,Ludovic %A Benjamin,Emelia J %A Borrelli,Belinda %A Manders,Emily S %A Fusco,Kelsey %A Kornej,Jelena %A Spartano,Nicole L %A Kheterpal,Vik %A Nowak,Christopher %A McManus,David D %A Liu,Chunyu %A Murabito,Joanne M %+ Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, 715 Albany St., Boston, MA, 02118, United States, 1 508 935 3461, murabito@bu.edu %K mobile health %K BMI %K smartwatch %K physical activity %K cardiovascular diseases %K cardiology %K digital health %K mHealth %K mobile health apps %D 2022 %7 27.4.2022 %9 Original Paper %J JMIR Cardio %G English %X Background: The prevalence of obesity is rising. Most previous studies that examined the relations between BMI and physical activity (PA) measured BMI at a single timepoint. The association between BMI trajectories and habitual PA remains unclear. Objective: This study assesses the relations between BMI trajectories and habitual step-based PA among participants enrolled in the electronic cohort of the Framingham Heart Study (eFHS). Methods: We used a semiparametric group-based modeling to identify BMI trajectories from eFHS participants who attended research examinations at the Framingham Research Center over 14 years. Daily steps were recorded from the smartwatch provided at examination 3. We excluded participants with <30 days or <5 hours of smartwatch wear data. We used generalized linear models to examine the association between BMI trajectories and daily step counts. Results: We identified 3 trajectory groups for the 837 eFHS participants (mean age 53 years; 57.8% [484/837] female). Group 1 included 292 participants whose BMI was stable (slope 0.005; P=.75), group 2 included 468 participants whose BMI increased slightly (slope 0.123; P<.001), and group 3 included 77 participants whose BMI increased greatly (slope 0.318; P<.001). The median follow-up period for step count was 516 days. Adjusting for age, sex, wear time, and cohort, participants in groups 2 and 3 took 422 (95% CI –823 to –21) and 1437 (95% CI –2084 to –790) fewer average daily steps, compared with participants in group 1. After adjusting for metabolic and social risk factors, group 2 took 382 (95% CI –773 to 10) and group 3 took 1120 (95% CI –1766 to –475) fewer steps, compared with group 1. Conclusions: In this community-based eFHS, participants whose BMI trajectory increased greatly over time took significantly fewer steps, compared with participants with stable BMI trajectories. Our findings suggest that greater weight gain may correlate with lower levels of step-based physical activity. %M 35476038 %R 10.2196/32348 %U https://cardio.jmir.org/2022/1/e32348 %U https://doi.org/10.2196/32348 %U http://www.ncbi.nlm.nih.gov/pubmed/35476038 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e37279 %T Investigating New Sensory Methods Related to Taste Sensitivity, Preferences, and Diet of Mother-Infant Pairs and Their Relationship With Body Composition and Biomarkers: Protocol for an Explorative Study %A Fuchs-Neuhold,Bianca %A Staubmann,Wolfgang %A Peterseil,Marie %A Rath,Anna %A Schweighofer,Natascha %A Kronberger,Anika %A Riederer,Monika %A van der Kleyn,Moenie %A Martin,Jochen %A Hörmann-Wallner,Marlies %A Waldner,Irmgard %A Konrad,Manuela %A Aufschnaiter,Anna Lena %A Siegmund,Barbara %A Berghold,Andrea %A Holasek,Sandra %A Pail,Elisabeth %+ Health Perception Lab, Institute of Dietetics and Nutrition, FH JOANNEUM GmbH - University of Applied Sciences, Eggenberger Allee 11, Graz, 8010, Austria, 43 316 5453 ext 6726, bianca.fuchsneuhold@fh-joanneum.at %K taste %K preferences %K nutrition %K biomarkers %K body composition %K air displacement plethysmography %K Baby Facial Actions Coding System %K mother %K infant %K parenting %K pediatrics %K prenatal %K postnatal %D 2022 %7 27.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Early experiences with different flavors play an important role in infant development, including food and taste acceptance. Flavors are already perceived in utero with the development of the taste and olfactory system and are passed on to the child through breast and bottle feeding. Therefore, the first 1000 days of life are considered a critical window for infant developmental programming. Objective: The objective of our study is to investigate, both in the prenatal and postnatal period, taste sensitivity, preferences, and dietary diversity of mother-infant pairs. The explorative study design will also report on the impact of these variables on body composition (BC) and biomarkers. In contrast to conventional methods, this study involves long-term follow-up data collection from mother-infant pairs; moreover, the integration of audiovisual tools for recording infants' expressions pertaining to taste stimuli is a novelty of this study. Considering these new methodological approaches, the study aims to assess taste-related data in conjunction with BC parameters like fat-free mass or fat mass, biomarkers, and nutritional intake in infants and children. Methods: Healthy pregnant women aged between 18 and 50 years (BMI≥18.5 kg/m2 to ≤30 kg/m2; <28 weeks of gestation) were recruited from January 2014 to October 2014. The explorative design implies 2 center visits during pregnancy (24-28 weeks of gestation and 32-34 weeks of gestation) and 2 center visits after delivery (6-8 weeks postpartum and 14-16 weeks postpartum) as well as follow-up visits at 1, 3-3.5, and 6 years after delivery. Data collection encompasses anthropometric and biochemical measurements as well as BC analyses with air displacement plethysmography, taste perception assessments, and multicomponent questionnaires on demographics, feeding practices, and nutritional and lifestyle behaviors. Audiovisual data from infants’ reactions to sensory stimuli are collected and coded by trained staff using Baby Facial Action Coding and the Body Action Posture System. Birth outcomes and weight development are obtained from medical records, and additional qualitative data are gathered from 24 semistructured interviews. Results: Our cohort represents a homogenous group of healthy women with stringent exclusion criteria. A total of 54 women met the eligibility criteria, whereas 47 mother-child pairs completed data collection at 4 center visits during and after pregnancy. Follow-up phases, data analyses, and dissemination of the findings are scheduled for the end of 2023. The study was approved by the ethics committee of the Medical University of Graz (EC No 26–066 ex 13/14), and all participants provided informed consent. Conclusions: The results of this study could be useful for elucidating the connections between maternal and infant statuses regarding diet, taste, biomarkers, and prenatal and postnatal weight development. This study may also be relevant to the establishment of further diagnostic and interventional strategies targeting childhood obesity and early body fat development. International Registered Report Identifier (IRRID): DERR1-10.2196/37279 %M 35475790 %R 10.2196/37279 %U https://www.researchprotocols.org/2022/4/e37279 %U https://doi.org/10.2196/37279 %U http://www.ncbi.nlm.nih.gov/pubmed/35475790 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e29088 %T Effectiveness of Web-Based Personalized Nutrition Advice for Adults Using the eNutri Web App: Evidence From the EatWellUK Randomized Controlled Trial %A Zenun Franco,Rodrigo %A Fallaize,Rosalind %A Weech,Michelle %A Hwang,Faustina %A Lovegrove,Julie A %+ Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, University of Reading, Whiteknights, Reading, RG6 6DZ, United Kingdom, 44 0118 378 6418, j.a.lovegrove@reading.ac.uk %K personalized nutrition %K web-based %K nutrition app %K app %K dietary intervention %K eNutri %K precision nutrition %K mHealth %K healthy eating index %K diet quality scores %K FFQ %K food frequency questionnaire %K EatWellUK %D 2022 %7 25.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Evidence suggests that eating behaviors and adherence to dietary guidelines can be improved using nutrition-related apps. Apps delivering personalized nutrition (PN) advice to users can provide individual support at scale with relatively low cost. Objective: This study aims to investigate the effectiveness of a mobile web app (eNutri) that delivers automated PN advice for improving diet quality, relative to general population food-based dietary guidelines. Methods: Nondiseased UK adults (aged >18 years) were randomized to PN advice or control advice (population-based healthy eating guidelines) in a 12-week controlled, parallel, single-blinded dietary intervention, which was delivered on the web. Dietary intake was assessed using the eNutri Food Frequency Questionnaire (FFQ). An 11-item US modified Alternative Healthy Eating Index (m-AHEI), which aligned with UK dietary and nutritional recommendations, was used to derive the automated PN advice. The primary outcome was a change in diet quality (m-AHEI) at 12 weeks. Participant surveys evaluated the PN report (week 12) and longer-term impact of the PN advice (mean 5.9, SD 0.65 months, after completion of the study). Results: Following the baseline FFQ, 210 participants completed at least 1 additional FFQ, and 23 outliers were excluded for unfeasible dietary intakes. The mean interval between FFQs was 10.8 weeks. A total of 96 participants were included in the PN group (mean age 43.5, SD 15.9 years; mean BMI 24.8, SD 4.4 kg/m2) and 91 in the control group (mean age 42.8, SD 14.0 years; mean BMI 24.2, SD 4.4 kg/m2). Compared with that in the control group, the overall m-AHEI score increased by 3.5 out of 100 (95% CI 1.19-5.78) in the PN group, which was equivalent to an increase of 6.1% (P=.003). Specifically, the m-AHEI components nuts and legumes and red and processed meat showed significant improvements in the PN group (P=.04). At follow-up, 64% (27/42) of PN participants agreed that, compared with baseline, they were still following some (any) of the advice received and 31% (13/42) were still motivated to improve their diet. Conclusions: These findings suggest that the eNutri app is an effective web-based tool for the automated delivery of PN advice. Furthermore, eNutri was demonstrated to improve short-term diet quality and increase engagement in healthy eating behaviors in UK adults, as compared with population-based healthy eating guidelines. This work represents an important landmark in the field of automatically delivered web-based personalized dietary interventions. Trial Registration: ClinicalTrials.gov NCT03250858; https://clinicaltrials.gov/ct2/show/NCT03250858 %M 35468093 %R 10.2196/29088 %U https://www.jmir.org/2022/4/e29088 %U https://doi.org/10.2196/29088 %U http://www.ncbi.nlm.nih.gov/pubmed/35468093 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e29380 %T Weight Loss Trajectories and Related Factors in a 16-Week Mobile Obesity Intervention Program: Retrospective Observational Study %A Kim,Ho Heon %A Kim,Youngin %A Michaelides,Andreas %A Park,Yu Rang %+ Department of Biomedical Systems Informatics, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 010 5240 3434, yurangpark@yuhs.ac %K clustering %K mobile health %K weight loss %K weight management %K behavior management %K time series analysis %K mHealth %K obesity %K outcomes %K machine learning %K mobile app %K adherence %K prediction %K mobile phone %D 2022 %7 15.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: In obesity management, whether patients lose ≥5% of their initial weight is a critical factor in clinical outcomes. However, evaluations that take only this approach are unable to identify and distinguish between individuals whose weight changes vary and those who steadily lose weight. Evaluation of weight loss considering the volatility of weight changes through a mobile-based intervention for obesity can facilitate understanding of an individual’s behavior and weight changes from a longitudinal perspective. Objective: The aim of this study is to use a machine learning approach to examine weight loss trajectories and explore factors related to behavioral and app use characteristics that induce weight loss. Methods: We used the lifelog data of 13,140 individuals enrolled in a 16-week obesity management program on the health care app Noom in the United States from August 8, 2013, to August 8, 2019. We performed k-means clustering with dynamic time warping to cluster the weight loss time series and inspected the quality of clusters with the total sum of distance within the clusters. To identify use factors determining clustering assignment, we longitudinally compared weekly use statistics with effect size on a weekly basis. Results: The initial average BMI value for the participants was 33.6 (SD 5.9) kg/m2, and it ultimately reached 31.6 (SD 5.7) kg/m2. Using the weight log data, we identified five clusters: cluster 1 (sharp decrease) showed the highest proportion of participants who reduced their weight by >5% (7296/11,295, 64.59%), followed by cluster 2 (moderate decrease). In each comparison between clusters 1 and 3 (yo-yo) and clusters 2 and 3, although the effect size of the difference in average meal record adherence and average weight record adherence was not significant in the first week, it peaked within the initial 8 weeks (Cohen d>0.35) and decreased after that. Conclusions: Using a machine learning approach and clustering shape-based time series similarities, we identified 5 weight loss trajectories in a mobile weight management app. Overall adherence and early adherence related to self-monitoring emerged as potential predictors of these trajectories. %M 35436211 %R 10.2196/29380 %U https://www.jmir.org/2022/4/e29380 %U https://doi.org/10.2196/29380 %U http://www.ncbi.nlm.nih.gov/pubmed/35436211 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e33057 %T Pilot Results of a Digital Hypertension Self-management Program Among Adults With Excess Body Weight: Single-Arm Nonrandomized Trial %A Wilson-Anumudu,Folasade %A Quan,Ryan %A Cerrada,Christian %A Juusola,Jessie %A Castro Sweet,Cynthia %A Bradner Jasik,Carolyn %A Turken,Michael %+ Omada Health, Inc, 500 Sansome Street, Suite 200, San Francisco, CA, 94111, United States, 1 6502696532, folasade.anumudu@omadahealth.com %K hypertension %K self-management %K digital health %K home measurement %K lifestyle %D 2022 %7 30.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Home-measured blood pressure (HMBP) in combination with comprehensive medication support and lifestyle change are the mainstays of evidence-based hypertension (HTN) management. To date, the precise components needed for effective HTN self-management programs have yet to be defined, and access to multicomponent targeted support for HTN management that include telemonitoring remain inaccessible and costly. Objective: The aim of this pilot study was to evaluate the impact of a digital HTN self-management program on blood pressure (BP) control among adults with excess body weight. Methods: A single-arm, nonrandomized trial was performed to evaluate a digital HTN self-management program that combines comprehensive lifestyle counseling with HTN education, guided HMBP, support for taking medications, and led by either a registered nurse or certified diabetes care and education specialist. A sample of 151 participants were recruited using a web-based research platform (Achievement Studies, Evidation Health Inc). The primary outcome was change in systolic BP from baseline to 3 months, and secondary outcomes included change in diastolic BP and medication adherence. Results: Participants’ mean age was 44.0 (SD 9.3) years and mean BP was 139/85 mm Hg. At follow-up, systolic and diastolic BP decreased by 7 mm Hg (P<.001, 95% CI –9.3 to –4.7) and 4.7 mm Hg (P<.001, 95% CI –6.3 to –3.2), respectively. Participants who started with baseline BP at goal remained at goal. For participants with stage 1 HTN, systolic and diastolic BP decreased by 3.6 mm Hg (P=.09, 95% CI –7.8 to 0.6) and 2.5 mm Hg (P=.03, 95% CI –4.9 to –0.3). Systolic and diastolic BP decreased by 10.3 mm Hg (P<.001, 95% CI –13.4 to –7.1) and 6.5 mm Hg (P<.001, 95% CI –8.6 to –4.4), respectively, for participants with stage 2 HTN. Medication adherence significantly improved (P=.02). Conclusions: This pilot study provides initial evidence that a digital HTN self-management program improves BP and medication adherence. %M 35353040 %R 10.2196/33057 %U https://formative.jmir.org/2022/3/e33057 %U https://doi.org/10.2196/33057 %U http://www.ncbi.nlm.nih.gov/pubmed/35353040 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e25906 %T The Effectiveness of Physical Activity-Promoting Web- and Mobile-Based Distance Weight Loss Interventions on Body Composition in Rehabilitation Settings: Systematic Review, Meta-analysis, and Meta-Regression Analysis %A Lahtio,Heli %A Rintala,Aki %A Immonen,Jaakko %A Sjögren,Tuulikki %+ Faculty of Sport and Health Sciences, The University of Jyväskylä, Keskussairaalantie 4, Jyväskylä, 40014, Finland, 358 14 260 1211, heli.lahtio@gmail.com %K technology %K weight loss %K rehabilitation %K overweight %K obesity %K body mass index %K waist circumference %K body fat percentage %K mobile phone %D 2022 %7 24.3.2022 %9 Review %J J Med Internet Res %G English %X Background: Overweight and obesity are major problems worldwide, and they lead to an increased risk for several diseases. The use of technology in the treatment of obesity is promising, but in the existing literature, there is considerable uncertainty regarding its efficacy. In this review, we included web- and mobile-based weight loss interventions that were implemented remotely in rehabilitation settings. Objective: The aim of this systematic review is to study the effectiveness of physical activity-promoting web- and mobile-based distance weight loss interventions in rehabilitation settings on body composition in comparison with control groups that did not use technology. Methods: Studies were searched from 9 databases. The inclusion criteria were as follows: population: age 18-65 years; intervention: physical activity-promoting web- and mobile-based distance weight loss interventions; comparison: control groups without the use of technology; outcome: changes in BMI, waist circumference, or body fat percentage; study design: randomized controlled trial. The quality of the studies was assessed by 2 researchers. Meta-analysis was performed, and we also conducted a meta-regression analysis to evaluate the factors associated with the changes in body composition outcomes if statistical heterogeneity was observed. Results: The meta-analysis included 30 studies. The mean quality of the studies was 7 of 13 (SD 1.9; range 3-10). A statistically significant difference was observed in BMI (mean difference [MD] 0.83, 95% CI 0.51-1.15 kg/m2; P<.001), waist circumference (MD 2.45, 95% CI 1.83-3.07 cm; P<.001), and body fat percentage (MD 1.07%, 95% CI 0.74%-1.41%; P<.001) in favor of the weight loss groups using web- or mobile-based interventions. Meta-regression analyses found an association between personal feedback and BMI (P=.04), but other factors did not play a role in explaining statistical heterogeneity. Conclusions: Web- and mobile-based distance weight loss interventions significantly reduced BMI, waist circumference, and body fat percentage. Future studies should focus on the comparability of the intervention content. Future studies are needed to better understand weight loss and identify which components are essential in achieving it. Trial Registration: PROSPERO CRD42016035831; https://tinyurl.com/7c93tvd4 %M 35323126 %R 10.2196/25906 %U https://www.jmir.org/2022/3/e25906 %U https://doi.org/10.2196/25906 %U http://www.ncbi.nlm.nih.gov/pubmed/35323126 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e28692 %T Statistical Methods for Item Reduction in a Representative Lifestyle Questionnaire: Pilot Questionnaire Study %A Staffini,Alessio %A Fujita,Kento %A Svensson,Akiko Kishi %A Chung,Ung-Il %A Svensson,Thomas %+ Precision Health, Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan, 81 358414737, kishi@bioeng.t.u-tokyo.ac.jp %K item reduction %K surveys and lifestyle questionnaires %K feedback measures %K questionnaire design %K variance inflation factor %K factor analysis %K mobile phone %D 2022 %7 18.3.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: Reducing the number of items in a questionnaire while maintaining relevant information is important as it is associated with advantages such as higher respondent engagement and reduced response error. However, in health care, after the original design, an a posteriori check of the included items in a questionnaire is often overlooked or considered to be of minor importance. When conducted, this is often based on a single selected method. We argue that before finalizing any lifestyle questionnaire, a posteriori validation should always be conducted using multiple approaches to ensure the robustness of the results. Objective: The objectives of this study are to compare the results of two statistical methods for item reduction (variance inflation factor [VIF] and factor analysis [FA]) in a lifestyle questionnaire constructed by combining items from different sources and analyze the different results obtained from the 2 methods and the conclusions that can be made about the original items. Methods: Data were collected from 79 participants (heterogeneous in age and sex) with a high risk of metabolic syndrome working in a financial company based in Tokyo. The lifestyle questionnaire was constructed by combining items (asked with daily, weekly, and monthly frequency) from multiple validated questionnaires and other selected questions. Item reduction was conducted using VIF and exploratory FA. Adequacy tests were used to check the data distribution and sampling adequacy. Results: Among the daily and weekly questions, both VIF and FA identified redundancies in sleep-related items. Among the monthly questions, both approaches identified redundancies in stress-related items. However, the number of items suggested for reduction often differed: VIF suggested larger reductions than FA for daily questions but fewer reductions for weekly questions. Adequacy tests always confirmed that the structural detection was adequate for the considered items. Conclusions: As expected, our analyses showed that VIF and FA produced both similar and different findings, suggesting that questionnaire designers should consider using multiple methods for item reduction. Our findings using both methods indicate that many questions, especially those related to sleep, are redundant, indicating that the considered lifestyle questionnaire can be shortened. %M 35302507 %R 10.2196/28692 %U https://www.i-jmr.org/2022/1/e28692 %U https://doi.org/10.2196/28692 %U http://www.ncbi.nlm.nih.gov/pubmed/35302507 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 5 %N 1 %P e34772 %T Vitiligo and Metabolic Syndrome: Systematic Review and Meta-Analysis %A Xia,Joyce %A Melian,Christina %A Guo,William %A Usmani,Hunya %A Clark,Richard %A Lozeau,Daniel %+ Renaissance School of Medicine, Stony Brook University, 101 Nicolls Rd, Stony Brook, NY, 11794, United States, 1 7185010945, joyce.xia@stonybrookmedicine.edu %K vitiligo %K leukoderma %K metabolic syndrome X %K dysmetabolic syndrome X %K insulin resistance syndrome X %K syndrome X %D 2022 %7 16.3.2022 %9 Review %J JMIR Dermatol %G English %X Background: Metabolic syndrome (MetS) has been associated with various skin conditions including vitiligo. However, the association between these 2 conditions has yet to be determined by quantitative meta-analysis. Objective: The aim of this paper was to determine the association between vitiligo and metabolic syndrome via systematic review and meta-analysis. Methods: A systematic literature search of Pubmed, Embase, Cochrane, and Web of Science was performed for all published literature prior to August 16, 2020. Case control and prospective cross-sectional studies analyzing the association between vitiligo and MetS were included in this review. The primary outcome measures include the type of vitiligo, diagnostic criteria for MetS, components of MetS (waist circumference, blood pressure, triglycerides, fasting glycemic index, and high-density lipoprotein cholesterol), low-density lipoprotein cholesterol levels, and BMI. A meta-analysis was performed to evaluate the prevalence and association of MetS in patients with vitiligo. Results: A total of 6 studies (n=734 participants) meeting eligibility criteria were included for systematic review and meta-analysis. The pooled prevalence of MetS in patients with vitiligo was (0.296, 95% CI 0.206, 0.386; P<.001). Patients with vitiligo were no more likely to develop MetS compared to control patients (odds ratio 1.66, 95% CI 0.83, 3.33; P=.01). A leave-one-out sensitivity analysis showed a significant association between MetS and vitiligo (P<.001). Significant elevations in fasting glycemic index (mean difference 5.35, 95% CI 2.77, 7.93; P<.001) and diastolic blood pressure (mean difference 1.97, 95% CI 0.02, 3.92; P=.05) were observed in patients with vitiligo compared to control patients. Conclusions: The association between vitiligo and metabolic syndrome carries important clinical implications. Dermatologists and other multidisciplinary team members should remain vigilant when treating this patient population in order to prevent serious cardiovascular complications that may arise as a result of metabolic disease. %M 37632859 %R 10.2196/34772 %U https://derma.jmir.org/2022/1/e34772 %U https://doi.org/10.2196/34772 %U http://www.ncbi.nlm.nih.gov/pubmed/37632859 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e29782 %T Designing Digital Health Technology to Support Patients Before and After Bariatric Surgery: Qualitative Study Exploring Patient Desires, Suggestions, and Reflections to Support Lifestyle Behavior Change %A Robinson,Anna %A Husband,Andrew %A Slight,Robert %A Slight,Sarah P %+ School of Pharmacy, Newcastle University, King George VI Building, Newcastle University, Newcastle upon Tyne, NE1 7RU, United Kingdom, 44 191 208 6000, Sarah.slight@newcastle.ac.uk %K digital technology %K eHealth %K mHealth %K bariatric surgery %K behavior change %K qualitative research %K co-design %K perioperative care %K mobile phone %D 2022 %7 4.3.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: A patient’s capability, motivation, and opportunity to change their lifestyle are determinants of successful outcomes following bariatric surgery. Lifestyle changes before and after surgery, including improved dietary intake and physical activity levels, have been associated with greater postsurgical weight loss and improved long-term health. Integrating patient-centered digital technologies within the bariatric surgical pathway could form part of an innovative strategy to promote and sustain healthier behaviors, and provide holistic patient support, to improve surgical success. Previous research focused on implementing digital technologies and measuring effectiveness in surgical cohorts. However, there is limited work concerning the desires, suggestions, and reflections of patients undergoing bariatric surgery. This qualitative investigation explores patients’ perspectives on technology features that would support behavior changes during the pre- and postoperative periods, to potentially maintain long-term healthy lifestyles following surgery. Objective: This study aims to understand how digital technologies can be used to support patient care during the perioperative journey to improve weight loss outcomes and surgical success, focusing on what patients want from digital technologies, how they want to use them, and when they would be of most benefit during their surgical journey. Methods: Patients attending bariatric surgery clinics in one hospital in the North of England were invited to participate. Semistructured interviews were conducted with purposively sampled pre- and postoperative patients to discuss lifestyle changes and the use of digital technologies to complement their care. The interviews were audio recorded and transcribed verbatim. Reflexive thematic analysis enabled the development of themes from the data. Ethical approval was obtained from the National Health Service Health Research Authority. Results: A total of 20 patients were interviewed (preoperative phase: 40% (8/20); postoperative phase: 60% (12/20). A total of 4 overarching themes were developed and related to the optimization of technology functionality. These centered on providing tailored content and support; facilitating self-monitoring and goal setting; delivering information in an accessible, trusted, and usable manner; and meeting patient information-seeking and engagement needs during the surgical pathway. Functionalities that delivered personalized feedback and postoperative follow-up were considered beneficial. Individualized goal setting functionality could support a generation of digitally engaged patients with bariatric conditions as working toward achievable targets was deemed an effective strategy for motivating behavior change. The creation of digital package of care checklists between patients and clinicians was a novel finding from this study. Conclusions: Perceptions of patients undergoing bariatric surgery validated the integration of digital technologies within the surgical pathway, offering enhanced connectedness and support. Recommendations are made relating to the design, content, and functionality of digital interventions to best address the needs of this cohort. These findings have the potential to influence the co-design and integration of person-centered, perioperative technologies. %M 35254271 %R 10.2196/29782 %U https://humanfactors.jmir.org/2022/1/e29782 %U https://doi.org/10.2196/29782 %U http://www.ncbi.nlm.nih.gov/pubmed/35254271 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 2 %P e25890 %T Effectiveness of Mobile Phone and Web-Based Interventions for Diabetes and Obesity Among African American and Hispanic Adults in the United States: Systematic Review %A Enyioha,Chineme %A Hall,Matthew %A Voisin,Christiane %A Jonas,Daniel %+ Department of Family Medicine, University of North Carolina at Chapel Hill, 590 Manning Drive, Chapel Hill, NC, 27514, United States, 1 9849744888, chineme_enyioha@med.unc.edu %K mHealth %K mobile health %K technology %K diabetes %K obesity %K African American %K Hispanic %D 2022 %7 4.2.2022 %9 Review %J JMIR Public Health Surveill %G English %X Background: Mobile health (mHealth) and web-based technological advances allow for new approaches to deliver behavioral interventions for chronic diseases such as obesity and diabetes. African American and Hispanic adults experience a disproportionate burden of major chronic diseases. Objective: This paper reviews the evidence for mHealth and web-based interventions for diabetes and obesity in African American and Hispanic adults. Methods: Literature searches of PubMed/Medline, The Cochrane Library, EMBASE, CINAHL Plus, Global Health, Scopus, and Library & Information Science Source were conducted for relevant English-language articles. Articles identified through searches were reviewed by 2 investigators and, if they met the inclusion criteria, were extracted and assessed for risk of bias. Findings were summarized in tabular and narrative format. The overall strength of the evidence was assessed as high, moderate, low, or insufficient on the basis of risk of bias, consistency of findings, directness, precision, and other limitations. Results: Searches yielded 2358 electronic publications, 196 reports were found to be eligible for inclusion, and 7 studies met the eligibility criteria. All 7 included studies were randomized control trials. Five studies evaluated the effectiveness of an mHealth intervention for weight loss, including one that evaluated the effectiveness for diabetes and two studies focused on diabetes. Of all the studies that focused on weight loss, 3 reported significant differences in weight loss in participants in the intervention group compared with those in the usual care group. Although all studies on diabetes control showed greater improvement in glycemic control for the intervention group compared to that in the control group, only one study showed a significant difference between the 2 groups. Conclusions: This analysis indicates that there are few published studies that assessed mHealth interventions among minority populations and focused on weight or diabetes. Although the overall strength of evidence was low for diabetes control, it was moderate for weight loss, and our findings suggest that mHealth and web-based interventions may provide a promising approach for interventions among African American and Hispanic adults who have obesity or diabetes. %M 35119368 %R 10.2196/25890 %U https://publichealth.jmir.org/2022/2/e25890 %U https://doi.org/10.2196/25890 %U http://www.ncbi.nlm.nih.gov/pubmed/35119368 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e30416 %T Long-term Effectiveness of a Smartphone App Combined With a Smart Band on Weight Loss, Physical Activity, and Caloric Intake in a Population With Overweight and Obesity (Evident 3 Study): Randomized Controlled Trial %A Lugones-Sanchez,Cristina %A Recio-Rodriguez,Jose I %A Agudo-Conde,Cristina %A Repiso-Gento,Irene %A G Adalia,Esther %A Ramirez-Manent,José Ignacio %A Sanchez-Calavera,Maria Antonia %A Rodriguez-Sanchez,Emiliano %A Gomez-Marcos,Manuel A %A Garcia-Ortiz,Luis %A , %+ Primary Care Research Unit of Salamanca (APISAL), Institute of Biomedical Research of Salamanca, Health Service of Castilla y León, Avda Portugal 83, 2nd Fl., Salamanca, 37005, Spain, 34 923291100 ext 54750, crislugsa@gmail.com %K mobile app %K telemedicine %K eHealth %K weight control %K exercise %K obesity %K mobile phone %D 2022 %7 1.