Testing a Personalized Behavioral Weight Loss Approach Using Multifactor Prescriptions and Self-Experimentation: 12-Week mHealth Pilot Randomized Controlled Trial Results

Abstract

Background: Behavioral weight loss (WL) interventions typically follow standard diet and activity prescriptions for intervention duration to produce an energy deficit. Though average weight losses in these programs are clinically meaningful, there is heterogeneity in weight outcomes. Personalized diet and activity prescriptions may help increase the potency of WL programs by reducing this heterogeneity. Methods: This 12-week pilot study randomized participants (n = 35; BMI 34.6 ± 4.9 kg/m2, 34% with HbA1c 5.7%–6.4%) in a 3:1 ratio to a Personalized Behavioral Weight Loss (PBWL) or standard BWL and compared the feasibility and efficacy of these approaches. Both groups received a study mobile app, smart scale, activity tracker, and weekly telephone coaching sessions; PBWL participants received a continuous glucose monitoring device. PBWL participants had goals for 1) macronutrient composition (low fat or carbohydrate), 2) meal frequency (3 meals or meals and snacks), and 3) activity focus (daily or weekly goal); they experimented with different 3-part prescriptions, in random order and combination, for the first 4 weeks then picked their 3 goals to follow for weeks 5–12. Results: Study retention (100%) and satisfaction were high. Mean 3-month weight loss (kg) was greater in PBWL (−7.08 (0.74)) than BWL (−3.79 (0.84), P = 0.03); 74% of PBWL and 63% of BWL participants were “optimizers” who achieved a 5% weight loss at 3 months. PBWL optimizers lost more weight (−8.66 (0.66)) than BWL optimizers (−4.76 (0.43), p < 0.001). Conclusions: Experimentally-derived personalized prescriptions supported greater 12-week weight loss than standard recommendations. Trial Registration: ClinicalTrials.gov NCT04639076.