The effectiveness of the tailored feedback in digital interventions may be limited by the quality of the dietary assessment (DA) upon which it is based. The present study systematically reviewed ...studies reporting the protocols for DA methods used to inform tailored feedback in digital weight loss interventions. The search included: PubMed—National Library of Medicine database, MEDLINE, Cochrane Library of Systematic Reviews, Web of Science and ProQuest. Search terms were related to five groups: dietary assessment, weight loss, clinical trials, technology and tailoring. Thirteen articles were eligible for inclusion. The most common DA method was a digital dietary record linked to a food database that provided instant feedback on daily energy intake. Only four studies provided feedback on overall diet quality and intake of fruit, vegetables and fibre. Dietary feedback was provided using text messages, email, mobile applications and online intervention websites. Most digital dietary feedback focused on reducing energy intake without providing feedback to enhance diet quality. This review highlighted the heterogeneity in DA methods used in tailored weight loss interventions, which may account for the range of outcome results reported. Future interventions should publish the protocols describing how dietary data was collected and used to inform dietary feedback.
Key points
The dietary assessment (DA) methods used to inform digital, tailored feedback vary in quality, duration and scope.
Digital weight management interventions should provide feedback to improve diet quality, and not just to reduce energy intake.
The effectiveness of digital, tailored dietary feedback can be improved with dietetic input to provide evidence‐based DA and tailored feedback.
Assessing the implementation of nutrition interventions is important to identify characteristics and dietary patterns of individuals who benefit most. The aim was to report on young adults' ...experiences of receiving dietary feedback text messaging intervention. Diet was captured using an image-based 4-day mobile food record
application (mFR
) and assessed to formulate two tailored feedback text messages on fruit and vegetables and energy-dense nutrient-poor (EDNP) foods and beverages. At 6-months 143 participants completed a second mFR
and a questionnaire evaluating the dietary feedback. Participants who agreed the text messages made them think about how much vegetables they ate were more likely to increase their intake by at least half a serve than those who disagreed odds ratio (OR) = 4.28, 95% Confidence Interval (CI): 1.76 to 10.39. Those who agreed the text messages made them think about how much EDNP foods they ate, were twice as likely to decrease their intake by over half a serve (OR = 2.39, 95%CI: 1.12 to 5.25) than those who disagreed. Undertaking detailed dietary assessment ensured the tailored feedback was constructive and relevant. Personal contemplation about vegetable and EDNP food intake appears to be a mediator of dietary change in young adults.
The Tailored Diet and Activity (ToDAy) study aims to build on the campaign by adding a digital intervention with the potential to provide wide-reaching, cost-effective weight management support.
The ...ToDAy study aims to build a tailored intervention using mobile technology to improve diet and physical activity behaviours in adults with overweight and obesity. The main objectives were to identify behavior change techniques for diet and physical activity (PA) change for weight loss and explore preferences for digital intervention features that would be effective in changing diet and PA behaviors.
This qualitative study uses the principles of a person-based approach to intervention development; the behavioral intervention technology framework; and the capability, opportunity, motivation, and behavior (COM-B) framework. Focus groups and telephone interviews were conducted with 56 adults in Western Australia. Open-ended questions and example intervention features were used to explore the usability and acceptability of the self-monitoring tools, knowledge about effective weight-loss strategies, and acceptability of tailored feedback. Findings from the focus groups and interviews were analyzed using thematic analysis.
Qualitative findings revealed an awareness of key public health messages but a lack of confidence in how to perform these behaviors to help manage their weight. A total of 4 major themes were identified and mapped to the domains of the COM-B framework: (1) misinformation, (2) environmental support, (3) social norms, and (4) confidence.
This study explores users' capability, opportunity, and motivation to perform the target behaviors for weight loss. The findings suggested that a digital weight management intervention using a mobile food record and activity trackers to inform tailored feedback may be acceptable and feasible. Participants expressed a preference for simple expert advice, digital self-monitoring tools, and visual feedback.
RR2-10.2196/12782.
Excess weight is a major risk factor for chronic diseases. In Australia, over 60% of adults are overweight or obese. The overconsumption of energy-dense nutrient-poor (EDNP) foods and low physical ...activity (PA) levels are key factors contributing to population obesity. New cost-effective approaches to improve population diet and PA behaviors are needed.
This 1-year randomized controlled trial (6-month intervention and 6-month follow-up) aims to investigate whether a tailored intervention using mobile technology can improve diet and PA behaviors leading to weight loss in adults (aged 18-65 years) who are overweight or obese and recruited through a social marketing campaign (LiveLighter).
All eligible participants will provide data on demographics and lifestyle behaviors online at baseline, 6 months, and 12 months. Using two-stage randomization, participants will be allocated into one of three conditions (n=200 per group): tailored feedback delivered via email at seven time points, informed by objective dietary (mobile food record app) and activity (wearable activity monitor) assessment; active control receiving no tailored feedback, but undergoing the same objective assessments as tailored feedback; and online control receiving no tailored feedback or objective assessments. Primary outcome measures at 6 and 12 months are changes in body mass, EDNP food and beverage consumption, and daily moderate-to-vigorous PA (measured via accelerometry). Secondary outcomes include change in fruit and vegetable consumption, daily sedentary behaviors, and cost effectiveness.
Enrolment commenced in August 2017. Primary outcomes at 12 months will be available for analysis from September 2019.
Tailored email feedback provided to individuals may deliver a cost-effective strategy to overcome existing barriers to improving diet and PA. If found to be successful and cost effective, upscaling this intervention for inclusion in larger-scale interventions is highly feasible.
Australian New Zealand Clinical Trials Registry ACTRN12617000554369; https://www.anzctr.org.au /Trial/Registration/TrialReview.aspx?id=371325&isReview=true.
DERR1-10.2196/12782.
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