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Multicomponent mobile health approaches can improve lifestyle intervention results, although little is known about their long-term effectiveness. Objective: This study aims to evaluate the long-term effectiveness (12 months) of a multicomponent mobile health intervention—combining a smartphone app, an activity tracker wristband, and brief counseling, compared with a brief counseling group only—on weight loss and improving body composition, physical activity, and caloric intake in Spanish sedentary adults with overweight or obesity. Methods: We conducted a randomized controlled, multicenter clinical trial (Evident 3). A total of 650 participants were recruited from 5 primary care centers, with 318 participants in the intervention group (IG) and 332 in the control group (CG). All participants were briefly counseled about a healthy diet and physical activity at the baseline visit. For the 3-month intervention period, the IG received training to use the app to promote healthy lifestyles and the smart band (Mi Band 2, Xiaomi). All measurements were performed at baseline and at 3 and 12 months. Physical activity was measured using the International Physical Activity Questionnaire–Short Form. Nutritional habits were assessed using the Food Frequency Questionnaire and Adherence to Mediterranean diet questionnaire. Results: Of the 650 participants included, 563 (86.6%) completed the 3-month visit and 443 (68.2%) completed the 12-month visit. After 12 months, the IG showed net differences in weight (−0.26, 95% CI −1.21 to 0.70 kg; P=.02), BMI (−0.06, 95% CI −0.41 to 0.28 points; P=.01), waist-height ratio (−0.25, 95% CI −0.94 to 0.44; P=.03), body adiposity index (−0.33, 95% CI −0.77 to 0.11; P=.03), waist circumference (−0.48, 95% CI −1.62 to 0.66 cm, P=.04) and hip circumference (−0.69, 95% CI –1.62 to 0.25 cm; P=.03). Both groups lowered daily caloric intake and increased adherence to the Mediterranean diet, with no differences between the groups. The IG increased light physical activity time (32.6, 95% CI −30.3 to 95.04 min/week; P=.02) compared with the CG. Analyses by subgroup showed changes in body composition variables in women, people aged >50 years, and married people. Conclusions: The low-intensity intervention of the Evident 3 study showed, in the IG, benefits in weight loss, some body composition variables, and time spent in light physical activity compared with the CG at 3 months, but once the devices were collected, the downward trend was not maintained at the 12-month follow-up. No differences in nutritional outcomes were observed between the groups. Trial Registration: ClinicalTrials.gov NCT03175614; https://clinicaltrials.gov/ct2/show/NCT03175614 International Registered Report Identifier (IRRID): RR2-10.1097/MD.0000000000009633 %M 35103609 %R 10.2196/30416 %U https://www.jmir.org/2022/2/e30416 %U https://doi.org/10.2196/30416 %U http://www.ncbi.nlm.nih.gov/pubmed/35103609 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e31989 %T A Remote Health Coaching, Text-Based Walking Program in Ethnic Minority Primary Care Patients With Overweight and Obesity: Feasibility and Acceptability Pilot Study %A Smart,Mary H %A Nabulsi,Nadia A %A Gerber,Ben S %A Gupta,Itika %A Di Eugenio,Barbara %A Ziebart,Brian %A Sharp,Lisa K %+ Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, 833 South Wood St, Chicago, IL, 60612, United States, 1 312 355 3569, sharpl@uic.edu %K mHealth %K Fitbit %K SMART goals %K texting %K health coach %K mobile phone %D 2022 %7 19.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Over half of US adults have at least one chronic disease, including obesity. Although physical activity is an important component of chronic disease self-management, few reach the recommended physical activity goals. Individuals who identify as racial and ethnic minorities are disproportionally affected by chronic diseases and physical inactivity. Interventions using consumer-based wearable devices have shown promise for increasing physical activity among patients with chronic diseases; however, populations with the most to gain, such as minorities, have been poorly represented to date. Objective: This study aims to assess the feasibility, acceptability, and preliminary outcomes of an 8-week text-based coaching and Fitbit program aimed at increasing the number of steps in a predominantly overweight ethnic minority population. Methods: Overweight patients (BMI >25 kg/m2) were recruited from an internal medicine clinic located in an inner-city academic medical center. Fitbit devices were provided. Using 2-way SMS text messaging, health coaches (HCs) guided patients to establish weekly step goals that were specific, measurable, attainable, realistic, and time-bound. SMS text messaging and Fitbit activities were managed using a custom-designed app. Program feasibility was assessed via the recruitment rate, retention rate (the proportion of eligible participants completing the 8-week program), and patient engagement (based on the number of weekly text message goals set with the HC across the 8-week period). Acceptability was assessed using a qualitative, summative evaluation. Exploratory statistical analysis included evaluating the average weekly steps in week 1 compared with week 8 using a paired t test (2-tailed) and modeling daily steps over time using a linear mixed model. Results: Of the 33 patients initially screened; 30 (91%) patients were enrolled in the study. At baseline, the average BMI was 39.3 (SD 9.3) kg/m2, with 70% (23/33) of participants presenting as obese. A total of 30% (9/30) of participants self-rated their health as either fair or poor, and 73% (22/30) of participants set up ≥6 weekly goals across the 8-week program. In total, 93% (28/30) of participants completed a qualitative summative evaluation, and 10 themes emerged from the evaluation: patient motivation, convenient SMS text messaging experience, social support, supportive accountability, technology support, self-determined goals, achievable goals, feedback from Fitbit, challenges, and habit formation. There was no significant group change in the average weekly steps for week 1 compared with week 8 (mean difference 7.26, SD 6209.3; P=.99). However, 17% (5/30) of participants showed a significant increase in their daily steps. Conclusions: Overall, the results demonstrate the feasibility and acceptability of a remotely delivered walking study that included an HC; SMS text messaging; a wearable device (Fitbit); and specific, measurable, attainable, realistic, and time-bound goals within an ethnic minority patient population. Results support further development and testing in larger samples to explore efficacy. %M 35044308 %R 10.2196/31989 %U https://formative.jmir.org/2022/1/e31989 %U https://doi.org/10.2196/31989 %U http://www.ncbi.nlm.nih.gov/pubmed/35044308 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e27192 %T Effect of an Integrative Mobile Health Intervention in Patients With Hypertension and Diabetes: Crossover Study %A Oh,Sang Woo %A Kim,Kyoung-Kon %A Kim,Sung Soo %A Park,Su Kyung %A Park,Sangshin %+ Department of Family Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, 27, Dongguk-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10326, Republic of Korea, 82 31 961 7490, osw6021@naver.com %K diabetes mellitus type 2 %K obesity %K hypertension %K mHealth %K mobile phone %D 2022 %7 11.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Obesity, hypertension, and type 2 diabetes mellitus (T2DM) are worldwide epidemics that inflict burdens on both public health and health care costs. Self-management plays an important role in the proper management of these 3 chronic diseases, and in this context, mobile health (mHealth) can be a cost-effective self-management tool. Objective: The aim of this pilot study is to evaluate the effects of an integrative mHealth approach for obesity, hypertension, and T2DM on body fat, blood pressure, and blood glucose levels and demonstrate the clinical outcomes. The participants were patients aged 40 to 70 years who were treated for T2DM (hemoglobin A1c [HbA1c] above 6.0%) without insulin or hypertension and obesity, controlled with pharmacotherapy. Methods: This pilot study was performed using a controlled, randomized, 3-month, 2-period crossover design. A total of 37 participants were recruited from 2 university hospitals in South Korea. Integrative mHealth comprised 4 parts: self-measuring home devices for monitoring blood glucose and blood pressure; 2 smartphone apps, where one gathered lifestyle data, giving them feedback with health information, and the other provided drug information and reminders of the medication schedule; unmanned kiosks for official measurement of blood pressure and body composition; and web-based access to participants’ health information. Results: Data from the 32 participants were analyzed. Their mean HbA1c level was 7.5% (SD 0.8, ranging from 6.1% to 9.4%). Approximately 38% (12/32) of the participants had hypertension. BMIs of all participants except 1 were >23 kg/m2. The input rates of food intake and exercise to the smartphone app were very low (24.9% and 5.3%, respectively). On the contrary, the input rate of medicine intake was high (84.0%). Moreover, there was no significant difference in the input rate of taking medicine irrespective of whether the mHealth period was before or after the conventional treatment period (80.3% and 87.3%, respectively; P=.06). Among the 3 input functions of food intake, exercise, and medicine intake in smartphone apps, the input of medicine intake was a more helpful, easier to use, and better-designed function than the others. There were no significant differences in changes in body weight (−0.519 kg vs 0 kg), BMI (−0.133 kg/m2 vs −0.167 kg/m2), body composition (body fat −0.255% vs 0.172%), blood pressure (systolic −0.226 mm Hg vs −2.839 mm Hg), and HbA1c (−0.269% vs –0.009%) between the integrative mHealth and conventional treatment groups. However, in proportion to the elevation in the input rate of taking medicine, body fat mass (P=.04) and HbA1c (P=.03) were lower in the integrative mHealth group. Conclusions: Although smartphone apps can influence body fat and blood glucose levels, they have failed to show clinical improvement. A higher input rate of taking medicine was related to significantly lower body fat mass and HbA1c levels. %M 35014961 %R 10.2196/27192 %U https://mhealth.jmir.org/2022/1/e27192 %U https://doi.org/10.2196/27192 %U http://www.ncbi.nlm.nih.gov/pubmed/35014961 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e19750 %T Short-Term and Long-Term Renal Outcomes in Patients With Obesity After Minimally Invasive Versus Open Partial Nephrectomy for the Treatment of Renal Cancer: Retrospective Study %A Flippo,Brittany %A Stone,Bradley %A Stahr,Shelbie %A Khalil,Mahmoud %A Davis,Rodney %A Kamel,Mohamed %A Singh,Manisha %+ University of Arkansas for Medical Sciences, #501, 4301 West Markham st, Little Rock, AR, 72205, United States, 1 5012405804, msingh@uams.edu %K renal outcomes %K renal cell carcinoma %K minimally invasive vs open partial nephrectomy %K obesity %K kidney %K cancer %K surgery %K retrospective %K outcome %K short-term %K long-term %D 2022 %7 10.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Obesity is significantly associated with renal cell carcinoma. Surgery is the preferred treatment for demarcated lesions of renal cell carcinoma; however, obesity increases the complexity of surgical outcomes. Minimally invasive surgical techniques are preferred over open partial nephrectomy (OPN), but controversy remains regarding the most efficacious technique in patients with obesity. Objective: This study aims to determine whether minimally invasive partial nephrectomy (MIPN) or OPN better preserves renal function and investigate short- and long-term renal outcomes in patients with obesity undergoing a partial nephrectomy. Methods: We conducted a retrospective chart review of 242 adult patients aged ≥18 years who underwent MIPN or OPN between January 1, 2005, and December 31, 2016, at the University of Arkansas for Medical Sciences. Using creatinine as a measure of kidney function, patients’ preoperative levels were compared with their postoperative levels in 2-time frames: short (3-6 months postsurgery) or long (>6 months). The primary outcome was the change in creatinine values from preoperative to >6 months postoperatively in patients with obesity. Secondary outcomes included the change in creatinine values from preoperative to 3 to 6 months postoperatively in patients with obesity who underwent MIPN versus OPN. We also analyzed the creatinine values of nonobese patients (BMI <30) who underwent partial nephrectomy using the same time frames. Unconditional logistic regression was used to estimate crude and multivariable-adjusted odds ratios (ORs) and 95% CI to observe associations between surgery type and changes in creatinine values from while stratifying for obesity. Results: A total of 140 patients were included in the study, of whom 75 were obese and 65 were nonobese. At >6 months after MIPN (n=20), the odds of patients with obesity having a decrease or no change in creatinine values was 1.24 times higher than those who had OPN (n=13; OR 1.24, 95% CI 0.299-6.729; P=.80). At 3 to 6 months after MIPN (n=27), the odds were 0.62 times lower than those after OPN (n=17; OR 0.62, 95% CI 0.140-2.753; P=.56). In the nonobese group, at 3 to 6 months after undergoing minimally invasive surgery (n=18), the odds of having a decrease or no change in creatinine values was 4.86 times higher than those who had open surgery (n=21; OR 4.86, 95% CI 1.085-21.809; P=.04). At more than 6 months after MIPN (n=14), the odds were 4.13 times higher than those after OPN (n=11; OR 4.13, 95% CI 0.579-29.485; P=.16). Conclusions: We observed a nonstatistically significant preservation of renal function in patients with obesity who underwent OPN at 3 to 6 months postoperatively. Conversely, after 6 months, the same was true for MIPN, indicating the long-term benefit of MIPN. In the nonobese group, MIPN was favored over OPN.  %M 35006078 %R 10.2196/19750 %U https://formative.jmir.org/2022/1/e19750 %U https://doi.org/10.2196/19750 %U http://www.ncbi.nlm.nih.gov/pubmed/35006078 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e31801 %T Development of a Web-Based, Guided Self-help, Acceptance and Commitment Therapy–Based Intervention for Weight Loss Maintenance: Evidence-, Theory-, and Person-Based Approach %A Richards,Rebecca %A Jones,Rebecca A %A Whittle,Fiona %A Hughes,Carly A %A Hill,Andrew J %A Lawlor,Emma R %A Bostock,Jennifer %A Bates,Sarah %A Breeze,Penny R %A Brennan,Alan %A Thomas,Chloe V %A Stubbings,Marie %A Woolston,Jennifer %A Griffin,Simon J %A Ahern,Amy L %+ Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Level 3 Institute of Metabolic Science, Cambridge, CB2 0SL, United Kingdom, 44 1223 769129, Rebecca.richards@mrc-epid.cam.ac.uk %K weight management %K eHealth %K acceptance and commitment therapy %K third-wave cognitive behavioral therapy %K guided self-help %D 2022 %7 7.