Comparison of Smartphone‐Based Behavioral Obesity Treatment With Gold Standard Group Treatment and Control: A Randomized Trial

Objective This study aimed to determine whether weight losses from a primarily smartphone‐based behavioral obesity treatment (SMART) differed from those of a more intensive group‐based behavioral obesity treatment (GROUP) and a control condition (CONTROL). Methods A total of 276 adults with overweight/obesity were randomly assigned to 18 months of GROUP‐based treatment with meetings weekly for 6 months, meetings biweekly for 6 months, and meetings monthly for 6 months and self‐monitoring via paper diaries with written feedback; SMART‐based treatment with online lessons, self‐monitoring, and feedback plus monthly weigh‐ins; or a CONTROL condition with self‐monitoring via paper diaries with written feedback and monthly weigh‐ins. Results Among the 276 participants (17% men; 7.2% minority; mean [SD] age: 55.1 [9.9] years; weight: 95.9 [17.0] kg; BMI: 35.2 [5.0] kg/m2), 18‐month retention was significantly higher in both GROUP (83%) and SMART (81%) compared with CONTROL (66%). Estimated mean (95% CI) weight change over 18 months did not differ across the three conditions: 5.9 kg (95% CI: 4.5‐7.4) in GROUP, 5.5 kg (95% CI: 3.9‐7.1) in SMART, and 6.4 kg (95% CI: 3.7‐9.2) in CONTROL. Conclusions Mobile online delivery of behavioral obesity treatment can achieve weight loss outcomes that are at least as good as those obtained via the more intensive gold standard group‐based approach.