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The long-term impact and cost-effectiveness of weight management programs depend on posttreatment weight maintenance. There is growing evidence that interventions based on third-wave cognitive behavioral therapy, particularly acceptance and commitment therapy (ACT), could improve long-term weight management; however, these interventions are typically delivered face-to-face by psychologists, which limits the scalability of these types of intervention. Objective: The aim of this study is to use an evidence-, theory-, and person-based approach to develop an ACT-based intervention for weight loss maintenance that uses digital technology and nonspecialist guidance to minimize the resources needed for delivery at scale. Methods: Intervention development was guided by the Medical Research Council framework for the development of complex interventions in health care, Intervention Mapping Protocol, and a person-based approach for enhancing the acceptability and feasibility of interventions. Work was conducted in two phases: phase 1 consisted of collating and analyzing existing and new primary evidence and phase 2 consisted of theoretical modeling and intervention development. Phase 1 included a synthesis of existing evidence on weight loss maintenance from previous research, a systematic review and network meta-analysis of third-wave cognitive behavioral therapy interventions for weight management, a qualitative interview study of experiences of weight loss maintenance, and the modeling of a justifiable cost for a weight loss maintenance program. Phase 2 included the iterative development of guiding principles, a logic model, and the intervention design and content. Target user and stakeholder panels were established to inform each phase of development, and user testing of successive iterations of the prototype intervention was conducted. Results: This process resulted in a guided self-help ACT-based intervention called SWiM (Supporting Weight Management). SWiM is a 4-month program consisting of weekly web-based sessions for 13 consecutive weeks followed by a 4-week break for participants to reflect and practice their new skills and a final session at week 18. Each session consists of psychoeducational content, reflective exercises, and behavioral experiments. SWiM includes specific sessions on key determinants of weight loss maintenance, including developing skills to manage high-risk situations for lapses, creating new helpful habits, breaking old unhelpful habits, and learning to manage interpersonal relationships and their impact on weight management. A trained, nonspecialist coach provides guidance for the participants through the program with 4 scheduled 30-minute telephone calls and 3 further optional calls. Conclusions: This comprehensive approach facilitated the development of an intervention that is based on scientific theory and evidence for supporting people with weight loss maintenance and is grounded in the experiences of the target users and the context in which it is intended to be delivered. The intervention will be refined based on the findings of a planned pilot randomized controlled trial. %M 34994698 %R 10.2196/31801 %U https://formative.jmir.org/2022/1/e31801 %U https://doi.org/10.2196/31801 %U http://www.ncbi.nlm.nih.gov/pubmed/34994698 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e32441 %T Using Interactive Text Messaging to Improve Diet Quality and Increase Redemption of Foods Approved by the Special Supplemental Nutrition Program for Women, Infants, and Children: Protocol for a Cohort Feasibility Study %A Kay,Melissa C %A Hammad,Nour M %A Herring,Sharon J %A Bennett,Gary G %+ Duke University, 310 Trent Dr., Durham, NC, 27708, United States, 1 7812493062, melissa.kay@duke.edu %K WIC %K diet quality %K digital health %K text messaging %K mothers %K postpartum %K child obesity %K mobile phone %D 2021 %7 15.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Children in the United States eat too few fruits, vegetables, and whole grains and too many energy-dense foods; these dietary behaviors are associated with increased risk of obesity. Maternal diet plays a key role in shaping children's diets; however, many mothers have poor diet quality, especially those living in low-income households. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federal nutrition assistance program that provides mothers and children with nutrient-dense foods, and those who participate have better diet quality. However, many mothers do not redeem all their WIC-approved foods. Thus, there is a need to create effective interventions to improve diet quality, especially among low-income children and families. Objective: This paper aims to describe the development and protocol for a study to evaluate the feasibility, satisfaction, and preliminary efficacy of a fully automated text messaging intervention as a strategy to improve maternal diet quality and the redemption of WIC-approved foods. Methods: We describe the use of the framework developed for the description of nonrandomized feasibility studies. Using an observational, prospective cohort study design, we will recruit mothers enrolled in WIC with a child aged ≤2 years. Participants will receive automated SMS text messages aimed at improving the redemption of WIC-approved foods to improve the participants’ diet quality for 12 weeks. All outcome measures will be analyzed using descriptive and inferential statistics. Qualitative data will be analyzed using thematic analysis. Results: Data collection for this study began in March 2021. We expect the study results to be available within 9 months of study commencement. The results will shed light on the feasibility, acceptability, and effectiveness of using automated text messages as a behavior change strategy for mothers enrolled in WIC. Conclusions: The results of this pilot study will explore whether this digital behavioral intervention, which will deliver nutrition guidance in accordance with the Dietary Guidelines for Americans using interactive self-monitoring and feedback, is feasible and acceptable. This will lay the foundation for a larger evaluation to determine efficacy for improving diet quality in those most at risk for obesity. Trial Registration: ClinicalTrials.gov NCT04098016; https://clinicaltrials.gov/ct2/show/NCT04098016 International Registered Report Identifier (IRRID): DERR1-10.2196/32441 %M 34914616 %R 10.2196/32441 %U https://www.researchprotocols.org/2021/12/e32441 %U https://doi.org/10.2196/32441 %U http://www.ncbi.nlm.nih.gov/pubmed/34914616 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e29916 %T Adoption and Appropriateness of mHealth for Weight Management in the Real World: A Qualitative Investigation of Patient Perspectives %A Breland,Jessica Y %A Agha,Khizran %A Mohankumar,Rakshitha %+ Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA, 94025, United States, 1 650 493 5000, jessica.breland@va.gov %K mHealth %K implementation %K adoption %K engagement %K weight management %K obesity %K weight loss %K mobile health %K veterans %K barriers %D 2021 %7 8.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) interventions for weight management can result in weight loss outcomes comparable to in-person treatments. However, there is little information on implementing these treatments in real-world settings. Objective: This work aimed to answer two implementation research questions related to mHealth for weight management: (1) what are barriers and facilitators to mHealth adoption (initial use) and engagement (continued use)? and (2) what are patient beliefs about the appropriateness (ie, perceived fit, relevance, or compatibility) of mHealth for weight management? Methods: We conducted semistructured interviews with patients with obesity at a single facility in an integrated health care system (the Veterans Health Administration). All participants had been referred to a new mHealth program, which included access to a live coach. We performed a rapid qualitative analysis of interviews to identify themes related to the adoption of, engagement with, and appropriateness of mHealth for weight management. Results: We interviewed 24 veterans, seven of whom used the mHealth program. Almost all participants were ≥45 years of age and two-thirds were White. Rapid analysis identified three themes: (1) coaching both facilitates and prevents mHealth adoption and engagement by promoting accountability but leading to guilt among those not meeting goals; (2) preferences regarding the mode of treatment delivery, usability, and treatment content were barriers to mHealth appropriateness and adoption, including preferences for in-person care and a dislike of self-monitoring; and (3) a single invitation was not sufficient to facilitate adoption of a new mHealth program. Themes were unrelated to participants’ age, race, or ethnicity. Conclusions: In a study assessing real-world use of mHealth in a group of middle-aged and older adults, we found that—despite free access to mHealth with a live coach—most did not complete the registration process. Our findings suggest that implementing mHealth for weight management requires more than one information session. Findings also suggest that focusing on the coaching relationship and how users’ lives and goals change over time may be an important way to facilitate engagement and improved health. Most participants thought mHealth was appropriate for weight management, with some nevertheless preferring in-person care. Therefore, the best way to guarantee equitable care will be to ensure multiple routes to achieving the same behavioral health goals. Veterans Health Administration patients have the option of using mHealth for weight management, but can also attend group weight management programs or single-session nutrition classes or access fitness facilities. Health care policy does not allow such access for most people in the United States; however, expanded access to behavioral weight management is an important long-term goal to ensure health for all. %M 34889761 %R 10.2196/29916 %U https://formative.jmir.org/2021/12/e29916 %U https://doi.org/10.2196/29916 %U http://www.ncbi.nlm.nih.gov/pubmed/34889761 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e28242 %T Impact of a Mobile Telerehabilitation Solution on Metabolic Health Outcomes and Rehabilitation Adherence in Patients With Obesity: Randomized Controlled Trial %A Bughin,François %A Bui,Gaspard %A Ayoub,Bronia %A Blervaque,Leo %A Saey,Didier %A Avignon,Antoine %A Brun,Jean Frédéric %A Molinari,Nicolas %A Pomies,Pascal %A Mercier,Jacques %A Gouzi,Fares %A Hayot,Maurice %+ PhyMedExp, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Avenue Doyen Gaston Giraud, Montpellier, 34090, France, 33 467338284, f-bughin@chu-montpellier.fr %K telerehabilitation %K mHealth %K rehabilitation %K obesity %K mobile phone %D 2021 %7 6.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Obesity is a major public health issue. Combining exercise training, nutrition, and therapeutic education in metabolic rehabilitation (MR) is recommended for obesity management. However, evidence from randomized controlled studies is lacking. In addition, MR is associated with poor patient adherence. Mobile health devices improve access to MR components. Objective: The aim of this study is to compare the changes in body composition, anthropometric parameters, exercise capacity, and quality of life (QOL) within 12 weeks of patients in the telerehabilitation (TR) program to those of usual care patients with obesity. Methods: This was a parallel-design randomized controlled study. In total, 50 patients with obesity (BMI>30 kg/m²) were included in a TR group (TRG) or a usual care group (UCG) for 12 weeks. Patients underwent biometric impedance analyses, metabolic exercise tests, actimetry, and QOL and satisfaction questionnaires. The primary outcome was the change in fat mass at 12 weeks from baseline. Secondary outcomes were changes in body weight, metabolic parameters, exercise capacity, QOL, patients’ adhesion, and satisfaction. Results: A total of 49 patients completed the study. No significant group × time interaction was found for fat mass (TRG: mean 1.7 kg, SD 2.6 kg; UCG: mean 1.2 kg, SD 2.4 kg; P=.48). Compared with the UCG, TRG patients tended to significantly improve their waist to hip ratios (TRG: −0.01 kg, SD 0.04; UCG: +0.01 kg, SD 0.06; P=.07) and improved QOL physical impact (TRG: +21.8, SD 43.6; UCG: −1.2, SD 15.4; P=.005). Significant time effects were observed for body composition, 6-minute walk test distance, exercise metabolism, sedentary time, and QOL. Adherence (95%) and satisfaction in the TRG were good. Conclusions: In adults with obesity, the TR program was not superior to usual care for improving body composition. However, TR was able to deliver full multidisciplinary rehabilitation to patients with obesity and improve some health outcomes. Given the patients’ adherence and satisfaction, pragmatic programs should consider mobile health devices to improve access to MR. Further studies are warranted to further establish the benefits that TR has over usual care. Trial Registration: ClinicalTrials.gov NCT03396666; http://clinicaltrials.gov/ct2/show/NCT03396666 %M 34874887 %R 10.2196/28242 %U https://mhealth.jmir.org/2021/12/e28242 %U https://doi.org/10.2196/28242 %U http://www.ncbi.nlm.nih.gov/pubmed/34874887 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e33568 %T Optimizing a Just-in-Time Adaptive Intervention to Improve Dietary Adherence in Behavioral Obesity Treatment: Protocol for a Microrandomized Trial %A Goldstein,Stephanie P %A Zhang,Fengqing %A Klasnja,Predrag %A Hoover,Adam %A Wing,Rena R %A Thomas,John Graham %+ Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond St., Providence, RI, 02903, United States, 1 4017939727, stephanie_goldstein@brown.edu %K obesity %K weight loss %K dietary adherence %K just-in-time adaptive intervention %K microrandomized trial %K mobile phone %D 2021 %7 6.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Behavioral obesity treatment (BOT) is a gold standard approach to weight loss and reduces the risk of cardiovascular disease. However, frequent lapses from the recommended diet stymie weight loss and prevent individuals from actualizing the health benefits of BOT. There is a need for innovative treatment solutions to improve adherence to the prescribed diet in BOT. Objective: The aim of this study is to optimize a smartphone-based just-in-time adaptive intervention (JITAI) that uses daily surveys to assess triggers for dietary lapses and deliver interventions when the risk of lapse is high. A microrandomized trial design will evaluate the efficacy of any interventions (ie, theory-driven or a generic alert to risk) on the proximal outcome of lapses during BOT, compare the effects of theory-driven interventions with generic risk alerts on the proximal outcome of lapse, and examine contextual moderators of interventions. Methods: Adults with overweight or obesity and cardiovascular disease risk (n=159) will participate in a 6-month web-based BOT while using the JITAI to prevent dietary lapses. Each time the JITAI detects elevated lapse risk, the participant will be randomized to no intervention, a generic risk alert, or 1 of 4 theory-driven interventions (ie, enhanced education, building self-efficacy, fostering motivation, and improving self-regulation). The primary outcome will be the occurrence of lapse in the 2.5 hours following randomization. Contextual moderators of intervention efficacy will also be explored (eg, location and time of day). The data will inform an optimized JITAI that selects the theory-driven approach most likely to prevent lapses in a given moment. Results: The recruitment for the microrandomized trial began on April 19, 2021, and is ongoing. Conclusions: This study will optimize a JITAI for dietary lapses so that it empirically tailors the provision of evidence-based intervention to the individual and context. The finalized JITAI will be evaluated for efficacy in a future randomized controlled trial of distal health outcomes (eg, weight loss). Trial Registration: ClinicalTrials.gov NCT04784585; http://clinicaltrials.gov/ct2/show/NCT04784585 International Registered Report Identifier (IRRID): DERR1-10.2196/33568 %M 34874892 %R 10.2196/33568 %U https://www.researchprotocols.org/2021/12/e33568 %U https://doi.org/10.2196/33568 %U http://www.ncbi.nlm.nih.gov/pubmed/34874892 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e25305 %T A Theory- and Evidence-Based Digital Intervention Tool for Weight Loss Maintenance (NoHoW Toolkit): Systematic Development and Refinement Study %A Marques,Marta M %A Matos,Marcela %A Mattila,Elina %A Encantado,Jorge %A Duarte,Cristiana %A Teixeira,Pedro J %A Stubbs,R James %A Sniehotta,Falko F %A Ermes,Miikka %A Harjumaa,Marja %A Leppänen,Juha %A Välkkynen,Pasi %A Silva,Marlene N %A Ferreira,Cláudia %A Carvalho,Sérgio %A Palmeira,Lara %A Horgan,Graham %A Heitmann,Berit Lilienthal %A Evans,Elizabeth H %A Palmeira,António L %+ Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Rua do Instituto Bacteriológico, nº 5 l, Lisbon, 1150-190, Portugal, 351 218803105, mmarques@nms.unl.pt %K mHealth %K behavior change techniques %K weight management %K motivation %K self-regulation %K emotion regulation %K self-monitoring %K user testing %K logic models %D 2021 %7 3.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Many weight loss programs show short-term effectiveness, but subsequent weight loss maintenance is difficult to achieve. Digital technologies offer a promising means of delivering behavior change approaches at low costs and on a wide scale. The Navigating to a Healthy Weight (NoHoW) project, which was funded by the European Union’s Horizon 2020 research and innovation program, aimed to develop, test, and evaluate a digital toolkit designed to promote successful long-term weight management. The toolkit was tested in an 18-month, large-scale, international, 2×2 factorial (motivation and self-regulation vs emotion regulation) randomized controlled trial that was conducted on adults with overweight or obesity who lost ≥5% of their body weight in the preceding 12 months before enrollment into the intervention. Objective: This paper aims to describe the development of the NoHoW Toolkit, focusing on the logic models, content, and specifications, as well as the results from user testing. Methods: The toolkit was developed by using a systematic approach, which included the development of the theory-based logic models, the selection of behavior change techniques, the translation of these techniques into a web-based app (NoHoW Toolkit components), technical development, and the user evaluation and refinement of the toolkit. Results: The toolkit included a set of web-based tools and inputs from digital tracking devices (smart scales and activity trackers) and modules that targeted weight, physical activity, and dietary behaviors. The final toolkit comprised 34 sessions that were distributed through 15 modules and provided active content over a 4-month period. The motivation and self-regulation arm consisted of 8 modules (17 sessions), the emotion regulation arm was presented with 7 modules (17 sessions), and the combined arm received the full toolkit (15 modules; 34 sessions). The sessions included a range of implementations, such as videos, testimonies, and questionnaires. Furthermore, the toolkit contained 5 specific data tiles for monitoring weight, steps, healthy eating, mood, and sleep. Conclusions: A systematic approach to the development of digital solutions based on theory, evidence, and user testing may significantly contribute to the advancement of the science of behavior change and improve current solutions for sustained weight management. Testing the toolkit by using a 2×2 design provided a unique opportunity to examine the effect of motivation and self-regulation and emotion regulation separately, as well as the effect of their interaction in weight loss maintenance. %M 34870602 %R 10.2196/25305 %U https://www.jmir.org/2021/12/e25305 %U https://doi.org/10.2196/25305 %U http://www.ncbi.nlm.nih.gov/pubmed/34870602 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e30525 %T Ecological Momentary Assessment of Weight-Related Behaviors in the Home Environment of Children From Low-Income and Racially and Ethnically Diverse Households: Development and Usability Study %A Trofholz,Amanda %A Tate,Allan %A Janowiec,Mark %A Fertig,Angela %A Loth,Katie %A de Brito,Junia N %A Berge,Jerica %+ Humphrey School of Public Affairs, University of Minnestoa, 717 Delaware St SE, Room 454, Minneapolis, MN, 55414, United States, 1 6126247129, trofh002@umn.edu %K methods %K ecological momentary assessment %K weight-related behaviors %K racially and ethnically diverse %K children %K mobile phone %D 2021 %7 1.12.2021 %9 Early Report %J JMIR Res Protoc %G English %X Background: Ecological momentary assessment (EMA) is an innovative tool for capturing in-the-moment health behaviors as people go about their daily lives. EMA is an ideal tool to measure weight-related behaviors, such as parental feeding practices, stress, and dietary intake, as these occur on a daily basis and vary across time and context. A recent systematic review recommended standardized reporting of EMA design for studies that address weight-related behaviors. Objective: To answer the call for reporting study designs using EMA, this paper describes in detail the EMA design of the Family Matters study and how it was adapted over time to improve functionality and meet the needs of a racially, ethnically, and socioeconomically diverse sample. Methods: Family Matters is an incremental, 2-phased, mixed methods study, conducted with a racially and ethnically diverse, immigrant and refugee sample from largely low-income households, designed to examine risk and protective factors for child weight and weight-related behaviors in the home environment. The Family Matters study intentionally recruited White, Black, Hmong, Latino, Native American, and Somali parents with young children. Parents in phase 1 of the study completed 8 days of EMA on their smartphones, which included signal-contingent surveys (eg, asking about the parent’s stress at the time of the survey), event-contingent surveys (eg, descriptions of the meal the child ate), and end-of-day surveys (eg, overall assessment of the child’s day). Results: A detailed description of EMA strategies, protocols, and methods used in phase 1 of the Family Matters study is provided. Compliance with EMA surveys and participants’ time spent completing EMA surveys are presented and stratified by race and ethnicity. In addition, lessons learned while conducting phase 1 EMA are shared to document how EMA methods were improved and expanded upon for phase 2 of the Family Matters study. Conclusions: The results from this study provided an important next step in identifying best practices for EMA use in assessing weight-related behaviors in the home environment. International Registered Report Identifier (IRRID): DERR1-10.2196/30525 %M 34855612 %R 10.2196/30525 %U https://www.researchprotocols.org/2021/12/e30525 %U https://doi.org/10.2196/30525 %U http://www.ncbi.nlm.nih.gov/pubmed/34855612 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e31307 %T Designing Ruby: Protocol for a 2-Arm, Brief, Digital Randomized Controlled Trial for Internalized Weight Bias %A Hopkins,Christina M %A Miller,Hailey N %A Brooks,Taylor L %A Mo-Hunter,Lihua %A Steinberg,Dori M %A Bennett,Gary G %+ Duke Global Digital Health Science Center, Duke University, Rueben-Cooke Building, Suite 048, 417 Chapel Drive, Durham, NC, 27708, United States, 1 2152034945, christina.m.hopkins@duke.edu %K obesity %K stigma %K mHealth %K mindfulness %K self-compassion %K mobile phone %D 2021 %7 25.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Weight bias internalization, also known as weight self-stigma, is a serious health concern for individuals with higher body weight. Weight bias internalization is associated with the greater avoidance of health care and health-promoting activities, disordered eating, social isolation, and weight gain. Elevated weight bias internalization has been associated with low self-compassion, yet few investigations have explored self-compassion as a potential mechanism for reducing internalized weight bias. Objective: Ruby is a 2-arm randomized controlled trial that was designed to test the efficacy of a 4-week digital self-compassion intervention to reduce internalized weight bias compared with a wait-list control. Methods: Adults with elevated internalized weight bias and a BMI of >30 kg/m2 (N=80) were recruited. Ruby is a standalone digital trial that will be delivered entirely via a smartphone and will involve web-based data collection and text messages. The intervention content will include psychoeducation and daily mindfulness practices with a focus on self-compassion and body concerns. We will use intent-to-treat analyses to examine changes in weight bias internalization throughout time by treatment arm. The analyses will be conducted by using one-way analysis of covariance models and linear mixed models. Results: The protocol was designed in May 2020 and approved in December 2020. Data collection is currently underway. Conclusions: Ruby will be the first digital standalone, self-compassion–based intervention designed to reduce internalized weight bias. Owing to its standalone digital delivery, Ruby may be a highly scalable treatment for internalized weight bias that can be delivered on its own or combined with other treatments. We expect Ruby to be accessible to many, as participants can access the digital intervention at times of the day that are the most convenient in their schedule and are not burdened by in-person time commitments, which can be a barrier for participants with competing demands on their time and resources. If efficacious, Ruby will be poised to expand a burgeoning body of literature related to psychological intervention in this area. Trial Registration: ClinicalTrials.gov NCT04678973; https://clinicaltrials.gov/ct2/show/NCT04678973 International Registered Report Identifier (IRRID): DERR1-10.2196/31307 %M 34842549 %R 10.2196/31307 %U https://www.researchprotocols.org/2021/11/e31307 %U https://doi.org/10.2196/31307 %U http://www.ncbi.nlm.nih.gov/pubmed/34842549 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e28317 %T Impact of the COVID-19 Pandemic on Objectively Measured Physical Activity and Sedentary Behavior Among Overweight Young Adults: Yearlong Longitudinal Analysis %A Lawhun Costello,Victoria %A Chevance,Guillaume %A Wing,David %A Mansour-Assi,Shadia J %A Sharp,Sydney %A Golaszewski,Natalie M %A Young,Elizabeth A %A Higgins,Michael %A Ibarra,Anahi %A Larsen,Britta %A Godino,Job G %+ Center for Wireless and Population Health Systems, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, United States, 1 8582463302, jobg@fhcsd.org %K COVID-19 %K young adults %K physical activity %K sedentary behavior %K activity monitor %K public health %K wearable %K activity monitors %K wrist worn %K sedentary %K lifestyle %K pandemic %D 2021 %7 24.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has impacted multiple aspects of daily living, including behaviors associated with occupation, transportation, and health. It is unclear how these changes to daily living have impacted physical activity and sedentary behavior. Objective: In this study, we add to the growing body of research on the health impact of the COVID-19 pandemic by examining longitudinal changes in objectively measured daily physical activity and sedentary behavior among overweight or obese young adults participating in an ongoing weight loss trial in San Diego, California. Methods: Data were collected from 315 overweight or obese (BMI: range 25.0-39.9 kg/m2) participants aged from 18 to 35 years between November 1, 2019, and October 30, 2020, by using the Fitbit Charge 3 (Fitbit LLC). After conducting strict filtering to find valid data on consistent wear (>10 hours per day for ≥250 days), data from 97 participants were analyzed to detect multiple structural changes in time series of physical activity and sedentary behavior. An algorithm was designed to detect multiple structural changes. This allowed for the automatic identification and dating of these changes in linear regression models with CIs. The number of breakpoints in regression models was estimated by using the Bayesian information criterion and residual sum of squares; the optimal segmentation corresponded to the lowest Bayesian information criterion and residual sum of squares. To quantify the changes in each outcome during the periods identified, linear mixed effects analyses were conducted. In terms of key demographic characteristics, the 97 participants included in our analyses did not differ from the 210 participants who were excluded. Results: After the initiation of the shelter-in-place order in California on March 19, 2021, there were significant decreases in step counts (−2872 steps per day; 95% CI −2734 to −3010), light physical activity times (−41.9 minutes; 95% CI −39.5 to −44.3), and moderate-to-vigorous physical activity times (−12.2 minutes; 95% CI −10.6 to −13.8), as well as significant increases in sedentary behavior times (+52.8 minutes; 95% CI 47.0-58.5). The decreases were greater than the expected declines observed during winter holidays, and as of October 30, 2020, they have not returned to the levels observed prior to the initiation of shelter-in-place orders. Conclusions: Among overweight or obese young adults, physical activity times decreased and sedentary behavior times increased concurrently with the implementation of COVID-19 mitigation strategies. The health conditions associated with a sedentary lifestyle may be additional, unintended results of the COVID-19 pandemic. %M 34665759 %R 10.2196/28317 %U https://publichealth.jmir.org/2021/11/e28317 %U https://doi.org/10.2196/28317 %U http://www.ncbi.nlm.nih.gov/pubmed/34665759 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e26660 %T Obesity-Related Communication in Digital Chinese News From Mainland China, Hong Kong, and Taiwan: Automated Content Analysis %A Chang,Angela %A Schulz,Peter Johannes %A Jiao,Wen %A Liu,Matthew Tingchi %+ Faculty of Social Sciences, University of Macau, E21 FSS Bldg, 2nd Fl., Taipa, 100, Macao, 853 88228991, wychang@um.edu.mo %K public health %K computational content %K digital research methods %K obesity discourse %K gene disorders %K noncommunicable disease %D 2021 %7 23.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The fact that the number of individuals with obesity has increased worldwide calls into question media efforts for informing the public. This study attempts to determine the ways in which the mainstream digital news covers the etiology of obesity and diseases associated with the burden of obesity. Objective: The dual objectives of this study are to obtain an understanding of what the news reports on obesity and to explore meaning in data by extending the preconceived grounded theory. Methods: The 10 years of news text from 2010 to 2019 compared the development of obesity-related coverage and its potential impact on its perception in Mainland China, Hong Kong, and Taiwan. Digital news stories on obesity along with affliction and inferences in 9 Chinese mainstream newspapers were sampled. An automatic content analysis tool, DiVoMiner was proposed. This computer-aided platform is designed to organize and filter large sets of data on the basis of the patterns of word occurrence and term discovery. Another programming language, Python 3, was used to explore connections and patterns created by the aggregated interactions. Results: A total of 30,968 news stories were identified with increasing attention since 2016. The highest intensity of newspaper coverage of obesity communication was observed in Taiwan. Overall, a stronger focus on 2 shared causative attributes of obesity is on stress (n=4483, 33.0%) and tobacco use (n=3148, 23.2%). The burdens of obesity and cardiovascular diseases are implied to be the most, despite the aggregated interaction of edge centrality showing the highest link between the “cancer” and obesity. This study goes beyond traditional journalism studies by extending the framework of computational and customizable web-based text analysis. This could set a norm for researchers and practitioners who work on data projects largely for an innovative attempt. Conclusions: Similar to previous studies, the discourse between the obesity epidemic and personal afflictions is the most emphasized approach. Our study also indicates that the inclination of blaming personal attributes for health afflictions potentially limits social and governmental responsibility for addressing this issue. %M 34817383 %R 10.2196/26660 %U https://publichealth.jmir.org/2021/11/e26660 %U https://doi.org/10.2196/26660 %U http://www.ncbi.nlm.nih.gov/pubmed/34817383 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e29003 %T Effectiveness of Information and Communication Technology on Obesity in Childhood and Adolescence: Systematic Review and Meta-analysis %A Park,Jihyun %A Park,Mi-Jeong %A Seo,Young-Gyun %+ Department of Family Medicine, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang, 14068, Republic of Korea, 82 31 380 3805, yg035@daum.net %K ICT %K eHealth %K mHealth %K weight loss %K obesity %K BMI %K meta-analysis %K randomized controlled trial %K children %K adolescents %K mobile phone %D 2021 %7 17.11.2021 %9 Review %J J Med Internet Res %G English %X Background: Internet or mobile device use as a form of information and communication technology (ICT) can be more effective in weight loss and weight maintenance than traditional obesity interventions. Objective: The study aims to assess the effectiveness of child-centered ICT interventions on obesity-related outcomes. Methods: Articles were retrieved from the Cochrane Central Register of Controlled Trials, Embase, and PubMed web-based databases. We selected randomized controlled trials in which the participants were aged <18 years. The primary outcomes were BMI, body weight, BMI z-score, waist circumference, and percentage body fat. Results: In total, 10 of the initial 14,867 studies identified in the databases were selected according to the inclusion criteria. A total of 640 participants were included in the intervention group and 619 in the comparator group. Meta-analyses were conducted considering various subgroups (intervention type, comparator type, target participants, mean age, sex, BMI status, and follow-up period). Overall, ICT interventions demonstrated no significant effect on BMI, body weight, BMI z-score, waist circumference, and percentage body fat. Subgroup analyses revealed that the effect of the intervention was statistically significant for the following: web intervention (weighted mean difference [WMD]=−1.26 kg/m2, 95% CI −2.24 to −0.28), lifestyle modification comparator (WMD=−1.75, 95% CI −2.76 to −0.74), intervention involving both boys and girls (WMD=−1.30, 95% CI −2.14 to −0.46), and intervention involving obesity only (WMD=−1.92, 95% CI −3.75 to −0.09). Conclusions: The meta-analysis results for children with obesity who used the web intervention program confirmed significant effects on BMI reduction compared with lifestyle modification. Evidence from the meta-analysis identified internet technology as a useful tool for weight loss in children with obesity. %M 34787572 %R 10.2196/29003 %U https://www.jmir.org/2021/11/e29003 %U https://doi.org/10.2196/29003 %U http://www.ncbi.nlm.nih.gov/pubmed/34787572 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e26931 %T Digital Interventions on Healthy Lifestyle Management: Systematic Review %A Chatterjee,Ayan %A Prinz,Andreas %A Gerdes,Martin %A Martinez,Santiago %+ Department for Information and Communication Technologies, Centre for e-Health, University of Agder, Jon Lilletuns Vei 9, Grimstad, 4879, Norway, 47 94719372, ayan.chatterjee@uia.no %K eHealth %K digital intervention %K lifestyle %K obesity %K challenges %K mobile phone %D 2021 %7 17.11.2021 %9 Review %J J Med Internet Res %G English %X Background: Digital interventions have tremendous potential to improve well-being and health care conveyance by improving adequacy, proficiency, availability, and personalization. They have gained acknowledgment in interventions for the management of a healthy lifestyle. Therefore, we are reviewing existing conceptual frameworks, digital intervention approaches, and associated methods to identify the impact of digital intervention on adopting a healthier lifestyle. Objective: This study aims to evaluate the impact of digital interventions on weight management in maintaining a healthy lifestyle (eg, regular physical activity, healthy habits, and proper dietary patterns). Methods: We conducted a systematic literature review to search the scientific databases (Nature, SpringerLink, Elsevier, IEEE Xplore, and PubMed) that included digital interventions on healthy lifestyle, focusing on preventing obesity and being overweight as a prime objective. Peer-reviewed articles published between 2015 and 2020 were included. We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and a framework for an evidence-based systematic review. Furthermore, we improved the review process by adopting the Rayyan tool and the Scale for the Assessment of Narrative Review Articles. Results: Our initial searches identified 780 potential studies through electronic and manual searches; however, 107 articles in the final stage were cited following the specified inclusion and exclusion criteria. The identified methods for a successful digital intervention to promote a healthy lifestyle are self-monitoring, self-motivation, goal setting, personalized feedback, participant engagement, psychological empowerment, persuasion, digital literacy, efficacy, and credibility. In this study, we identified existing conceptual frameworks for digital interventions, different approaches to provide digital interventions, associated methods, and execution challenges and their impact on the promotion of healthy lifestyle management. Conclusions: This systematic literature review selected intervention principles (rules), theories, design features, ways to determine efficient interventions, and weaknesses in healthy lifestyle management from established digital intervention approaches. The results help us understand how digital interventions influence lifestyle management and overcome the existing shortcomings. It serves as a basis for further research with a focus on designing, developing, testing, and evaluating the generation of personalized lifestyle recommendations as a part of digital health interventions. %M 34787575 %R 10.2196/26931 %U https://www.jmir.org/2021/11/e26931 %U https://doi.org/10.2196/26931 %U http://www.ncbi.nlm.nih.gov/pubmed/34787575 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e30622 %T The Relationship Between Weight Loss Outcomes and Engagement in a Mobile Behavioral Change Intervention: Retrospective Analysis %A Carey,Alissa %A Yang,Qiuchen %A DeLuca,Laura %A Toro-Ramos,Tatiana %A Kim,Youngin %A Michaelides,Andreas %+ Academic Research, Noom Inc, Fl 9, 229 W 28th St, New York, NY, 10001, United States, 1 631 938 1248, andreas@noom.com %K engagement %K mHealth %K obesity %K weight management %K Noom %K application %K app %K behavioral change %K digital behavior change interventions %D 2021 %7 8.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is large variance in weight loss outcomes of digital behavior change interventions (DBCIs). It has been suggested that different patterns of engagement in the program could be responsible for this variance in outcomes. Previous studies have found that the amount of engagement on DBCIs, such as the number of meals logged or articles read, is positively associated with weight loss. Objective: This retrospective study extends previous research by observing how important weight loss outcomes (high weight loss: 10% or greater body weight loss; moderate weight loss: between 5% to 10%; stable weight: 0 plus or minus 1%) are associated with engagement on a publicly available mobile DBCI (Noom) from 9 to 52 weeks. Methods: Engagement and weight data for eligible participants (N=11,252) were extracted from the Noom database. Engagement measures included the number of articles read, meals logged, steps recorded, messages to coach, exercise logged, weigh-ins, and days with 1 meal logged per week. Weight was self-reported on the program. Multiple linear regressions examined how weight loss outcome (moderate and high vs stable) was associated with each engagement measure across 3 study time periods: 9-16 weeks, 17-32 weeks, and 33-52 weeks. Results: At 9-16 weeks, among the 11,252 participants, 2594 (23.05%) had stable weight, 6440 (57.23%) had moderate weight loss, and 2218 (19.71%) had high weight loss. By 33-52 weeks, 525 (18.21%) had stable weight, 1214 (42.11%) had moderate weight loss, and 1144 (39.68%) had high weight loss. Regression results showed that moderate weight loss and high weight loss outcomes were associated with all engagement measures to a significantly greater degree than was stable weight (all P values <.001). These differences held across all time periods with the exception of exercise for the moderate weight loss category at 1 time period of 33-52 weeks. Exercise logging increased from 9 to 52 weeks regardless of the weight loss group. Conclusions: Our results suggest that these clinically important weight loss outcomes are related to the number of articles read, meals logged, steps recorded, messages to coach, exercise logged, weigh-ins, and days with 1 meal logged per week both in the short-term and long-term (ie, 1 year) on Noom. This provides valuable data on engagement patterns over time on a self-directed mobile DBCI, can help inform how interventions tailor recommendations for engagement depending on how much weight individuals have lost, and raises important questions for future research on engagement in DBCIs. %M 34747706 %R 10.2196/30622 %U https://mhealth.jmir.org/2021/11/e30622 %U https://doi.org/10.2196/30622 %U http://www.ncbi.nlm.nih.gov/pubmed/34747706 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e24336 %T Areas of Interest and Attitudes Toward Antiobesity Drugs: Thematic and Quantitative Analysis Using Twitter %A Alvarez-Mon,Miguel Angel %A Llavero-Valero,Maria %A Asunsolo del Barco,Angel %A Zaragozá,Cristina %A Ortega,Miguel A %A Lahera,Guillermo %A Quintero,Javier %A Alvarez-Mon,Melchor %+ Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Av Gran Vía del Este 80, Madrid, 28031, Spain, 34 911 91 80 00, maalvarezdemon@icloud.com %K obesity %K social media %K Twitter %K drug therapy %K pharmacotherapy %K attitude %K thematic analysis %K quantitative analysis %K drug %D 2021 %7 26.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Antiobesity drugs are prescribed for the treatment of obesity in conjunction with healthy eating, physical activity, and behavior modification. However, poor adherence rates have been reported. Attitudes or beliefs toward medications are important to ascertain because they may be associated with patient behavior. The analysis of tweets has become a tool for health research. Objective: The aim of this study is to investigate the content and key metrics of tweets referring to antiobesity drugs. Methods: In this observational quantitative and qualitative study, we focused on tweets containing hashtags related to antiobesity drugs between September 20, 2019, and October 31, 2019. Tweets were first classified according to whether they described medical issues or not. Tweets with medical content were classified according to the topic they referred to: side effects, efficacy, or adherence. We additionally rated it as positive or negative. Furthermore, we classified any links included within a tweet as either scientific or nonscientific. Finally, the number of retweets generated as well as the dissemination and sentiment score obtained by the antiobesity drugs analyzed were also measured. Results: We analyzed a total of 2045 tweets, 945 of which were excluded according to the criteria of the study. Finally, 320 out of the 1,100 remaining tweets were also excluded because their content, although related to drugs for obesity treatment, did not address the efficacy, side effects, or adherence to medication. Liraglutide and semaglutide accumulated the majority of tweets (682/780, 87.4%). Notably, the content that generated the highest frequency of tweets was related to treatment efficacy, with liraglutide-, semaglutide-, and lorcaserin-related tweets accumulating the highest proportion of positive consideration. We found the highest percentages of tweets with scientific links in those posts related to liraglutide and semaglutide. Semaglutide-related tweets obtained the highest probability of likes and were the most disseminated within the Twitter community. Conclusions: This analysis of posted tweets related to antiobesity drugs shows that the interest, beliefs, and experiences regarding these pharmacological treatments are heterogeneous. The efficacy of the treatment accounts for the majority of interest among Twitter users. %M 34698653 %R 10.2196/24336 %U https://www.jmir.org/2021/10/e24336 %U https://doi.org/10.2196/24336 %U http://www.ncbi.nlm.nih.gov/pubmed/34698653 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e28689 %T How Food Marketing on Instagram Shapes Adolescents’ Food Preferences: Online Randomized Trial %A Bragg,Marie %A Lutfeali,Samina %A Greene,Tenay %A Osterman,Jessica %A Dalton,Madeline %+ Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave, 3rd Floor, New York City, NY, 10016, United States, 1 646 501 2717, Marie.Bragg@nyulangone.org %K food marketing %K traditional media %K social media %K adolescents %K Instagram %D 2021 %7 22.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Worldwide obesity rates have prompted 16 countries to enact policies to reduce children’s exposure to unhealthy food marketing, but few policies address online advertising practices or protect adolescents from being targeted. Given adolescents spend so much time online, it is critical to understand how persuasive Instagram food advertisements (ads) are compared with traditional food ads. To strengthen online food marketing policies, more evidence is needed on whether social media ads are more persuasive than other types of ads in shaping adolescents’ preferences. Objective: This study examined whether adolescents could identify food companies’ Instagram posts as ads, and the extent to which Instagram versus traditional food ads shape adolescents’ preferences. Methods: In Part 1, participants aged 13-17 years (N=832) viewed 8 pairs of ads and were asked to identify which ads originated from Instagram. One ad in each pair was selected from traditional sources (eg, print; online banner ad), and the other ad was selected from Instagram, but we removed the Instagram frame—which includes the logo, comments, and “likes.” In Part 2, participants were randomized to rate food ads that ostensibly originated from (1) Instagram (ie, we photoshopped the Instagram frame onto ads); or (2) traditional sources. Unbeknownst to participants, half of the ads in their condition originated from Instagram and half originated from traditional sources. Results: In Part 1, adolescents performed worse than chance when asked to identify Instagram ads (P<.001). In Part 2, there were no differences on 4 of 5 outcomes in the “labeled ad condition.” In the “unlabeled ad condition,” however, they preferred Instagram ads to traditional ads on 3 of 5 outcomes (ie, trendiness, P=.001; artistic appeal, P=.001; likeability, P=.001). Conclusions: Adolescents incorrectly identified traditional ads as Instagram posts, suggesting the artistic appearance of social media ads may not be perceived as marketing. Further, the mere presence of Instagram features caused adolescents to rate food ads more positively than ads without Instagram features. %M 34677136 %R 10.2196/28689 %U https://www.jmir.org/2021/10/e28689 %U https://doi.org/10.2196/28689 %U http://www.ncbi.nlm.nih.gov/pubmed/34677136 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e28622 %T Reach Outcomes and Costs of Different Physician Referral Strategies for a Weight Management Program Among Rural Primary Care Patients: Type 3 Hybrid Effectiveness-Implementation Trial %A Porter,Gwenndolyn %A Michaud,Tzeyu L %A Schwab,Robert J %A Hill,Jennie L %A Estabrooks,Paul A %+ Department of Health Promotion, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE, 68198, United States, 1 4025591082, gwenndolyn.porter@unmc.edu %K weight management %K rural %K RE-AIM %K hybrid effectiveness-implementation %K primary care %K obesity %K physicians %K digital health %K health technology %K mobile phone %D 2021 %7 20.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Rural residents are at high risk for obesity; however, little resources exist to address this disproportional burden of disease. Primary care may provide an opportunity to connect primary care patients with overweight and obesity to effective weight management programming. Objective: The purpose of this study is to examine the utility of different physician referral and engagement processes for improving the reach of an evidence-based and technology-delivered weight management program with counseling support for rural primary care patients. Methods: A total of 5 rural primary care physicians were randomly assigned a sequence of four referral strategies: point-of-care (POC) referral with active telephone follow-up (ATF); POC referral, no ATF; a population health registry–derived letter referral with ATF; and letter referral, no ATF. For registry-derived referrals, physicians screened a list of patients with BMI ≥25 and approved patients for participation to receive a personalized referral letter via mail. Results: Out of a potential 991 referrals, 573 (57.8%) referrals were made over 16 weeks, and 98 (9.9%) patients were enrolled in the program (58/98, 59.2% female). Differences based on letter (485/991, 48.9%) versus POC (506/991, 51.1%) referrals were identified for completion (100% vs 7%; P<.001) and for proportion screened (36% vs 12%; P<.001) but not for proportion enrolled (12% vs 8%; P=.10). Patients receiving ATF were more likely to be screened (47% vs 7%; P<.001) and enrolled (15% vs 7%; P<.001) than those not receiving ATF. On the basis of the number of referrals made in each condition, we found variations in the proportion and number of enrollees (POC with ATF: 27/190, 50%; POC no ATF: 14/316, 41%; letter ATF: 30/199; 15.1%; letter no ATF: 27/286, 9.4%). Across all conditions, participants were representative of the racial and ethnic characteristics of the region (60% female, P=.15; 94% White individuals, P=.60; 94% non-Hispanic, P=.19). Recruitment costs totaled US $6192, and the overall recruitment cost per enrolled participant was US $63. Cost per enrolled participant ranged from POC with ATF (US $47), registry-derived letter without ATF (US $52), and POC without ATF (US $56) to registry-derived letter with ATF (US $91). Conclusions: Letter referral with ATF appears to be the best option for enrolling a large number of patients in a digitally delivered weight management program; however, POC with ATF and letters without ATF yielded similar numbers at a lower cost. The best referral option is likely dependent on the best fit with clinical resources. Trial Registration: ClinicalTrials.gov NCT03690557; http://clinicaltrials.gov/ct2/show/NCT03690557 %M 34668873 %R 10.2196/28622 %U https://formative.jmir.org/2021/10/e28622 %U https://doi.org/10.2196/28622 %U http://www.ncbi.nlm.nih.gov/pubmed/34668873 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e17811 %T Young People’s Experiences of Engaging With Fitspiration on Instagram: Gendered Perspective %A Mayoh,Joanne %A Jones,Ian %+ Department of Sport and Event Management, Bournemouth University, Fern Barrow, Poole, BH12 5BB, United Kingdom, 44 1202968385, jmayoh@bournemouth.ac.uk %K social media %K gender %K physical fitness %K women’s health %K men’s health %K body ideals %D 2021 %7 4.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Fitness inspiration or fitspiration is a term used to describe web-based images of fit people, people in the gym, health foods, or inspirational quotes relating to diet and fitness being shared and consumed via visual social media. The popularity of this content is most notable via the Instagram platform. Currently, the majority of fitspiration research has focused on women’s experiences; however, increasingly, studies have pointed to the need to explore the gendered ways by which people engage with this content. Objective: The aim of this study is to explore how young men and women engage in fitspiration content on Instagram and provide a gendered analysis of how and why they consume this content. Methods: This study used a cross-sectional web-based survey (N=1213) of UK-based fitspiration users aged 18-24 years consisting of closed-ended questions to capture quantitative data. Results: The majority actively using Instagram for fitspiration (therefore eligible participants) were women (826/1175, 70.30%). Men were more likely to view content posted by athletes (χ21, N=1153=71.8; P=.001) and bodybuilders (χ21, N=1153=32.8; P<.001), whereas women were more likely to view content related to weight loss (χ21, N=1153=36.8; P<.001), diet plans (χ21, N=1153=11.9; P<.001), and celebrities’ content (χ21, N=1153=33.5; P<.001). Men were more likely to use fitspiration as a source of inspiration to exercise to gain muscle or get stronger (χ21, N=1147=17.9; P<.001), whereas women were more likely to use fitspiration as inspiration for healthy eating (χ21, N=1147=37.7; P<.001), or to exercise to diet or lose weight (χ21, N=1147=13.5; P<.001). Women were more likely to engage in passive behaviors such as viewing content on their feed (χ21, N=1139=7.9; P=.005) or scrolling through accounts (χ21, N=1139=15.2; P<.001), whereas men were more likely to engage in active consumption by tagging fitspiration accounts in posts (χ21, N=1139=7.2; P=.007), commenting on posts (χ21, N=1139=8.1; P=.004), and posting fitspiration content (χ21, N=1139=6.4; P=.01). Conclusions: Female fitspiration consumers engaged with content that reinforced the feminine thin but shapely ideal, whereas male users sought out content that reinforced the masculine muscular ideal. Male users were more likely to engage actively with content (eg, posting fitspiration content), while female users were more likely to engage passively (eg, scrolling through accounts, posts, or images). Future research should consider how fitspiration consumption reflects and reproduces oppressive gender ideology. %M 34605768 %R 10.2196/17811 %U https://www.jmir.org/2021/10/e17811 %U https://doi.org/10.2196/17811 %U http://www.ncbi.nlm.nih.gov/pubmed/34605768 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e23237 %T Introducing an Integrated Model of Adults’ Wearable Activity Tracker Use and Obesity Information–Seeking Behaviors From a National Quota Sample Survey %A Kim,Bokyung %A Hong,Seoyeon %A Kim,Sungwook %+ Department of Public Relations & Advertising, Ric Edelman College of Communication & Creative Arts, Rowan University, 301 High St, Room 322, Glassboro, NJ, 08028, United States, 1 8562564293, kimb@rowan.edu %K wearable activity tracker %K wearable health technology %K obesity %K health belief %K health belief model %K Technology Acceptance Model %K online information seeking %D 2021 %7 29.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Research from multiple perspectives to investigate adults’ use of wearable activity-tracking devices is limited. We offer a multiperspective model and provide empirical evidence of what leads to frequent usage of wearable health technologies from a large, nationally representative survey sample. Objective: This study aims to explore factors affecting the use of wearable activity-tracking devices among health consumers from the perspectives of individual health beliefs (perceived severity, perceived susceptibility, perceived benefits, and self-efficacy) and information-seeking behaviors. Methods: Our Integrated Model of Wearable Activity Tracker (IMWAT) use and proposed hypotheses were validated and tested with data collected from a telephone survey with a national quota sample. The data were analyzed using a variety of statistical techniques, including structural equation analysis. Results: The sample comprised 2006 participants. Our results showed that the perceived benefits of physical activity, perceived susceptibility, and self-efficacy toward obesity were significant predictors of information-seeking behaviors, which, in turn, mediated their effects on the use of wearable activity trackers. Perceptions of obesity severity directly promoted wearable device usage. Conclusions: This study provided a new and powerful theoretical model that combined the health beliefs and information-seeking behaviors behind the use of wearable activity trackers in the adult population. The findings provide meaningful implications for developers and designers of wearable health technology products and will assist health informatics practitioners and obesity prevention communicators. %M 34586076 %R 10.2196/23237 %U https://formative.jmir.org/2021/9/e23237 %U https://doi.org/10.2196/23237 %U http://www.ncbi.nlm.nih.gov/pubmed/34586076 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e29110 %T Low Carb Program Health App Within a Hospital-Based Obesity Setting: Observational Service Evaluation %A Hanson,Petra %A Summers,Charlotte %A Panesar,Arjun %A Oduro-Donkor,Dominic %A Lange,Maria %A Menon,Vinod %A Barber,Thomas M %+ DDM Health, Technology House, Science Park, University of Warwick, Coventry, CV4 7EZ, United Kingdom, 44 2476712201, charlotte@ddm.health %K obesity %K low carb program %K eHealth %K mobile app %K digital health %K health intervention %K mobile health %K COVID-19 %D 2021 %7 23.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Obesity underlies much chronic disease. Digitalization of obesity management provides an opportunity to innovate our traditional model of health care delivery within this setting, and to transform its scalability potentially to the population level. Objective: The objective was to assess the feasibility and effectiveness of the Low Carb Program app for weight loss, applied within our hospital-based (tier 3) obesity service. Due to the disrupting effects of the COVID-19 pandemic on our obesity service, we compared the clinical outcomes from the Low Carb Program app applied in the context of remote patient appointments over the telephone with the prepandemic traditional standard of care. Methods: We invited patients who attended our hospital-based obesity service to engage with the Low Carb Program smartphone app. We combined this approach with remote delivery (over the telephone) of obesity management from medical and psychology members of our obesity team during the COVID-19 pandemic. Outcome variables included changes in body weight and changes in HbA1c as a marker of glycemic control. We compared data from the Low Carb Program group with a retrospective control group (n=126) that had received traditional face-to-face obesity management from our team without concomitant use of the Low Carb Program app in the pre–COVID-19 era. T test comparisons were employed, with P<.05 considered significant. Results: The mean weight of participants (n=105) was 130.2 kg, with 59% (n=62) females and a mean age of 48.8 years. Most participants (90/105, 86%) completed the Low Carb Program app registration process and engaged with the Low Carb Program app program; at follow-up, most participants (88/105, 84%) had actively engaged with the Low Carb Program app within the prior 30 days. The majority of participants (58/105, 55%) self-reported outcomes within the app. Mean duration of clinical follow-up for recruited participants who received the app was 7.4 months. Paired data were available for 48 participants for body weight and 41 participants for HbA1c. Paired sample t test analysis revealed a statistically significant mean loss of body weight of 2.7 kg (P=.001) and improvement in HbA1c of 3.3 mmol/mol (P=.01). The mean weight of control group patients (n=126) was 137.1 kg, with 74% (93/126) females and a mean age of 44.4 years. The mean follow-up for this group was 6 months. Data comparisons between the app user group and the pre–COVID-19 retrospective control group revealed equivalence for loss of body weight and change in HbA1c between the two groups. Conclusions: We provide evidence to support the feasibility of implementing the Low Carb Program app combined with remote management; this is the first proof of concept for digitalized management within a hospital-based (tier 3) obesity service. We demonstrate the potential clinical efficacy of the approach in terms of improvements in body weight and glycemic control. %M 34449405 %R 10.2196/29110 %U https://formative.jmir.org/2021/9/e29110 %U https://doi.org/10.2196/29110 %U http://www.ncbi.nlm.nih.gov/pubmed/34449405 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e28600 %T Optimizing the Periconception Lifestyle of Women With Overweight Using a Blended Personalized Care Intervention Combining eHealth and Face-to-face Counseling (eFUSE): Protocol for a Randomized Controlled Trial %A van der Windt,Melissa %A Schoenmakers,Sam %A Willemsen,Sten %A van Rossem,Lenie %A Steegers-Theunissen,Régine %+ Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Wytemaweg 80, Rotterdam, 3015 CN, Netherlands, 31 107036815, r.steegers@erasmusmc.nl %K eHealth %K periconception period %K lifestyle intervention %K maternal and child health %K pregnancy %K birth outcomes %K healthy lifestyle %K psychotherapy %K obesity %K randomized controlled trial %K behavior change %D 2021 %7 3.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Maternal overweight has a substantial impact on reproductive, maternal, pregnancy, and neonatal outcomes with long-term and transgenerational health consequences. Interventions that aim to optimize periconception maternal lifestyle can improve maternal and fetal health during pregnancy and throughout the life course. However, it remains difficult to change and adopt adequate lifestyle behaviors. We hypothesize that additional psychological therapy targeting cognitive and affective factors substantially contribute to the effectiveness of these interventions. Objective: The proposed study aims to examine the feasibility and effectiveness of a blended personalized periconception lifestyle care intervention with additional psychological therapy aimed at women with a BMI≥25 and who are contemplating pregnancy or are already pregnant (≤12 weeks) in reducing inadequate lifestyle behaviors and improving early and late pregnancy outcome. Methods: The eHealth and Face-to-face Counseling (eFUSE) study follows a single-center two-arm randomized controlled trial design at the Erasmus MC, University Medical Center, with a multicenter regional referral. The female patients with overweight (BMI≥25), together with their male partner, will be stratified by pregnancy status (preconception vs pregnant) and randomized to receive either the blended personalized periconception lifestyle care intervention with additional psychological therapy (n=313) or usual care (n=313). The primary outcome is a change in the lifestyle risk score (between baseline and 24 weeks) between the randomization arms (difference in differences). Secondary outcomes include measurements defined as most relevant by the International Consortium for Health Outcomes Measurement, including behavioral determinants, patient satisfaction, provider feasibility, and maternal pregnancy and neonatal complications. Results: The study will be open for recruitment from Fall 2021 onward. Data collection is expected to be completed by the beginning of 2023, and the results are expected to be published by Fall 2023. Conclusions: This study will evaluate the feasibility and effectiveness of a blended periconception lifestyle intervention with additional psychological therapy, aimed at women with a BMI≥25. Positive results of this innovative care approach will be used for implementation in routine medical care of all women with overweight, with the ultimate aim to improve clinical outcomes of these high-risk pregnancies. Trial Registration: Netherlands Trial Register NL9264; https://www.trialregister.nl/trial/9264 International Registered Report Identifier (IRRID): PRR1-10.2196/28600 %M 34477561 %R 10.2196/28600 %U https://www.researchprotocols.org/2021/9/e28600 %U https://doi.org/10.2196/28600 %U http://www.ncbi.nlm.nih.gov/pubmed/34477561 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e24017 %T Obesity and BMI Cut Points for Associated Comorbidities: Electronic Health Record Study %A Liu,Natalie %A Birstler,Jen %A Venkatesh,Manasa %A Hanrahan,Lawrence %A Chen,Guanhua %A Funk,Luke %+ Department of Surgery, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI, 53792, United States, 1 6082631036, funk@surgery.wisc.edu %K obesity %K body mass index (BMI) %K risk factors %K screening %K health services %K chronic disease %D 2021 %7 9.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Studies have found associations between increasing BMIs and the development of various chronic health conditions. The BMI cut points, or thresholds beyond which comorbidity incidence can be accurately detected, are unknown. Objective: The aim of this study is to identify whether BMI cut points exist for 11 obesity-related comorbidities. Methods: US adults aged 18-75 years who had ≥3 health care visits at an academic medical center from 2008 to 2016 were identified from eHealth records. Pregnant patients, patients with cancer, and patients who had undergone bariatric surgery were excluded. Quantile regression, with BMI as the outcome, was used to evaluate the associations between BMI and disease incidence. A comorbidity was determined to have a cut point if the area under the receiver operating curve was >0.6. The cut point was defined as the BMI value that maximized the Youden index. Results: We included 243,332 patients in the study cohort. The mean age and BMI were 46.8 (SD 15.3) years and 29.1 kg/m2, respectively. We found statistically significant associations between increasing BMIs and the incidence of all comorbidities except anxiety and cerebrovascular disease. Cut points were identified for hyperlipidemia (27.1 kg/m2), coronary artery disease (27.7 kg/m2), hypertension (28.4 kg/m2), osteoarthritis (28.7 kg/m2), obstructive sleep apnea (30.1 kg/m2), and type 2 diabetes (30.9 kg/m2). Conclusions: The BMI cut points that accurately predicted the risks of developing 6 obesity-related comorbidities occurred when patients were overweight or barely met the criteria for class 1 obesity. Further studies using national, longitudinal data are needed to determine whether screening guidelines for appropriate comorbidities may need to be revised. %M 34383661 %R 10.2196/24017 %U https://www.jmir.org/2021/8/e24017 %U https://doi.org/10.2196/24017 %U http://www.ncbi.nlm.nih.gov/pubmed/34383661 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e30450 %T Prioritization of Features for Mobile Apps for Families in a Federal Nutrition Program for Low-Income Women, Infants, and Children: User-Centered Design Approach %A Weber,Summer J %A Shearer,Elyse %A Mulvaney,Shelagh A %A Schmidt,Douglas %A Thompson,Chris %A Jones,Jessica %A Ahmad,Haseeb %A Coe,Martina %A Hull,Pamela C %+ Markey Cancer Center, University of Kentucky, 2365 Harrodsburg Rd, Suite A230, Lexington, KY, 40504-3381, United States, 1 859 323 9965, Pam.Hull@uky.edu %K WIC %K mobile technology %K maternal-child health %K childhood obesity %K nutrition %K government programs %K mobile app %K user-centered design %K low income %K women %K infant %K child %K formative %K development %D 2021 %7 30.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) is a federal nutrition program that provides nutritious food, education, and health care referrals to low-income women, infants, and children up to the age of 5 years. Although WIC is associated with positive health outcomes for each participant category, modernization and efficiency are needed at the clinic and shopping levels to increase program satisfaction and participation rates. New technologies, such as electronic benefits transfer (EBT), online nutrition education, and mobile apps, can provide opportunities to improve the WIC experience for participants. Objective: This formative study applies user-centered design principles to inform the layout and prioritization of features in mobile apps for low-income families participating in the WIC program. Methods: To identify and prioritize desirable app features, caregivers (N=22) of the children enrolled in WIC participated in individual semistructured interviews with a card sorting activity. Interviews were transcribed verbatim and analyzed using constant comparative analysis for themes. App features were ranked and placed into natural groupings by each participant. The sum and average of the rankings were calculated to understand which features were prioritized by the users. Natural groupings of features were labeled according to participant descriptions. Results: Natural groupings focused on the following categories: clinics/appointments, shopping/stores, education/assessments, location, and recipes/food. Themes from the interviews triangulated the results from the ranking activity. The priority app features were balance checking, an item scanner, and appointment scheduling. Other app features discussed and ranked included appointment reminders, nutrition training and quizzes, shopping lists, clinic and store locators, recipe gallery, produce calculator, and dietary preferences/allergies. Conclusions: This study demonstrates how a user-centered design process can aid the development of an app for low-income families participating in WIC to inform the effective design of the app features and user interface. %M 34328432 %R 10.2196/30450 %U https://formative.jmir.org/2021/7/e30450 %U https://doi.org/10.2196/30450 %U http://www.ncbi.nlm.nih.gov/pubmed/34328432 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e29013 %T Building on Lessons Learned in a Mobile Intervention to Reduce Pain and Improve Health (MORPH): Protocol for the MORPH-II Trial %A Fanning,Jason %A Brooks,Amber K %A Hsieh,Katherine L %A Kershner,Kyle %A Furlipa,Joy %A Nicklas,Barbara J %A Rejeski,W Jack %+ Department of Health and Exercise Science, Wake Forest University, Worrell Professional Center 2164B, PO Box 7868, Winston-Salem, NC, United States, 1 336 758 5042, fanninjt@wfu.edu %K aging %K physical activity %K sedentary behavior %K weight loss %K chronic pain %K mHealth %D 2021 %7 19.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Engaging in sufficient levels of physical activity, guarding against sustained sitting, and maintaining a healthy body weight represent important lifestyle strategies for managing older adults’ chronic pain. Our first Mobile Health Intervention to Reduce Pain and Improve Health (MORPH) randomized pilot study demonstrated that a partially remote group-mediated diet and daylong activity intervention (ie, a focus on moving often throughout the day) can lead to improved physical function, weight loss, less pain intensity, and fewer minutes of sedentary time. We also identified unique delivery challenges that limited the program’s scalability and potential efficacy. Objective: The purpose of the MORPH-II randomized pilot study is to refine the MORPH intervention package based on feedback from MORPH and evaluate the feasibility, acceptability, and preliminary efficacy of this revised package prior to conducting a larger clinical trial. Methods: The MORPH-II study is an iteration on MORPH designed to pilot a refined framework, enhance scalability through fully remote delivery, and increase uptake of the daylong movement protocol through revised education content and additional personalized remote coaching. Older, obese, and low-active adults with chronic multisite pain (n=30) will be randomly assigned to receive a 12-week remote group-mediated physical activity and dietary weight loss intervention followed by a 12-week maintenance period or a control condition. Those in the intervention condition will partake in weekly social cognitive theory–based group meetings via teleconference software plus one-on-one support calls on a tapered schedule. They will also engage with a tablet application paired with a wearable activity monitor and smart scale designed to provide ongoing social and behavioral support throughout the week. Those in the control group will receive only the self-monitoring tools. Results: Recruitment is ongoing as of January 2021. Conclusions: Findings from MORPH-II will help guide other researchers working to intervene on sedentary behavior through frequent movement in older adults with chronic pain. Trial Registration: ClinicalTrials.gov NCT04655001; https://clinicaltrials.gov/ct2/show/NCT04655001 International Registered Report Identifier (IRRID): PRR1-10.2196/29013 %M 34279241 %R 10.2196/29013 %U https://www.researchprotocols.org/2021/7/e29013 %U https://doi.org/10.2196/29013 %U http://www.ncbi.nlm.nih.gov/pubmed/34279241 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e26485 %T Digital Technology Use and BMI: Evidence From a Cross-sectional Analysis of an Adolescent Cohort Study %A Shen,Chen %A Dumontheil,Iroise %A Thomas,Michael %A Röösli,Martin %A Elliott,Paul %A Toledano,Mireille %+ MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, St Mary's Campus, Norfolk Place, London, London, W2 1PG, United Kingdom, 44 02075943298, m.toledano@imperial.ac.uk %K adolescent %K digital technology %K obesity %K insufficient sleep %K mediation analysis %K mobile phone %D 2021 %7 5.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of digital technology such as mobile phones is ubiquitous in adolescents. However, excessive use may have adverse health effects, possibly partially mediated by disruptions to sleep. Objective: This study aims to assess the social predictors of digital technology use and their cross-sectional association with BMI z scores and being overweight in a large sample of adolescents. Methods: We used baseline data from a subset of a large adolescent cohort from 39 schools across Greater London who participated in the Study of Cognition, Adolescents and Mobile Phones (n=1473). Digital technology use included phone calls, internet use on mobile phones, and video gaming on any device. Multilevel regression was used to assess the associations between digital technology use and age-specific and sex-specific BMI z scores and being overweight (including obesity). Measurements were derived from height and weight, obtained by the Tanita BC-418 Body Composition Analyzer. We examined whether these associations were mediated by insufficient sleep. Results: Generally, participants with lower socioeconomic status reported more use of digital technology. Controlling for socioeconomic status, internet use on mobile phones for more than 3 hours per day was associated with higher BMI z scores (adjusted β=.30, 95% CI 0.11-0.48) and greater odds of being overweight (adjusted odds ratio 1.60, 95% CI 1.09-2.34), compared with low use (≤30 minutes). Similar associations were found between video gaming and BMI z scores and being overweight. The BMI z score was more strongly related to weekday digital technology use (internet use on mobile phones and video gaming) than weekend use. Insufficient sleep partly mediated the associations between digital technology use and BMI z scores (proportion of mediation from 8.6% to 17.8%) by an indirect effect. Conclusions: We found an association between digital technology use and BMI in adolescents, partly mediated by insufficient sleep, suggesting that the underlying mechanisms may be multifactorial. Further research with longitudinal data is essential to explore the direction of the relationships. %M 35143408 %R 10.2196/26485 %U https://www.jmir.org/2021/7/e26485 %U https://doi.org/10.2196/26485 %U http://www.ncbi.nlm.nih.gov/pubmed/35143408 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e26619 %T The Effectiveness and Usability of Online, Group-Based Interventions for People With Severe Obesity: Protocol for a Systematic Review %A Milne-Ives,Madison %A Swancutt,Dawn %A Burns,Lorna %A Pinkney,Jonathan %A Tarrant,Mark %A Calitri,Raff %A Chatterjee,Arunangsu %A Meinert,Edward %+ Centre for Health Technology, University of Plymouth, 6 Kirkby Place, Plymouth, PL4 6DT, United Kingdom, 44 1752600600, edward.meinert@plymouth.ac.uk %K internet-based interventions %K telemedicine %K group-based interventions %K obesity %K severe obesity %K obesity management %K weight loss %K weight reduction programs %K diet therapy %K exercise %K systematic review %K weight management %D 2021 %7 30.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Globally, obesity is a growing crisis. Despite obesity being preventable, over a quarter of the UK adult population is currently considered clinically obese (typically body mass index ≥35 kg/m2). Access to treatment for people with severe obesity is limited by long wait times and local availability. Online and group-based interventions provide means of increasing the accessibility of obesity prevention and treatment services. However, there has been no prior review of the effectiveness of group-based interventions delivered online for people with severe obesity. Objective: The purpose of this systematic review protocol is to provide an evaluation of the effectiveness and usability of different types of online, group-based interventions for people with severe obesity. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) and the Population, Intervention, Comparator, Outcome, and Study (PICOS) frameworks were used to structure this review. The review will systematically search 7 databases: MEDLINE, Embase, the Cumulative Index of Nursing and Allied Health Literature, APA PsycNet, Web of Science, CENTRAL, and the ProQuest Dissertations and Theses databases. Two authors (MM-I and LB) will independently screen the titles and abstracts of identified articles, select studies for inclusion based on the eligibility criteria, and extract data into a standardized form. Any disagreements will be discussed and resolved by a third reviewer (EM) if necessary. Risk of bias will be assessed using the Cochrane Collaboration Risk of Bias 2 tool and a descriptive analysis will be used to evaluate effectiveness and usability. Results: The systematic review has not yet been started. It is expected to be completed and submitted for publication by December 2021. Conclusions: This systematic review will summarize the effectiveness and usability of online, group-based interventions for people with obesity. It will identify the types of online delivery that have the strongest support to help inform the development of more useful and engaging interventions for people with severe obesity. Trial Registration: National Institute for Health Research, PROSPERO CRD42021227101; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021227101 International Registered Report Identifier (IRRID): PRR1-10.2196/26619 %M 34255710 %R 10.2196/26619 %U https://www.researchprotocols.org/2021/6/e26619 %U https://doi.org/10.2196/26619 %U http://www.ncbi.nlm.nih.gov/pubmed/34255710 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e25043 %T Exploring the Potential of Personalized Dietary Advice for Health Improvement in Motivated Individuals With Premetabolic Syndrome: Pretest-Posttest Study %A van der Haar,Sandra %A Hoevenaars,Femke P M %A van den Brink,Willem J %A van den Broek,Tim %A Timmer,Mariëlle %A Boorsma,André %A Doets,Esmée L %+ Wageningen Food & Biobased Research, Wageningen University & Research, Bornse Weilanden 9, Wageningen, 6708 WG, Netherlands, 31 0317 480171, sandra.vanderhaar@wur.nl %K personalized nutrition %K metabolic syndrome %K dietary behavior %K diet %K metabolic %K metabolic health %K dietary advice %K dietary feedback %K digital health %D 2021 %7 24.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Dietary quality plays an essential role in the prevention and management of metabolic syndrome (MetS). Objective: The aim of this pilot study is to organize personalized dietary advice in a real-life setting and to explore the effects on dietary intake, metabolic health, and perceived health. Methods: We followed a one-group pretest-posttest design and included 37 individuals at risk of MetS, who indicated motivation to change dietary behavior. For a period of 16 weeks, participants received personalized advice (t=0 and t=8) and feedback (t=0, t=4, t=8, t=12 and t=16) on dietary quality and metabolic health (ie, waist circumference, BMI, blood pressure, lipid profile, fasting glucose levels, and C-peptide). Personalized advice was generated in a two-stage process. In stage 1, an automated algorithm generated advice per food group, integrating data on individual dietary quality (Dutch Healthy Diet Index; total score 8-80) and metabolic health parameters. Stage 2 included a telephone consultation with a trained dietitian to define a personal dietary behavior change strategy and to discuss individual preferences. Dietary quality and metabolic health markers were assessed at t=0, t=8, and t=16. Self-perceived health was evaluated on 7-point Likert scales at t=0 and t=16. Results: At the end of the study period, dietary quality was significantly improved compared with the baseline (Dutch Healthy Diet Index +4.3; P<.001). In addition, lipid profile (triglycerides, P=.02; total cholesterol, P=.01; high-density lipoprotein, P<.001; and low-density lipoprotein, P<.001), BMI (P<.001), waist circumference (P=.01), and C-peptide (P=.01) were all significantly improved, whereas plasma glucose increased by 0.23 nmol/L (P=.04). In line with these results, self-perceived health scores were higher at t=16 weeks than at baseline (+0.67; P=.005). Conclusions: This exploratory study showed that personalized dietary advice resulted in positive effects on dietary behavior, metabolic health, and self-perceived health in motivated pre-MetS adults. The study was performed in a do-it-yourself setting, highlighting the potential of at-home health improvement through dietary changes. Trial Registration: ClinicalTrials.gov NCT04595669; https://clinicaltrials.gov/ct2/show/NCT04595669 %M 34185002 %R 10.2196/25043 %U https://formative.jmir.org/2021/6/e25043/ %U https://doi.org/10.2196/25043 %U http://www.ncbi.nlm.nih.gov/pubmed/34185002 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 4 %N 1 %P e3936 %T Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review %D 2012 %7 ..2012 %9 %J Online J Public Health Inform %G English %X The aim of this study was to examine the association between the local food environment and obesity proportions among 3- to 4-year-old children who were participants in the WIC program in Los Angeles County using spatial analyses techniques. Spatial analysis software, ArcGIS and Geoda, were used to compute the retail food environment index (RFEI) per ZIP code, to check for spatial autocorrelation and to control for permeability of the boundaries. Linear regression and ANOVA were used to examine the impact of the food environment on childhood obesity. Fast-food restaurants represented 30% and convenience stores represented 40% of the sum of food outlets in areas where WIC participants reside. Although there was no statistically significant association between RFEI and 3- to 4-year-old obesity proportions among WIC children, analysis of variance (ANOVA) tests demonstrated statistically significant positive associations between obesity and the number of convenience stores and the number of supermarkets. Our findings suggest that RFEI, as currently constructed, may not be the optimal way to capture the food environment. This study suggests that convenience stores and supermarkets are a likely source of excess calories for children in low-income households. Given the ubiquity of convenience stores in low-income neighborhoods, interventions to improve availability of healthy food in these stores should be part of the many approaches to addressing childhood obesity. This study adds to the literature by examining the validity of the RFEI and by demonstrating the need and illustrating the use of spatial analyses, using GeoDA, in the environment/obesity studies. %M 23569623 %R 10.5210/ojphi.v4i1.3936 %U %U https://doi.org/10.5210/ojphi.v4i1.3936 %U http://www.ncbi.nlm.nih.gov/pubmed/23569623 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 3 %N 1 %P e3392 %T Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review %D 2011 %7 ..2011 %9 %J Online J Public Health Inform %G English %X Objectives:Develop a website, the OLC, which supports those people who work on promoting a healthy weight and tackling obesity. Research shows that original networks where sharing of information and peer interaction take place create solutions to current public health challenges.Methods:Considerations that are relevant when building a new information service as well as the technical set up and information needs of users were taken into account prior to building the OLC and during continuous development and maintenance.Results:The OLC provides global news, resources and tools and link out to other networks, websites and organisations providing similar useful information. The OLC also uses social networking tools to highlight new and important information.Discussion:Networks contribute to a stronger community that can respond to emerging challenges in public health. The OLC improves connections of people and services from different backgrounds and organisations. Some challenges exist in the technical set up and also because of other aspects, e.g. public health information and differing information needs.Conclusion:Public health work programmes should include networking opportunities where public policy can be disseminated. The provision of necessary tools and resources can lead to better decision-making, save time and money and lead to improved public health outcomes. %M 23569599 %R 10.5210/ojphi.v3i1.3392 %U %U https://doi.org/10.5210/ojphi.v3i1.3392 %U http://www.ncbi.nlm.nih.gov/pubmed/23569599